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Screening Patients Undergoing Total Hip or Knee Arthroplasty with Perioperative Urinalysis and the Effect of a Practice Change on Antimicrobial Use

Published online by Cambridge University Press:  21 November 2016

Samuel Bailin ,
Nicolas Noiseux ,
Jean M. Pottinger ,
Birgir Johannsson ,
Ambar Haleem ,
Sarah Johnson  and
Loreen A. Herwaldt
Samuel Bailin
Affiliation:
Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa
Nicolas Noiseux
Affiliation:
Department of Orthopaedics, The University of Iowa Carver College of Medicine, Iowa City, Iowa
Jean M. Pottinger
Affiliation:
Program of Hospital Epidemiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Birgir Johannsson
Affiliation:
Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa
Ambar Haleem
Affiliation:
Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa
Sarah Johnson
Affiliation:
Department of Pharmaceutical Care; The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Loreen A. Herwaldt*
Affiliation:
Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa Program of Hospital Epidemiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
*
Address correspondence to Loreen A. Herwaldt, MD, Department of Internal Medicine, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1081 ([email protected]).
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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 (P<.0001; P<.0001) and urine white blood cell count>5 (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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 281 - 286
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Kurtz, SM, Lau, E, Schmier, J, Ong, KL, Zhao, K, Parvizi, J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008;23:984–991.Google Scholar
2. Maderazo, EG, Judson, S, Pasternak, H. Late infections of total joint prostheses. A review and recommendations for prevention. Clin Orthop Relat Res 1988;229:131–142.Google Scholar
3. Pulido, L, Ghanem, E, Joshi, A, Purtill, JJ, Parvizi, J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008;466:1710–1715.Google Scholar
4. Rodríguez, D, Pigrau, C, Euba, G, et al. Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management. Clin Microbiol Infect 2010;16:1789–1795.CrossRefGoogle ScholarPubMed
5. Bengtson, S, Blomgren, G, Knutson, K, Wigren, A, Lidgren, L. Hematogenous infection after knee arthroplasty. Acta Orthop Scand 1987;58:529–534.CrossRefGoogle ScholarPubMed
6. Deacon, JM, Pagliaro, AJ, Zelicof, SB, Horowitz, HW. Prophylactic use of antibiotics for procedures after total joint replacement. J Bone Joint Am 1996;78:1755–1770.Google Scholar
7. Kaandorp, CJ, Dinant, HJ, van de Laar, MA, Moens, HJ, Prins, AP, Dijkmans, BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997;56:470–475.Google Scholar
8. Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625–663.Google Scholar
9. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
10. De Rosa, R, Grosso, S, Bruschetta, G, et al. Evaluation of the Sysmex UF1000i flow cytometer for ruling out bacterial urinary tract infection. Clin Chim Acta 2010;411:1137–1142.Google Scholar
11. Devillé, WL, Yzermans, JC, van Duijn, NP, Bezemer, PD, van der Windt, DA, Bouter, LM. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol 2004;4:4.CrossRefGoogle ScholarPubMed
12. Pépin, J, Saheb, N, Coulombe, MA, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.Google Scholar
13. David, TS, Vrahas, MS. Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg 2000;8:66–74.CrossRefGoogle ScholarPubMed
14. Surin, VV, Sundholm, K, Bäckman, L. Infection after total hip replacement. With special reference to a discharge from the wound. J Bone Joint Surg Br 1983;65:412–418.Google Scholar
15. Wymenga, AB, van Horn, JR, Theeuwes, A, Muytjens, HL, Slooff, TJ. Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2,651 hip operations. Acta Orthop Scand 1992;63:665–671.Google Scholar
16. Donovan, TL, Gordon, RO, Nagel, DA. Urinary infections in total hip arthroplasty. Influences of prophylactic cephalosporins and catheterization. J Bone Joint Surg Am 1976;58:1134–1137.Google Scholar
17. Berbari, EF, Hanssen, AD, Duffy, MC, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998;27:1247–1254.Google Scholar
18. Koulouvaris, P, Sculco, P, Finerty, E, Sculco, T, Sharrock, NE. Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty. Clin Orthop Relat Res 2009;467:1859–1867.Google Scholar
19. Wilson, MG, Kelley, K, Thornhill, TS. Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am 1990;72:878–883.Google Scholar
20. Fitzgerald, RH Jr, Nolan, DR, Ilstrup, DM, Van Scoy, RE, Washington, JA II, Coventry, MB. Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 1977;59:847–855.CrossRefGoogle ScholarPubMed
21. Ducharme, J, Neilson, S, Ginn, JL. Can urine cultures and reagent strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptoms? CJEM 2007;9:87–92.Google Scholar
22. Khasriya, R, Khan, S, Lunawat, R, et al. The inadequacy of urinary dipstick and microscopy as surrogate markers of urinary tract infection in urological outpatients with lower urinary tract symptoms without acute frequency and dysuria. J Urol 2010;183:1843–1847.Google Scholar
23. Monane, M, Gurwitz, JH, Lipsitz, LA, Glynn, RJ, Choodnovskiy, I, Avorn, J. Epidemiologic and diagnostic aspects of bacteriuria: a longitudinal study in older women. J Am Geriatr Soc 1995;43:618–622.Google Scholar
24. Schwartz, DS, Barone, JE. Correlation of urinalysis and dipstick results with catheter-associated urinary tract infections in surgical ICU patients. Intensive Care Med 2006;32:1797–1801.Google Scholar
25. Lammers, RL, Gibson, S, Kovacs, D, Sears, W, Strachan, G. Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points. Ann Emerg Med 2001;38:505–512.CrossRefGoogle ScholarPubMed
26. Leuck, AM, Wright, D, Ellingson, L, Kraemer, L, Kuskowski, MA, Johnson, JR. Complications of Foley catheters—Is infection the greatest risk? J Urol 2012;187:1662–1666.Google Scholar
27. Sousa, R, Muñoz-Mahamud, E, Quayle, J, et al. Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis 2014;59:41–47.Google Scholar
28. Cordero-Ampuero, J, González-Fernández, E, Martínez-Vélez, D, Esteban, J. Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria? Seeding risk with/without treatment. Clin Orthop Relat Res 2013;471:3822–3829.Google Scholar
29. Glynn, MK, Sheehan, JM. The significance of asymptomatic bacteriuria in patients undergoing hip/knee arthroplasty. Clin Orthop Relat Res 1984;185:151–154.CrossRefGoogle Scholar