Preoperative urine culture fails to lower postoperative UTI risk: JAMA

A recent cohort study published in the Journal of American Medical Association unearthed the crucial insights that challenge the conventional practice of conducting preoperative urine cultures before nongenitourinary surgeries. Despite the prevailing guidelines that advise against this practice, many clinicians still resort to preoperative urine cultures and antibiotics administration for asymptomatic bacteriuria to reduce infection risks.

The study was conducted across 112 US Department of Veterans Affairs (VA) medical centers from January 2017 to December 2019 and scrutinized over 288,000 surgical procedures performed on VA enrollees. This research utilized machine learning and inverse probability of treatment weighting (IPTW) and meticulously balanced patient characteristics between those who underwent preoperative urine cultures and those who didn't.

The findings revealed that preoperative urine cultures held no significant association with a reduced risk of postoperative urinary tract infections (UTIs) or surgical site infections (SSIs). According to the IPTW analysis, the preoperative urine cultures were performed in 10.5% of the surgical procedures, while the adjusted odds ratios (AORs) for both UTI and SSI post-surgery remained largely unaffected. Even when focusing on orthopedic and neurosurgery cases that often involved prosthetic implants, this study found no link between preoperative urine cultures and reduced infection risks.

The study emphasized that these findings underline the need to reconsider the routine practice of preoperative urine cultures and subsequent antibiotic treatments before surgeries in cases involving prosthetic implants. The results advocate for the deimplementation of this practice which aligns with the recent guidelines that discourage such preoperative screenings.

Source:

O’Brien, W. J., Schweizer, M. L., Strymish, J., Beck, B. F., Au, V., Chan, J. A., Brown, M., Itani, K. M. F., Dukes, K. C., Walhof, J. F., & Gupta, K. (2024). Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture. In JAMA Network Open (Vol. 7, Issue 3, p. e240900). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.0900