Antibiotic prophylaxis for urinary catheter manipulation following arthroplasty: a systematic review. Issue 7 (21st January 2021)

• Record Type: Journal Article
• Authors: Roberts, Tobias; Smith, Toby O.; Simon, Henry; Goodmaker, Charles; Hing, Caroline B.
• Is Part Of: ANZ journal of surgery. Volume 91:Issue 7/8(2021)
• Page Start: 1405
• Page End: 1412
• Publication Date: 2021-01-21
• Subjects: antibiotic prophylaxis -- arthroplasty -- catheter -- prosthetic joint infection; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.16579
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Urinary catheter use in the peri‐ and post‐operative phase following arthroplasty may be associated with urinary tract infection (UTI) and deep prosthetic joint infection (PJI). These can be catastrophic complications in joint arthroplasty. We performed a systematic review of the evidence on use of antibiotics for urinary catheter insertion and removal following arthroplasty. Methods: Electronic databases were searched using the Healthcare Databases Advanced Search interface. Grey literature was searched. From 219 citations, six studies were deemed eligible for review. Due to study heterogeneity, a narrative approach was adopted. Methodological quality of each study was assessed using the Critical Appraisal Skills Programme appraisal tool. Results: A total of 4696 hip and knee arthroplasties were performed on 4578 participants across all studies. Of these, 1475 (31%) were on men and 3189 (68%) on women. The mean age of study participants was 69 years. Three thousand four hundred and eighty‐nine cases (74.3%) were related to hip arthroplasty and 629 (13.4%) to knee arthroplasty. Five hundred and seventy‐eight (12.3%) were either hip or knee arthroplasty. Forty‐five PJIs were reported across all studies (0.96%). Two studies found either no PJI or no statistical difference in the rate of PJI when no antibiotic prophylaxis was used for catheter manipulation. Another study found no statistical difference in PJI rates between patients with or without preoperative bacteriuria. Where studies report potential haematogenous spread from UTIs, this association can only be assumed. Increased duration of urinary catheterization is positively associated with UTI. Conclusion: It remains difficult to justify the use of prophylactic antibiotics for catheter manipulation in well patients. Their use is not recommended for this indication. Abstract : Despite reduction in their use, antibiotic prophylaxis for catheter insertion and removal still occurs in patients following hip and knee arthroplasty. We performed a systematic review of the evidence for this practice. Six papers were included for review. Based on the evidence presented, their use is not recommended for this indication.