Quick Take: Association of Screening and Treatment for Preoperative Asymptomatic Bacteriuria with Postoperative Outcomes Among US Veterans

It has been previously demonstrated that asymptomatic bacteriuria (ASB) is associated with an increased incidence of surgical site infection (SSI) and urinary tract infection (UTI) after non-urologic procedures. However, it is unclear whether screening for and treating ASB improves postoperative outcomes. In his retrospective cohort study, 68,265 patients that had undergone cardiac, orthopedic, or vascular surgical procedures were followed up to characterize the association between detection and treatment of preoperative ASB and postoperative outcomes. Complete medical records were reviewed to determine the results of the preoperative urine culture, whether the patient received antimicrobial prophylaxis against the microbe that was discovered, and to determine if SSI or UTI complicated the post-operative course. Of the patients included in the study, 17,749 (26.0%) had a urine culture. Of the 17,748 urine cultures performed, 755 (4.3%) had a positive result, of which 617 (81.7%) were designated as preoperative ASB. Researchers found that patients with ASB did not have a significantly increased risk of SSI (OR 1.58, 95% CI 0.93 to 2.70, p=0.08).  It was also found that antimicrobial therapy with activity against the microbes implicated in ASB did not result in a significantly reduced risk of SSI (OR 1.01, 95% CI 0.28 to 3.65, p=0.99). Additionally, treatment or prophylaxis for ASB did not reduce the incidence of postoperative UTI (OR 0.68, 95% CI 0.20 to 0.30, p=0.54). Investigators therefore concluded that the practice of screening and treating preoperative ASB is unnecessary, as antimicrobial therapy against microbes found in preoperative urine cultures was not associated with a reduction in postoperative UTI or SSI.

Click to read the study in JAMA Surgery

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