With a shift away from treating asymptomatic bacteriuria in men, new research calls into question the value of preoperative urine screening in patients undergoing nonurologic procedures. A retrospective study of nearly 1,700 men treated at a Veterans Affairs medical center published online in the December issue of Archives of Internal Medicine, reports that even if bacteriuria is identified, treatment offers “no benefit.” The researchers reviewed the medical records of 1,688 patients who underwent cardiothoracic, orthopedic (1,291 patients), and vascular procedures to identify urine culture (UC) orders or results during the seven days before each procedure. Bacteriuria was defined as high count (more than 100,000 colony-forming units [CFU]/mL), low count (10,000 to 90,000 CFU/mL), or negative (fewer than 10,000 CFU/mL). Overall, a urine culture was obtained before one-quarter of the procedures, but there was significant variation by medical service (cardiothoracic accounted for 85 percent; vascular, 48 percent; and orthopedic, 4 percent). Patients receiving preoperative urine screening were significantly older (66.9 years versus 60 years) and were significantly more likely to develop post-surgical complications including surgical sight infections, diarrhea, and Clostridium difficile infections (CDI), although confounding factors are cited as possible. “We found that preoperative urine cultures were ordered inconsistently, that findings […]
With a shift away from treating asymptomatic bacteriuria in men, new research calls into question the value of preoperative urine screening in patients undergoing nonurologic procedures. A retrospective study of nearly 1,700 men treated at a Veterans Affairs medical center published online in the December issue of Archives of Internal Medicine, reports that even if bacteriuria is identified, treatment offers “no benefit.”
The researchers reviewed the medical records of 1,688 patients who underwent cardiothoracic, orthopedic (1,291 patients), and vascular procedures to identify urine culture (UC) orders or results during the seven days before each procedure. Bacteriuria was defined as high count (more than 100,000 colony-forming units [CFU]/mL), low count (10,000 to 90,000 CFU/mL), or negative (fewer than 10,000 CFU/mL).
Overall, a urine culture was obtained before one-quarter of the procedures, but there was significant variation by medical service (cardiothoracic accounted for 85 percent; vascular, 48 percent; and orthopedic, 4 percent). Patients receiving preoperative urine screening were significantly older (66.9 years versus 60 years) and were significantly more likely to develop post-surgical complications including surgical sight infections, diarrhea, and Clostridium difficile infections (CDI), although confounding factors are cited as possible.
“We found that preoperative urine cultures were ordered inconsistently, that findings were rarely positive for bacteriuria, and that bacteriuria, when detected, usually was not treated,” write the authors, led by Dimitri Drekonja, M.D., from the Minneapolis Veterans Affairs Medical Center in Minnesota. “Our findings document that treatment of preoperative bacteriuria is associated with no benefit.”
In 11 percent (54 of 489 cultures) bacteriuria was detected. Preoperatively, 16 patients were treated for urinary tract infection, but half of the treated patients had only low-count bacteriuria or a negative test result for UC.
“Given the few treated patients and the strong likelihood of confounding variables, this study cannot provide conclusive evidence about the risks and benefits of treating preoperative bacteriuria in older men,” writes Barbara Trautner, M.D., Ph.D., from the Baylor College of Medicine in Houston, in an accompanying editorial. But “the treatment of asymptomatic bacteriuria in most clinical settings is not necessary and may be harmful in terms of CDI, antibiotic resistance, and unnecessary costs.”
