URINARY-TRACT INFECTION AND HIP FRACTURE

A routine audit revealed that in 25 per cent of patients with proximal femoral fracture, hospital stay was complicated by urinary tract infe ction (UTI). A prospective study was undertaken to investigate the rel ationship of UTI to fracture type, timing of surgery and the effect of perioperative antibiotics. Eighty-eight patients were investigated ov er a 4-month period with urine specimens obtained at lime of operation and 48 h from operation. Of the patients, all female, 12.5 per cent h ad positive urine cultures al the time of operation. OF all patients, 42 per cent had positive urine cultures 48 h after operation. Females with intra-capsular fractures were more likely to have positive cultur es both pre- and post-operatively (P < 0.005). Age (P < 0.05) and oper ative delay beyond 48 h (P < 0.05) were also found to predispose to in fection. All patients except one who had urinary infection at the time of surgery had post-operative urine infection with the same organism. Present audit methods have significantly under estimated the presence of UTI in these patients. Fracture type and operative delay would app ear to be the most significant determinants of a positive urine cultur e 48 h after operation. Prophylactic antibiotics appear to be ineffect ive in eradicating pre-existing or preventing early post-operative inf ection.