COMMENTARY

Pre-op Urine Screening: Changing Our Culture

Sonali D. Advani, MD, MBBS, MPH

Disclosures

February 06, 2019

Editorial Collaboration

Medscape &

Do Pre-op Urine Cultures Influence Surgical Outcomes?

A positive urine culture result often drives antibiotic prescribing even in the absence of symptoms. In a recent multicenter cohort study, Salazar and colleagues[1] retrospectively reviewed patients undergoing cardiac, orthopedic, or vascular surgical procedures to describe the association between preoperative asymptomatic bacteriuria (ASB) and postoperative infectious outcomes.

Preoperative urine samples from 17,749 patients were analyzed. Urine cultures were positive in 755 (4.3%) of the patients, and of these, 617 (81.7%) were classified as ASB. In adjusted analysis, patients with and without ASB had similar odds of surgical-site infection (SSI; 2.4% vs 1.6%; adjusted odds ratio [aOR], 1.58; P = .08). Similarly, patients with and without ASB had similar odds of urinary tract infection (UTI; 3.3% vs 1.5%; aOR, 1.42; P = .22). ASB treatment was not associated with a reduced SSI risk (aOR, 1.01; P = .99). Treatment or prophylaxis for ASB was also not associated with reduced odds of postoperative UTI (aOR, 0.68; P = .54).

Viewpoint

These data emphasize that screening for and treating ASB do not influence rates of postoperative SSIs or UTIs. This study provides high-quality evidence to discontinue the practice of preoperative urine screening and ASB treatment.[2] Changing the culture of culturing is challenging, but surgeons and infectious diseases physicians should collaborate to introduce this change for the benefit of patients.

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