Original Articles
Total joint arthroplasty and incidence of postoperative bacteriuria with an indwelling catheter or intermittent catheterization with one-dose antibiotic prophylaxis: A prospective randomized trial*,**

https://doi.org/10.1054/arth.2001.25547Get rights and content

Abstract

This study examined the difference in postoperative bacteriuria in total joint arthroplasty after use of either an indwelling catheter or intermittent catheterization. Previous studies showed a preference for an indwelling catheter over intermittent catheterization to resolve postoperative urinary retention in total joint arthroplasty, but these studies generally used 48 hours of antibiotic prophylaxis. Increasing awareness of costs and bacterial resistance to antibiotics have prompted many centers to reduce prophylaxis to only 1 preoperative dose A prospective, randomized, controlled trial was conducted in primary total hip and primary total knee arthroplasty patients. One dose of cefazolin, 1 g, was administered intravenously immediately preoperatively. Five of 13 (38%) men in the indwelling catheter group and 0 of 14 (0%) men in the intermittent catheterization group developed postoperative bacteriuria (P =.016), and 6 of 33 (18%) women in the indwelling catheter group and 3 of 39 (8%) women in the intermittent catheterization group developed postoperative bacteriuria (not significant). A total of 11 (24%) patients in the indwelling catheter group (n = 46) and 3 (6%) patients in the intermittent catheterization group (n = 53) developed postoperative bacteriuria (P =.018). In this setting with 1-dose antibiotic prophylaxis, intermittent catheterization resulted in a lower incidence of postoperative bacteriuria compared with an indwelling catheter. For men, this difference is significant.

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

References (31)

  • VV Surin et al.

    Infection after total hip replacement: With special reference to a discharge from the wound

    J Bone Joint Surg Br

    (1983)
  • MA Ritter et al.

    Urinary tract sequela: possible influence on joint infections following total joint replacements

    Orthopaedics

    (1987)
  • AB Wymenga et al.

    Perioperative factors associated with septic arthritis after arthroplasty, prospective multicenter study of 362 knee and 2651 hip operations

    Acta Orthop Scand

    (1992)
  • R Irvine et al.

    The relationship of genitourinary tract procedures and deep sepsis after total hip replacements

    Surg Gynecol Obstet

    (1974)
  • MK Benson et al.

    Infections following total hip replacement in a general hospital without special orthopaedic facilities

    Acta Orthop Scand

    (1975)
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    *

    No benefits or funds were received in support of this study.

    **

    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]

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