Elimination of Routine Urinalysis before Elective Orthopaedic Surgery Reduces Antibiotic Utilization without Impacting Catheter-associated Urinary Tract Infection or Surgical Site Infection Rates

Brian L. Hollenbeck; Megan Hoffman; Christopher J. Fang; Kevin Counterman; Susan Cohen; Christine A. Bell

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자료유형: 학술저널

저자정보: Brian L. Hollenbeck (Department of Orthopedic Surgery New England Baptist Hospital Boston MA USA) Megan Hoffman (Department of Orthopedic Surgery New England Baptist Hospital Boston MA USA) Christopher J. Fang (Department of Orthopedic Surgery New England Baptist Hospital Boston MA USA) Kevin Counterman (Department of Orthopedic Surgery New England Baptist Hospital Boston MA USA) Susan Cohen (Department of Orthopedic Surgery New England Baptist Hospital Boston MA USA) Christine A. Bell (Department of Orthopedic Surgery New England Baptist Hospital Boston MA USA)

저널정보: 대한고관절학회 Hip and Pelvis Hip and Pelvis 제33권 제4호

발행연도: 2021.12

수록면: 225 - 230 (6page)

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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.

#Arthroplasty #Antimicrobial stewardship #Urinalysis #Surgical wound infection #Urinary tract infections

참고문헌 (20)

참고문헌 신청

Kurtz S / 2007 / Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030 / J Bone Joint Surg Am 89:780~785

Shan L / 2015 / Intermediate and long-term quality of life after total knee replacement : a systematic review and meta-analysis / J Bone Joint Surg Am 97:156~168

Uçkay I / 2013 / Prevention of surgical site infections in orthopaedic surgery and bone trauma : state-of-the-art update / J Hosp Infect 84:5~12

Namba RS / 2013 / Risk factors associated with deep surgical site infections after primary total knee arthroplasty : an analysis of 56, 216 knees / J Bone Joint Surg Am 95:775~782

Irvine R / 1974 / The relationship of genitourinary tract procedures and deep sepsis after total hip replacements / Surg Gynecol Obstet 139:701~706

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