The relationship between asymptomatic bacteriuria and surgical site infection in hip fracture patients: a systematic review and meta-analysis.

BACKGROUND

There is no consensus on whether asymptomatic bacteriuria (ASB) should be screened for and treated in hip fracture patients (HFPs).

AIM: The aim of this study was to assess the relationship between the rate of peri-operative ASB and surgical site infection (SSI) in HFPs and explore the effect of treating ASB.

METHODS

PubMed, CINAHL and Cochrane Library were searched to identify studies that evaluated the relationship between peri-operative ASB and SSI. Meta-analysis was performed using a fixed- or random-effect model, as indicated. The study was prospectively registered with the International Prospective Register for Systematic Reviews (CRD42023431037).

RESULTS

A total of 2272 records were identified, with three studies included. The total sample size was 247 patients. Meta-analysis of all three studies reporting on ASB in HFPs (treated and not treated) showed an estimated SSI rate of 7.3% (95% confidence interval [CI]: 2.0-23.5%). The meta-analysis of two studies reporting on HFPs whose ASB was treated showed an overall estimated SSI rate of 13.0% (95% CI: 8.1-20.3%). However, in two studies in which ASB was not treated, the overall estimated SSI rate was 4.4% (95% CI: 1.7-11.2%). Due to the small number of studies, formal comparison between the two groups was not performed.

CONCLUSION

There is a dearth of high-quality evidence to guide the management of ASB in HFPs. Hence, an approach involving risk stratification, local antimicrobial resistance patterns and rapid diagnostic tools may be considered in this vulnerable cohort. In addition, as SSIs can have devastating effects on HFPs, using the principle of caution, hospitals may consider screening and treating positive ASB. Furthermore, high-quality evidence is needed to determine the concrete relation between ASB and SSI rates in HFPs and determine the role of ASB treatment in reducing SSI rates.