title: Screening Patients Undergoing Total Hip or Knee Arthroplasty with Perioperative Urinalysis and the Effect of a Practice Change on Antimicrobial Use.
abstract: OBJECTIVE To identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors. DESIGN We conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment. We then conducted a before-and-after study to assess whether implementing an intervention affected the frequency of treatment for UTI before or after THA/TKA. SETTING The orthopedics department of a university health center. PATIENTS Patients undergoing THA or TKA. INTERVENTION Surgeons revised their UTI screening and treatment practices. RESULTS Positive leukocyte esterase (P5 (P=.01; P=.01) were associated with preoperative or postoperative UTI treatment. In the prospective study, 12 patients (24%) had signs and symptoms consistent with UTI. The number of patients treated for presumed UTI decreased 80.2% after the surgeons changed their practices, and surgical site infection (SSI) rates, including prosthetic joint infections (PJIs), did not increase. CONCLUSIONS Urine leukocyte esterase and white blood cell count were the strongest predictors of treatment for UTI before or after THA/TKA. The intervention was associated with a significant decrease in treatment for UTI, and SSI/PJI rates did not increase. Infect Control Hosp Epidemiol 2017;38:281-286.
authors.affiliation: 1Department of Internal Medicine,The University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bailin
authors.affiliation: 2Department of Orthopaedics,The University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.affiliation: 3Program of Hospital Epidemiology,The University of Iowa Hospitals and Clinics,Iowa City,Iowa.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Pottinger
authors.affiliation: 1Department of Internal Medicine,The University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Birgir
authors.initials: B
authors.lastname: Johannsson
authors.affiliation: 1Department of Internal Medicine,The University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Ambar
authors.initials: A
authors.lastname: Haleem
authors.affiliation: 4Department of Pharmaceutical Care;The University of Iowa Hospitals and Clinics,Iowa City,Iowa.
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.affiliation: 1Department of Internal Medicine,The University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Loreen A
authors.initials: LA
authors.lastname: Herwaldt
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D002265:Carboxylic Ester Hydrolases / Q000652:urine; D005260:Female; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology*; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology*; D014556:Urine / Q000166:cytology
chemical_list: D000890:Anti-Infective Agents; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases