Abstract

Background
There is no consensus on whether asymptomatic bacteriuria (ASB) should be screened for and treated in hip fracture patients (HFPs).

Aim
To assess the relationship between the rate of perioperative ASB and surgical site infection (SSI) in HFPs and explore the effect of treating ASB.

Methods
PubMed, CINAHL and Cochrane Library were searched to identify studies that evaluated the relationship between perioperative ASB and SSI. Meta-analysis was performed using a fixed or random effects model, as indicated. The study was prospectively registered with PROSPERO (CRD42023431037).

Results
A total of 2,272 records were identified, with three studies included. The total sample size was 247 patients. Meta-analysis of all three studies reporting on ASB in HFPs (treated and not treated) showed an estimated SSI rate of 7.3% (95% confidence interval (CI) 2.0-23.5%). Meta-analysis of two studies reporting on HFPs whose ASB was treated showed an overall estimated SSI rate of 13.0% (95% CI 8.1-20.3%). However, in two studies in which ASB was not treated, the overall estimated SSI rate was 4.4% (95% CI 1.7-11.2%). Due to the small number of studies, formal comparison between the two groups was not performed.

Conclusion
There is a dearth of high-quality evidence to guide the management of ASB in HFPs. Hence, an approach involving risk stratification, local antimicrobial resistance patterns and rapid diagnostic tools may be considered in this vulnerable cohort. In addition, as SSIs can have devastating effects on HFPs, using the principle of caution, hospitals may consider screening and treating positive ASB. Further, high quality evidence is needed to determine the concrete relation between ASB and SSI rates in HFPs and determine the role of ASB treatment in reducing SSI rates.