Original ArticlesTotal joint arthroplasty and incidence of postoperative bacteriuria with an indwelling catheter or intermittent catheterization with one-dose antibiotic prophylaxis: A prospective randomized trial*,**
Section snippets
Patients and methods
A prospective randomized trial at our hospital was conducted between April 1997 and May 1998. The inclusion criteria were patients undergoing primary THA or TKA. Informed consent was obtained, and patients were given the opportunity to refuse or withdraw. Patients with a history of chronic or recurrent urinary tract infections, preoperative or perioperative steroid medication, long-term antibiotic therapy, endocarditis antibiotic prophylaxis, or preoperative bacteriuria or urinary tract
Results
Of the 148 patients eligible for this study, 29 (20%) were excluded because of a preoperative positive urinalysis. These 29 patients with asymptomatic bacteriuria all were older women (29 of 119 eligible women). These 29 women were operated (outside the study) with additional proper antibiotics because a preoperative asymptomatic bacteriuria has not been proved to be a risk factor for deep infection in THA and TKA when treated properly 24, 25. None of the men enrolled had a preoperative
Discussion
Postoperative bacteriuria after joint arthroplasty poses a threat to the survival of the prosthesis 5, 6, 7, 8. Previous studies favored the use of an indwelling catheter over intermittent catheterization to treat urinary retention after THA or TKA because it caused less bacteriuria, although this difference was not significant 12, 13, 14, 15, 16. In these studies, antibiotic prophylaxis was given for at least 48 hours postoperatively. Currently, because of increased cost awareness and the
Conclusion
The results of our study indicate that in the setting of primary THA and TKA with only 1 dose of cefazolin prophylaxis, intermittent catheterization for urinary retention causes less bacteriuria compared with an indwelling catheter for 48 hours. This difference is significant for men. For women, the incidence is twice as much for an indwelling catheter, but this difference is not significant in our study. Under these operating conditions with only 1 dose of cefazolin preoperatively, we
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No benefits or funds were received in support of this study.
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Reprint requests: R. M. Castelein, MD, PhD, Department of Orthopaedic Surgery, Isala Clinics, location Weezenlanden, PO Box 10500, 8000 GM Zwolle, The Netherlands. E-mail: [email protected]