Advertisement

International Orthopaedics

, Volume 42, Issue 4, pp 741–746 | Cite as

Peri-operative antibiotic treatment of bacteriuria reduces early deep surgical site infections in geriatric patients with proximal femur fracture

  • Ronny Langenhan
  • Stefanie Bushuven
  • Niklas Reimers
  • Axel Probst
Original Paper

Abstract

Purpose

The aim of this study was to conduct a re-evaluation of current strategies for peri-operative prophylaxis of infections in orthopaedic surgery of geriatric patients (≥65 years) with proximal femoral fractures (PFF).

Methods

Between 01/2010 and 08/2014 all post-operative infections after stabilization of PFF of 1,089 geriatric patients were recorded retrospectively. All patients pre-operatively received a single dose of 1.5 g cefuroxime (group 1). These were compared to prospectively determined post-operative rates of surgical site infection (SSI) of 441 geriatric patients, which were operated on between 09/2014 and 03/2017 due to PFF. In this second group we investigated the urinary tract on admission. Bacteriuria was treated with the pre-operative single dose of 1.5 g cefuroxime along with ciprofloxacin for five days, beginning on admission. Level of significance was set to p < 0.05.

Results

A total of 141 patients of group 2 had a bacteriuria. Seventy-seven of these patients revealed biochemical signs of manifest urinary tract infection. Multi-resistant pathogens were found in 15 patients and pathogens were cefuroxime-resistant in 37. The differences of SSI after at least three months were 2.1% in group 1 and 0.45% in group 2 for all patients with surgery of PFF (p < 0.02) and for those with arthroplasty (p < 0.037) significant.

Conclusions

The immediate antibiotic therapy of a prevalent bacteriuria for five days decreases the risk of SSI after surgery of PFF. Our single-centre study can only point out the problem of prevalent reservoirs of pathogens and the need for treatment. Evidence-based therapy concepts (indications of antibiotics, classes, duration) have to be developed in multi-centric and prospective studies.

Keywords

Proximal femoral fracture Geriatric patients Urinary tract infection Bacteriuria Pathogen resistances Perioperative prophylaxis of infections Early deep surgical site infection 

Notes

Source of funding

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, centre, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Compliance with ethical standards

Conflict of interest

The authors declare no competing interests.

This study was approved by the local ethics committee (Landesärztekammer BW, F-2016-068).

