Urinary tract infection is associated with a 2.4-fold increased risk of surgical site infection in hip fracture surgery: a systematic review and meta-analysis

Abstract

Background
Surgical site infection (SSI) is a devastating complication in hip fracture patients. There is no consensus regarding whether urinary tract infection (UTI) should be screened for or treated in hip fracture patients.

Aim
To assess the relationship between peri-operative UTI and SSI in hip fracture patients, and the relationship between urinary catheterisation and SSI in these patients.

Methods
We searched PubMed, EMBASE, CINAHL and Cochrane Library to identify studies that evaluated the relationship between peri-operative UTI and SSI and/or between urinary catheterisation and SSI. Articles were included if they used the term UTI or specified UTI as symptomatic bacteriuria. Statistical analysis was performed to provide the SSI rate and odds ratio (OR).

Findings
A total of 4,139 records were identified, with 8 studies included. Meta-analysis of 7 studies which evaluated peri-operative UTI and SSI showed an SSI rate of 7.1% (95%confidence interval (CI):3.8%-13.2%) among 1,217 patients with UTI versus 2.4% (95%CI:1.0%-5.7%) in 36,514 patients without UTI (OR=2.41, 95%CI:1.67-3.46, p<0.001). In 3 studies which specifically defined UTI as symptomatic bacteriuria, the SSI rate among UTI patients was 5.7% (95%CI:4.0%-8.1%) versus 1.1% (95%CI:0.2%-5.2%) in those without UTI (OR=3.00, 95%CI:0.55-16.26, p=0.20). One study evaluated urinary catheterisation and SSI.

Conclusion
Peri-operative UTI is associated with a higher risk of SSI among hip fracture patients but the evidence is limited by the heterogeneity in the definition of UTI. Given the devastating effects of SSI, we recommend considering the possibility of peri-operative UTI in hip fracture patients, with treatment administered as necessary to reduce SSI rates.