Routine Preoperative Urine Culture Study in Total Knee Arthroplasty? A Multicentric Follow-up Study for 2 Years in Indian Patients

Abstract

Background: Infection is a major complication after total knee arthroplasty (TKA). Various factors have been identified as risk factors for early prosthetic joint infection (PJI). The urinary tract is a common pathogenic shed, which can lead to subsequent surgical site infection. However, the need for routine screening of urine culture before elective surgery, the incidence of urine culture positivity, and subsequent risk of PJI are poorly understood in our population. Aims: The aims of this study are as follows: (1) incidence of urine culture positivity in patients undergoing TKA, (2) incidence of postoperative urinary catheterization, and (3) incidence of early PJI secondary to urinary tract infection (UTI). Materials and Methods: Patients undergoing primary TKA from November 2018 to October 2021 at two tertiary orthopedic care centers were followed up for 2 years. Complete preoperative investigations including urine culture, serum albumin, blood sugar, and glycated hemoglobin (Hb) A1c were recorded. Symptomatic UTIs and those patients with significant growth in culture (>1 lakh colony counts/mL) were treated with sensitive antibiotics for 5 days. Follow-up was done for 2 years for PJI. Results: A total of 2198 patients were included in the study. In 987 patients (44.9%), a urine routine study was positive for pus cells (>10 pus cells/mL) and out of them, 77 (3.5%) patients were positive for urine culture. The most common organism was Escherichia coli (70.12%) followed by Klebsiella (19.48%). About 43.54% of the patients were diabetic (957), and 64.14% (1410) were anemic (Hb = 13.5–17.5 g/dL in females and 12–15.5 g/dL in males). Around 55.78% of the patients were malnourished (serum albumin <3.5 g/dL). A total of 353 patients were catheterized for postoperative urinary retention (16.06%). About one patient (90.045%) developed early PJI, which was not statistically significant for the correlation with any of the study variables. Conclusion: Preoperative urine culture positivity, urinary catheterization, and patient profile do not show a statistically significant correlation with the incidence of early PJI. The need for regular screening of all the patients undergoing TKA for urine culture positivity may not be warranted, however, longer follow-up and larger multicentric studies are recommended in this regard.

Keywords

• bacteriuria
• prosthetic joint infection
• total knee arthroplasty