These authors conducted a retrospective case-control study of periprosthetic infections (PJI) following primary shoulder arthroplasty in patients with preoperative urinary tract infections (UTIs) utilizing the insurance-based PearlDiver patient records data repository. Their goal was to examine the association between preoperative UTIs and their timing with periprosthetic joint infection (PJI) following shoulder arthroplasty.
Patients undergoing primary shoulder arthroplasty diagnosed with a UTI in the preoperative period were separated into mutually exclusive groups based on one-week intervals up to six weeks prior to surgery. A matched control cohort without a preoperative UTI was created for comparison.
Compared with matched controls, patients with a UTI diagnosed within 1 week prior to shoulder arthroplasty (OR, 2.73; 95% CI 1.67-4.46; P < 0.001) and within 1 to 2 weeks preoperatively (OR, 1.77; 95% CI 1.24-2.52; P = 0.002) experienced significantly higher rates of PJI within 2 years postoperatively. There were no significant differences in the incidence of PJI between patients diagnosed with a UTI greater than 2 weeks prior to surgery and matched controls (P > 0.05).
Comment: Unfortunately this report did not identify the organisms causing the PJIs or the UTIs, so it is not possible to determine whether the joint may have been hematogenously seeded prior to the arthroplasty. Furthermore, the report did not characterize the antibiotic treatment or the URI. Other possible mechanisms for the observed association include (1) altered host microbiology resulting from antibiotic treatment of the UTI or (2) diminished host resistance to infection manifesting as both an increased susceptibility to both UTI and PJI.
In any event, the results of this study may be interpreted as suggesting that surgeons may wish to ask patients about prior UTIs and avoid shoulder arthroplasty soon after the diagnosis and treatment of a UTI.
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