What's the Risk for PJI After GU Procedures?

Although relatively rare, prosthetic joint infections (PJIs) are associated with significant morbidity and mortality; consequently, some organizations have recommended that antibiotic prophylaxis be considered for patients with prosthetic joints who are undergoing genitourinary (GU) procedures that could introduce bacteria into the bloodstream. Is this recommendation justified?

Mayo Clinic researchers performed a prospective case-control study to determine whether GU procedures — performed with or without antibiotic prophylaxis — were risk factors for PJI. They examined the medical records of 678 patients with a prosthetic knee or hip who were admitted to the orthopedic service between December 2001 and May 2006 (339 case-patients with a PJI and 339 controls admitted during the same period for other reasons) for a history of a GU procedure in the preceding 2 years.

Case-patients were more likely than controls to have diabetes, to be immunocompromised, and to have had more than one operation on the involved joint. Fifteen percent of the case-patients and 16% of the controls had undergone a GU procedure during the preceding 2 years, and only 12% and 13% of these patients, respectively, had received antibiotic prophylaxis for the procedures. The most common organisms causing PJIs were coagulase-negative staphylococci and Staphylococcus aureus; the prevalence of individual pathogens was similar between the PJI patients who had undergone a GU procedure and those who had not.