Urinary tract infections after early removal of urinary catheter in total joint arthroplasty.

Objective: Postoperative urine retention (POUR) is a well-known complication after total joint arthroplasty (TJA). POUR is most commonly managed with an indwelling catheter. However, indwelling catheters have been associated with a substantial risk of urinary tract infection (UTI). The purpose of this study was to (1) evaluate the incidence of UTI and POUR in patient with indwelling urinary catheter after TJA, (2) identify the microorganisms responsible for catheter colonization, and (3) assess preoperative risk factors (gender, body mass index, hypertension, diabetes mellitus, smoking) associated with catheter colonization.

Methods: Patients undergoing primary TJA with no preoperative bacteriuria were enrolled. Prior to the draping of the surgical site, each patient received an indwelling catheter that was inserted under sterile conditions and remained in place for 24 hours. Urine and tip catheter cultures were performed after catheter removal.

Results: 55 patients (38 females and 17 males) were recruited (26 total knee and 29 total hip arthroplasties). POUR was not reported in any patient, and only 1 patient (1.8%) had UTI. Cultures of catheter tips were positive in 16 patients (29.1%). Only 1 of these patients had a positive urine culture. Enterococcus faecalis was the most common pathogen isolated. None of the preoperative variables was associated with the risk of catheter colonization.

Conclusions: Data from this study support early catheter removal after TJA. Predominant catheter-isolated bacteria are enteric species. The culture of a catheter tip specimen should be discouraged for the diagnosis of UTI within the firsts 24 hours after surgery.