Preoperative asymptomatic bacteriuria and subsequent prosthetic joint infection: lack of a causal relation.

TO THE EDITOR—We read with great interest the paper of Sousa et al claiming that asymptomatic bacteriuria (ASB) is a risk factor for prosthetic joint infection (PJI) [1]. We congratulate the authors for this important multicenter study [1] and Dr Duncan for the accompanying editorial that highlights the key limitations of the study [2]. The administration of antibiotics for ASB before elective arthroplasty is controversial, but reflects widespread practice and likely represents a common reason for antibiotic misuse in many centers. A survey in the United Kingdom revealed that two-thirds of surgeons would treat ASB prior to knee arthroplasty, but 70% would not have any evidence to cite evidence in favor of this practice [3]. Unfortunately, most studies are retrospective single-center studies that do not differentiate between symptomatic infection and ASB and fail to take into account costs or unintended consequences of unnecessary antibiotic use [4]. A large prospective multicenter study on this topic is thus warmly welcome [1].