Background: Routine pre-operative urinalysis testing has been common practice for the surgical orthopedic population for decades regardless of the presence of symptoms. Studies demonstrate low concordance between bacteria cultured from the surgical wound and those cultured in the urine. In addition, antibiotic overuse is costly and promotes antibiotic resistance. We developed a quality improvement initiative aimed at reducing unnecessary antibiotic use by (1) modifying testing algorithms to target symptomatic and high-risk patients (2) modifying reflux to culture criteria and (3) developing treatment guidelines for providers.
Methods: This pre/post study utilized data from our hospital's orthopedic registry to identify all hip and knee arthroplasty and spine fusion procedures for a pre-practice and post-practice change period. Univariate analysis compared groups for differences in age, gender, diabetes, procedure mix, foley catheter utilization and other variables that may affect the outcomes. Surgical Site Infection (SSI) and Catheter-Associated Urinary Tract Infection (CAUTI) rates were extracted from infection control databases. Urinalysis results, urine culture results, and antibiotic prescriptions were collected retrospectively from every 10th chart from the pre-period, and measured prospectively on all patients for the post-period.
Results: 9,949 people met criteria for inclusion in the study. Baseline demographics were similar between study groups, with exception of catheter-utilization which decreased by 0.06 device days/ patient day between periods (P<0.05). During the pre-practice change period, 160 / 5340 (3.0%) patients were treated preoperatively for a positive urine culture, 40 / 160 (25%) of whom had urinary symptoms. During the post-practice change period, 10 / 4609 (0.2%) patients were treated preoperatively (P<0.05), all of whom had urinary symptoms. The SSI rate was 0.34 / 100 procedures in the pre-period and 0.17 / 100 procedures in the post period (P=0.11). One patient in the pre-period and one patient in the post-period developed CAUTI (P=0.92).
Conclusion: Elimination of routine urinalysis before orthopedic surgery resulted in no change in SSI or CAUTI rates, but 93% reduction in antibiotic utilization.
S. Querfurth, None
B. L. Hollenbeck, None
C. Bell, None