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The relation between wound and urine cultures and joint sepsis after hip and knee arthroplasty

Relation entre plaie contaminée, sonde urinaire et infection articulaire dans les arthroplasties de hanche et de genou

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Résumé

Les auteurs ont analysé la relation entre les prélèvements de plaie et cultures d'urine et les infections articulaires ultérieures dans une étude prospective portant sur 2 651 prothèses de hanche et 362 prothèses de genou. Tous les patients ont bénéficié d'une antibioprophylaxie per opératoire au cefuroxime. Dans 26 cas d'infection articulaire l'agent causal a été identifié: 42 % de St. aureus, 12 % de St. epidermidis, 24 % de germes Gram négatifs et 4 % de bactéries anaérobies. Le Cefuroxime couvrait correctement tous les spectres. L'infection articulaire était précédée de 12 infections de plaie opératoire sur 26 patients. Aucune relation n'a pu être retenue avec les 4,2 % de cultures positives des prélèvements per-opératoires. Par contre, il existe une relation nette entre les arthrites post-opératoires et les prélèvements post-opératoires positifs au niveau des plaies opératoires, sauf en ce qui concerne le St. epidermidis. Les cultures positives de drains n'ont pas permis de prédire l'infection articulaire. Dans ces conditions, les prélèvements per-opératoires et la mise en culture de drains ne semblent pas indiqués dans les cas d'arthroplastie primaire. L'infection urinaire post-opératoire survient chez 15 % de patients et est fortement en relation avec l'utilation de sondes à demeure. L'incidence de l'infection urinaire augmente avec la durée du sondage à demeure. L'ablation de la sonde est recommandée avant le 3ème jour post-opératoire, puisque 5 patients qui ont gardé la sonde plus de 72 h ont développé une septicémie. Dans cette étude l'augmentation du risque d'infection hématogène des prothèses de hanche, en cas d'infection urinaire, n'a pas pu être explorée au plan bactériologique dans la période post-opératoire précoce. Il n'y a pas de relation directe entre sonde urinaire et infection articulaire.

Abstract

The relation between wound and urine cultures and joint sepsis was analysed in a prospective study with 2651 hip and 362 knee replacements. All patients received peroperative cefuroxime. In 26 patients with joint sepsis, S.aureus (42%), S.epidermidis (12%), Gram-negative bacteria (24%) and anaerobic bacteria (4%) were identified as the causative agents. Cefuroxime covered this spectrum sufficiently. Joint sepsis was preceded by wound infection in 12 out of the 26 patients. Positive peroperative joint cultures (4.2%) were not related to joint sepsis. Positive postoperative woundcultures were clearly related to joint sepsis, except in case of isolation of S.epidermidis. Drain cultures were less reliable in predicting joint sepsis. Routine peroperative and drain cultures are therefore not indicated in primary joint replacement. Postoperative urinary tract infections (UTI) occurred in 15% of the patients and were strongly related to the use of indwelling catheters. The incidence of UTI increased with time the catheter was in situ. Removal before the third day is recommended, because five patients developed septicaemia having a catheter for more than 72 h. The increased risk for joint sepsis after hip replacement, in the presence of UTI in this study, could not be explained by early postoperative haematogenous bacterial seeding. There was no relation between the indwelling urinary catheters and joint sepsis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Academic Hospital Nijmegen, PO Box 9101, 6500 HB, Nijmegen, NL, The Netherlands

    A. B. Wymenga & T. J. J. H. Slooff

  2. Department of Medical Microbiology, Academic Hospital Nijmegen, PO Box 9101, 6500 HB, Nijmegen, NL, The Netherlands

    H. L. Muytjens

  3. Medical Statistics Department, Academic Hospital Nijmegen, PO Box 9101, 6500 HB, Nijmegen, NL, The Netherlands

    A. Theeuwes

  4. Department of Orthopaedic Surgery, Medisch Spectrum Twente, PO Box 50000, 7500 KA, Enschede, NL, The Netherlands

    J. R. Van Horn

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  1. A. B. Wymenga
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  3. J. R. Van Horn
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  4. A. Theeuwes
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  5. T. J. J. H. Slooff
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Wymenga, A.B., Muytjens, H.L., Van Horn, J.R. et al. The relation between wound and urine cultures and joint sepsis after hip and knee arthroplasty. Orthop Traumatol 3, 5–11 (1993). https://doi.org/10.1007/BF01798157

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