Screening for asymptomatic bacteriuria before total joint arthroplasty

Routine screening and treatment of arthroplasty patients for asymptomatic bacteriuria is an increasingly controversial topic. A link between urinary tract infection and prosthetic joint infection was first described in several case reports in the 1970s. This led to concern among orthopaedic surgeons that the clinical signs and symptoms of urinary tract infection may be masked in frail, older, and immunocompromised patients, and routine preoperative screening of urine for bacteriuria was established as routine practice.

However, antibiotic use is under scrutiny worldwide, and in the United Kingdom microbiologists and general practitioners are increasingly questioning routine treatment of asymptomatic bacteriuria before arthroplasty. Current guidance is conflicting: British Orthopaedic Association guidance1 supports routine preoperative urine screening but makes no comment on whether to treat, while guidelines from the Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Health and Care Excellence (NICE) state that patients with asymptomatic bacteriuria should …