关节置换前无症状菌尿

Asymptomatic bacteriuria before arthroplasty

背景:泌尿系感染的血源性播散是导致关节置换术后感染的原因之一,而对于泌尿系感染中的一种特殊情况,即无症状菌尿在关节置换术中的意义目前研究较少。目的:探究关节置换前无症状菌尿与置换后感染并发症的关系,评价对其进行筛查和治疗能否给患者带来收益。方法:采用系统回顾的方法,研究者检索了PubMed、Embase、Cochrane Library和中国期刊全文数据库等据库,搜集关于关节置换前无症状菌尿的临床研究,4个数提取文中数据,评价文献质量,并对该问题进行综合的评价和分析。结果与结论:最终筛选出7篇符合条件的文献,通过总结其内容证明:(1)关节置换前无症状菌尿的存在与置换后假体周围感染有显著相关性,但两者之间并不是因果关系;(2)患有置换前无症状菌尿的患者有着较高的浅表术区感染率,但并没有证据表明无症状菌尿是浅表感染的直接来源;(3)无症状菌尿可以作为预示指标,表明患者在关节置换后容易发生感染;(4)对置换前无症状菌尿进行治疗不能降低关节置换后各种感染并发症的发生;(5)目前研究并不支持对关节置换前无症状菌尿进行常规筛查和治疗。

BACKGROUND:Hematogenous spread of urinary tract infection is one of the causes of infection after arthroplasty.The significance of a special portion of urinary tract infection,namely asymptomatic bacteriuria in arthroplasty is little reported.OBJECTIVE:To explore the correlation of preoperative asymptomatic bacteriuria and infection after arthroplasty and evaluate the benefits of screening and treating asymptomatic bacteriuria.METHODS:The researchers searched PubMed,Embase,the Cochrane Library and CNKI databases to collect the clinical studies on asymptomatic bacteriuria before arthroplasty.Then,data extraction,quality assessment of the literature,and result analysis were conducted.RESULTS AND CONCLUSION:Finally,seven eligible articles were included.(1)Preoperative asymptomatic bacteriuria is significantly associated with the occurrence of postoperative prosthetic infection,but it is not a causal relationship.(2)Patients with asymptomatic bacteriuria have a high rate of superficial wound infection but no evidence shows that urinary infection is the direct source of contamination.(3)Asymptomatic bacteriuria is an indicator of increased susceptibility to infection after arthroplasty.(4)Treating asymptomatic bacteriuria before arthroplasty cannot decrease the incidence of various postoperative infectious complications.(5)Current clinical evidence does not support the routine screening and treatment of asymptomatic bacteriuria before arthroplasty.