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Invited Commentary
December 12, 2018

Observational Evidence Calls for Deimplementation of Routine Preoperative Urine Screening

Author Affiliations
  • 1Section of Health Services Research, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
JAMA Surg. Published online December 12, 2018. doi:10.1001/jamasurg.2018.4765

In this issue of JAMA Surgery, a retrospective cohort study by Gallegos Salazar et al1 provides high-quality evidence that preoperative screening urine cultures are not associated with improvements in infectious outcomes. Specifically, the authors examined all major cardiac, orthopedic joint replacement, and vascular surgery procedures within the US Department of Veterans Affairs health care system from 2008 to 2013, identifying 17 611 patients with a preoperative urine culture who had either a negative culture result or asymptomatic bacteriuria (ASB), defined as a positive culture result without urinary symptoms. No significant differences in risk of surgical site infection (SSI) (including prosthetic valve or joint infections) or urinary tract infection (UTI) were identified between patients with negative culture results and those with ASB in the overall cohort. Effective antibiotic treatment of the organisms causing ASB did not lower the risk of SSI or UTI.

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