Abstract
Background
Screening for and treatment of asymptomatic bacteriuria (ASB) is controversial prior to surgical valve replacement (SVR). The theoretical concern that the bacteria can translocate to the surgical site, causing infective endocarditis (IE), has not been well-described. At our institution, screening for and treatment of ASB is routine prior to SVR. This study aims to identify whether an association exists between ASB and post-op infections in patients undergoing SVR.
Methods
A single-center retrospective study was conducted for patients who had SVR between 2016 and 2018. Pre-op urinalyses (UAs) and cultures, symptoms of UTI, and antibiotic therapy were collected during the 60-day pre-op period. Infections, antibiotic therapy, development of resistance, 30-day readmission rates, and 30- and 90-day mortality rates were collected up to 3 months post-op. Statistical analysis was performed using the Chi-square and Fisher exact tests.
Results
Of the 358 patients who underwent SVR, pre-op UAs were performed in 329 (92%) patients; of whom, 296 (91%) were asymptomatic. Amongst those asymptomatic, 14 (5%) cultures were positive and 11 (79%) positive cultures were treated. Patients with ASB had no difference in post-op infection (1/14 [7%] vs. 32/282 [11%]; P = 1), 30-day readmission rate (1/14 [7%] vs. 44/282 [16%]; P = 0.7), or 90-day mortality rate (0/14 [0%] vs. 4/282 [1%]; P = 1) compared with those with negative urine cultures. Patients who were treated for ASB also showed no difference in these same outcomes compared with those not treated. IE was a complication in 3 of 358 (1%) cases, and none of these patients had ASB or symptomatic UTI prior to surgery. Antibiotic treatment prior to surgery was associated with acquisition of a multi-drug-resistant organism (9/68 [13%] vs. 15/290 [5%]; P = 0.02). There was a trend toward increased 30-day readmission rate (15/68 [22%] vs. 43/290 [15%]; P = 0.15) and development of resistance (1/68 [1%] vs. 0/290 [0%]; P = 0.19) in patients who received pre-op antibiotics.
Conclusion
In this study, ASB prior to SVR was not related to post-op infection, and treatment of ASB did not prevent future infection. Antibiotic treatment prior to SVR was associated with the development of MDROs. Urine screening prior to SVR should be avoided.
Disclosures
All authors: No reported disclosures.
Session: 157. Urinary Tract Infections
Friday, October 4, 2019: 12:15 PM