Monday, June 30, 2014

Asymptomatic Bacteriuria and Prosthetic Joint infection- Less is More

I am back on the ID consult service today. This will certainly keep me busy and conflict with viewing the World Cup games. 

Here is an intriguing article in Clinical Infectious Diseases that caught my eye this weekend.This was a multicenter study of patients undergoing total hip or total knee arthroplasty. A urine sample was cultured in all patients, and those with asymptomatic bacteriuria were identified. A total of 2497 patients were enrolled. The prevalence of asymptomatic bacteriuria was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P < .001). The overall prosthetic joint infection rate was 1.7%. The infection rate was significantly higher in the asymptomatic bacteriuria group than in the non-asymptomatic bacteriuria group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P = .001). 

But here is the most intriguing finding: in the asymptomatic bacteriuria group, there was no significant difference in joint infection rate between treated (3.9%) and untreated (4.7%) patients. Also, prosthetic joint infections did not correlate to isolates from urine cultures!
To me this underscores, again, that asymptomatic bacteriuria should not be treated except in pregnancy and in patients about to undergo invasive bladder procedures. Treatment of asymptomatic bacteriuria does not impact outcomes and likely breeds antibacterial resistance. 
With respect to treating asymptomatic bacteriuria, less is more.

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