Screening Patients Undergoing Total Hip or Knee Arthroplasty with Perioperative Urinalysis and the Effect of a Practice Change on Antimicrobial Use
Autor: | Nicolas O. Noiseux, Ambar Haleem, Jean M. Pottinger, Samuel Bailin, Loreen A. Herwaldt, Sarah J Johnson, Birgir Johannsson |
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Rok vydání: | 2016 |
Předmět: |
Microbiology (medical)
Male medicine.medical_specialty Urinalysis Epidemiology medicine.medical_treatment Urinary system Arthroplasty Replacement Hip 030232 urology & nephrology Urine 03 medical and health sciences Leukocyte Count 0302 clinical medicine Anti-Infective Agents medicine Humans Surgical Wound Infection Prospective Studies Prospective cohort study Arthroplasty Replacement Knee Perioperative Period Aged Retrospective Studies 030222 orthopedics medicine.diagnostic_test business.industry Retrospective cohort study Perioperative Middle Aged Arthroplasty Iowa Surgery Leukocyte esterase Infectious Diseases Logistic Models Orthopedic surgery Urinary Tract Infections Female business Carboxylic Ester Hydrolases |
Zdroj: | Infection control and hospital epidemiology. 38(3) |
ISSN: | 1559-6834 0899-823X |
Popis: | OBJECTIVETo identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors.DESIGNWe conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment. We then conducted a before-and-after study to assess whether implementing an intervention affected the frequency of treatment for UTI before or after THA/TKA.SETTINGThe orthopedics department of a university health center.PATIENTSPatients undergoing THA or TKA.INTERVENTIONSurgeons revised their UTI screening and treatment practices.RESULTSPositive leukocyte esterase (PP5 (P=.01;P=.01) were associated with preoperative or postoperative UTI treatment. In the prospective study, 12 patients (24%) had signs and symptoms consistent with UTI. The number of patients treated for presumed UTI decreased 80.2% after the surgeons changed their practices, and surgical site infection (SSI) rates, including prosthetic joint infections (PJIs), did not increase.CONCLUSIONSUrine leukocyte esterase and white blood cell count were the strongest predictors of treatment for UTI before or after THA/TKA. The intervention was associated with a significant decrease in treatment for UTI, and SSI/PJI rates did not increase.Infect Control Hosp Epidemiol2017;38:281–286 |
Databáze: | OpenAIRE |
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