References

  1. 1.
    Charnley J (1972) Post-operative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop Relat Res 87:167–187CrossRefPubMedGoogle Scholar
  2. 2.
    Bryson DJ, Morris DL, Shivji FS, Rollins KR, Snape S, Ollivere BJ (2016) Antibiotic prophylaxis in orthopaedic surgery: difficult decisions in an era of evolving antibiotic resistance. Bone Joint J 98:1014–1019.  https://doi.org/10.1302/0301-620X.98B8.37359 CrossRefPubMedGoogle Scholar
  3. 3.
    Meehan J, Jamali AA, Nguyen H (2009) Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am 91:2480–2490.  https://doi.org/10.2106/JBJS.H.01219 CrossRefPubMedGoogle Scholar
  4. 4.
    Buchheit J, Uhring J, Sergent P, Puyraveau M, Leroy J, Garbuio P (2015) Can pre-operative CRP levels predict infections of bipolar hemiarthroplasty performed for femoral neck fracture? A retrospective, multicenter study. Eur J Orthop Surg Traumatol 25:117–121.  https://doi.org/10.1007/s00590-014-1449-5 CrossRefPubMedGoogle Scholar
  5. 5.
    Sathiyakumar V, Greenberg SE, Molina CS, Thakore RV, Obremskey WT, Sethi MK (2015) Hip fractures are risky business: an analysis of the NSQIP data. Injury 46:703–708.  https://doi.org/10.1016/j.injury.2014.10.051 CrossRefPubMedGoogle Scholar
  6. 6.
    Gallardo-Calero I, Larrainzar-Coghen T, Rodriguez-Pardo D, Pigrau C, Sánchez-Raya J, Amat C, Lung M, Carrera L, Corona PS (2016) Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture. Injury 47:872–876.  https://doi.org/10.1016/j.injury.2015.12.032 CrossRefPubMedGoogle Scholar
  7. 7.
    Probst A, Reimers N, Hecht A, Langenhan R (2016) Geriatric proximal femoral fracture and urinary tract infection—considerations for peri-operative infection prophylaxis. Z Orthop Unfall 154:477–482CrossRefPubMedGoogle Scholar
  8. 8.
    Mody L, Juthani-Mehta M (2014) Urinary tract infections in older women: a clinical review. JAMA 311:844–854.  https://doi.org/10.1001/jama.2014.303 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Detweiler K, Mayers D, Fletcher SG (2015) Bacteruria and urinary tract infections in the elderly. Urol Clin North Am 42:561–568.  https://doi.org/10.1016/j.ucl.2015.07.002 CrossRefPubMedGoogle Scholar
  10. 10.
    Schaefer AJ, Nicolle LE (2016) Clinical practice. Urinary tract infection in older men. N Engl J Med 374:562–571.  https://doi.org/10.1056/NEJMcp1503950 CrossRefGoogle Scholar
  11. 11.
    Sousa R, Muñoz-Mahamud E, Quayle J, Dias da Costa L, Casals C, Scott P, Leite P, Vilanova P, Garcia S, Ramos MH, Dias J, Soriano A, Guyot A (2014) Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis 59:41–47.  https://doi.org/10.1093/cid/ciu235 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Yassa RR, Khalfaoui MY, Veravalli K, Evans DA (2017) Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis. JRSM Open 8:2054270416675083.  https://doi.org/10.1177/2054270416675083 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kass EH, Finland M (2002) Asymptomatic infections of the urinary tract. J Urol 168:420–424CrossRefPubMedGoogle Scholar
  14. 14.
    Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA, Smith H, Hawke C, Mullee M (2006) Developing clinical rules to predict urinary tract infection in primary care settings: sensitivity and specificity of near patient tests (dipsticks) and clinical scores. Br J Gen Pract 56:606–612PubMedPubMedCentralGoogle Scholar
  15. 15.
    Gillespie WJ, Walenkamp GH (2010) Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 17:CD000244.  https://doi.org/10.1002/14651858.CD000244.pub2 Google Scholar
  16. 16.
    Mody L, Bradley SF, Galecki A, Olmsted RN, Fitzgerald JT, Kauffman CA, Saint S, Krein SL (2011) Conceptual model for reducing infections and antimicrobial resistance in skilled nursing facilities: focusing on residents with indwelling devices. Clin Infect Dis 52:654–661.  https://doi.org/10.1093/cid/ciq205 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Trampuz A, Zimmerli W (2008) Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis. Curr Infect Dis Rep 10:394–403Google Scholar
  18. 18.
    Bayer (2015) PRODUCT MONOGRAPH PrCIPRO® XL 2015. http://omr.bayer.ca/omr/online/cipro-xl-pm-en.pdf. Accessed October 2017
  19. 19.
    Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, Kivelä SL (2011) Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 12:105.  https://doi.org/10.1186/1471-2474-12-105 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bouvet C, Lübbeke A, Bandi C, Pagani L, Stern R, Hoffmeyer P, Uçkay I (2014) Is there any benefit in pre-operative urinary analysis before elective total joint replacement? Bone Joint J 96:390–394.  https://doi.org/10.1302/0301-620X.96B3.32620 CrossRefPubMedGoogle Scholar
  21. 21.
    Duncan RA (2014) Prosthetic joint replacement: should orthopedists check urine because it's there? Clin Infect Dis 59:48–50.  https://doi.org/10.1093/cid/ciu243 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ferroni M, Taylor AK (2015) Asymptomatic bacteriuria in noncatheterized adults. Urol Clin North Am 42:537–545.  https://doi.org/10.1016/j.ucl.2015.07.003 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryHegau-Bodensee-Klinikum SingenSingenGermany
  2. 2.Department of Orthopaedic SurgeryKlinikum Chemnitz gGmbHChemnitzGermany

Personalised recommendations