Purpose: Routine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines. Materials and Methods: A pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period. Results: A total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed (P<0.0001), and a 93% reduction rate in antibiotic utilization (P<0.001). No significant difference in SSI and CAUTI rates was observed (P>0.05). Conclusion The elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.

Objective: This study described the clinical profile of a four-generation Cebuano family with juvenile-onset open-angle glaucoma (JOAG). Methods: Thisis a case series conducted in the out-patient department of Cebu Velez General Hospital. Thirtyeight (38) members in a four-generation family from the northern part of Cebu province were investigated. General medical and ophthalmologic histories were taken. Complete ophthalmologic examination was done. Results: Forty-two (42%) percent of participants examined had increased intraocular pressures (IOP); 15 were diagnosed with JOAG, one had ocular hypertension. There were more females than males affected. Mean age when symptoms were first noted was 14.56 ±6.63 years and mean age at diagnosis was 16.3 ±7.84 years. The most common initial symptom was rainbow or halos around lights (87.5%). Mean refraction was -3.09 ±2.54 diopters for both eyes. Mean IOP on examination was 24.56 ± 20.17 mmHg. Gonioscopy showed open angles with flat iris plane. All affected participants underwent medical treatment and 69% needed surgical interventions. Conclusion This family demonstrated the typical JOAG phenotype consisting of early age of onset, strong family history with an autosomal dominant pattern of inheritance, myopia, open angles, and increased IOP refractory to medical treatment.
Glaucoma ; Ocular Hypertension ; Phenotype ; Pedigree