Summary

Patients diagnosed with a UTI within 2 weeks prior to shoulder arthroplasty may be at an increased risk of postoperative PJI.

Abstract

Background

While literature describing the increased risk of postoperative infection for patients undergoing lower extremity arthroplasty with a preoperative urinary tract infection (UTI) is inconclusive, this relationship has yet to be adequately studied for shoulder arthroplasty. The goals of the present study were to (1) examine the association between preoperative UTIs and their timing with periprosthetic joint infection (PJI) following shoulder arthroplasty, and (2) if an antibiotic prescription mitigates this risk.

Methods

Patients undergoing primary shoulder arthroplasty diagnosed with a UTI in the preoperative period were identified in an insurance database and separated into mutually exclusive groups based on one-week intervals up to six weeks prior to surgery. Patients in each study cohort who received a preoperative antibiotic prescription for the UTI were then identified and compared to those without antibiotic prescriptions. A matched control cohort without a preoperative UTI was created for comparison. The incidence of PJI within two years following shoulder arthroplasty was then assessed for each cohort and compared using a logistic regression analysis.

Results

Compared with matched controls, patients with a UTI diagnosed within 1 week prior to shoulder arthroplasty (OR, 2.73; 95% CI 1.67-4.46; P < 0.001) and within 1 to 2 weeks preoperatively (OR, 1.77; 95% CI 1.24-2.52; P = 0.002) experienced significantly higher rates of PJI within 2 years postoperatively. There were no significant differences in the incidence of PJI between patients diagnosed with a UTI greater than 2 weeks prior to surgery and matched controls (P > 0.05). No significant differences were observed across all cohorts when comparing the incidence of PJI in patients who received an antibiotic prescriptions for a diagnosis of UTI and those who did not.

Conclusions

Patients diagnosed with a UTI within 2 weeks prior to shoulder arthroplasty may be at an increased risk of postoperative PJI. Antibiotic prescriptions do not appear to mitigate this increased risk.