Elimination of Routine Urinalysis before Elective Orthopaedic Surgery Reduces Antibiotic Utilization without Impacting Catheter-associated Urinary Tract Infection or Surgical Site Infection Rates
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Purpose: Routine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines. Materials and Methods: A pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period. Results: A total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed (P<0.0001), and a 93% reduction rate in antibiotic utilization (P<0.001). No significant difference in SSI and CAUTI rates was observed (P>0.05). Conclusion: The elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.
Abstract
Purpose: Routine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines. Materials and Methods: A pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period. Results: A total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed (P<0.0001), and a 93% reduction rate in antibiotic utilization (P<0.001). No significant difference in SSI and CAUTI rates was observed (P>0.05). Conclusion: The elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.
참고문헌 (20)
- Kurtz S, "Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030", J Bone Joint Surg Am, 89, pp.780~785 (2007)
- Shan L, "Intermediate and long-term quality of life after total knee replacement : a systematic review and meta-analysis", J Bone Joint Surg Am, 97, pp.156~168 (2015)
- Uçkay I, "Prevention of surgical site infections in orthopaedic surgery and bone trauma : state-of-the-art update", J Hosp Infect, 84, pp.5~12 (2013)
- Namba RS, "Risk factors associated with deep surgical site infections after primary total knee arthroplasty : an analysis of 56, 216 knees", J Bone Joint Surg Am, 95, pp.775~782 (2013)
- Irvine R, "The relationship of genitourinary tract procedures and deep sepsis after total hip replacements", Surg Gynecol Obstet, 139, pp.701~706 (1974)
- Punjani N, "The impact of common urologic complications on the risk of a periprosthetic joint infection", J Bone Joint Surg Am, 100, pp.1517~1523 (2018)
- Pulido L, "Periprosthetic joint infection : the incidence, timing, and predisposing factors", Clin Orthop Relat Res, 466, pp.1710~1715 (2008)
- Sousa RJG, "Is routine urinary screening indicated prior to elective total joint arthroplasty? A systematic review and meta-analysis", J Arthroplasty, 34, pp.1523~1530 (2019)
- Nicolle LE, "Errata: Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults", Clin Infect Dis, 40, pp.1556~ (2005)
- Cordero-Ampuero J, "Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria? Seeding risk with", without treatment, 2013, pp.471, 3822~3829
- Kong L, "Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty : a meta-analysis", Int Wound J, 14, pp.529~536 (2017)
- David TS, "Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty", J Am Acad Orthop Surg, 8, pp.66~74 (2000)
- Sousa R, "Is asymptomatic bacteriuria a risk factor for prosthetic joint infection", Clin Infect Dis, 59, pp.41~47 (2014)
- Weale R, "Pre-operative asymptomatic bacteriuria : a risk factor for prosthetic joint infection", J Hosp Infect, 101, pp.210~213 (2019)
- Honkanen M, "The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement : a retrospective study with a 1-year follow up", Clin Microbiol Infect, 24, pp.376~380 (2018)
- Lamb MJ, "Elimination of screening urine cultures prior to elective joint arthroplasty", Clin Infect Dis, 64, pp.806~809 (2017)
- Bailin S, "Screening patients undergoing total hip or knee arthroplasty with perioperative urinalysis and the effect of a practice change on antimicrobial use", Infect Control Hosp Epidemiol, 38, pp.281~286 (2017)
- Koulouvaris P, "Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty", Clin Orthop Relat Res, 467, pp.1859~1867 (2009)
- Bouvet C, "Is there any benefit in pre-operative urinary analysis before elective total joint replacement", Bone Joint J, 96, pp.390~394 (2014)
- Sendi P, "Management of asymptomatic bacteriuria, urinary catheters and symptomatic urinary tract infections in patients undergoing surgery for joint replacement : a position paper of the expert group ‘infection’ of swissorthopaedics", J Bone Jt Infect, 2, pp.154~159 (2017)