This study examined the difference in postoperative
bacteriuria in total joint
arthroplasty after use of either an
indwelling catheter or intermittent catheterization. Previous studies showed a preference for an
indwelling catheter over intermittent catheterization to resolve postoperative
urinary retention in total joint
arthroplasty, but these studies generally used 48 hours of
antibiotic prophylaxis. Increasing awareness of costs and bacterial resistance to
antibiotics have prompted many centers to reduce prophylaxis to only 1 preoperative dose A prospective, randomized, controlled trial was conducted in primary total hip and primary
total knee arthroplasty patients. One dose of
cefazolin, 1 g, was administered intravenously immediately preoperatively. Five of 13 (38%) men in the
indwelling catheter group and 0 of 14 (0%) men in the intermittent catheterization group developed postoperative
bacteriuria (P =.016), and 6 of 33 (18%) women in the
indwelling catheter group and 3 of 39 (8%) women in the intermittent catheterization group developed postoperative
bacteriuria (not significant). A total of 11 (24%) patients in the
indwelling catheter group (n = 46) and 3 (6%) patients in the intermittent catheterization group (n = 53) developed postoperative
bacteriuria (P =.018). In this setting with 1-dose
antibiotic prophylaxis, intermittent catheterization resulted in a lower incidence of postoperative
bacteriuria compared with an
indwelling catheter. For men, this difference is significant.