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International Braz J Urol : Official... 2015To estimate the efficacy of antibiotic prophylaxis to prevent urinary tract infection in patients (both gender) who undergo a cystoscopy with sterile urine. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To estimate the efficacy of antibiotic prophylaxis to prevent urinary tract infection in patients (both gender) who undergo a cystoscopy with sterile urine.
MATERIALS AND METHODS
Search strategy (January 1980-December 2013) in Medline via PubMed, CENTRAL, and EMBASE. Additionally, we searched databases for registered trials and conference abstracts, as well as reference lists of systematic reviews and included studies. Seven published randomized clinical trials (January 1, 1980 to December 31, 2013) were included in quantitative analyses with no language restrictions. Two independent reviewers collected data. Risk of bias was evaluated with the Cochrane Collaboration tool. We performed a fixed effect analyses due to statistical homogeneity. The primary outcome was urinary tract infection and the secondary was asymptomatic bacteriuria. The effect measure was the risk difference (RD) with 95% confidence interval. The planned interventions were: Antibiotic vs placebo; Antibiotic vs no intervention and Antibiotic vs any other intervention.
RESULTS
3038 patients were found in seven studies. For the primary outcome, we included 5 studies and we found a RR 0.53 CI95% (0.31, 0.90) and a RD-0.012 CI95% (-0.023,-0.002), favoring antibiotic prophylaxis. For asymptomatic bacteriuria we included 6 studies and we found a RR 0.28 CI95% (0.20, 0.39) and a RD-0.055 CI95% (-0.07,-0.039), was found favoring prophylaxis. According to GRADE evaluation, we considered moderate quality of evidence for both outcomes. The subgroup analysis showed that only two studies were classified as having low risk of bias: Cam 2009 and Garcia-Perdomo 2013. They showed no statistical differences (RD-0.009 CI95% -0.03, 0.011).
CONCLUSIONS
Based on studies classified as low risk of bias, we found moderate evidence to not recommend the use of antibiotic prophylaxis to prevent urinary tract infection and asymptomatic bacteriuria in patients who undergo cystoscopy with sterile urine in an ambulatory setting.
Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cystoscopy; Female; Humans; Male; Middle Aged; Publication Bias; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Tract Infections
PubMed: 26200530
DOI: 10.1590/S1677-5538.IBJU.2014.0198 -
Oxidative Medicine and Cellular... 2020Urinary tract infection (UTI) is common in individuals with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) and in veterans with SCI who... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Urinary tract infection (UTI) is common in individuals with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) and in veterans with SCI who use antibiotics improperly for asymptomatic bacteriuria. Cranberry (CB) has been suggested for UTI prevention.
METHODS
We performed a systematic search up to May 2020 in the following databases: AccessMedicine, BioMed Central, CINAHL, Cochrane Library, ProQuest, and PubMed. Quality assessment was performed using a specifically designed quality score. Risk ratio was calculated with both random effect model analysis (DerSimonian-Laird method) and quality effect model analysis (Doi Thalib method).
RESULTS
Six studies on bacteriuria and SCI were reviewed. From the four studies available for meta-analysis, two of which with individuals taking both CB and control, 477 data from 415 participants were analysed (241 CB and 236 control). No significant differences were detected with meta-analysis. However, bias, limitations, and incompleteness were observed in the reviewed studies.
CONCLUSION
Although further studies are needed, we suggest an accurate monitoring of diet and fluid intake, the evaluation of risk for potential food or nutraceutical interactions with drugs, and the inclusion of inflammatory markers among the outcomes in addition to UTI.
Topics: Bacteriuria; Humans; Spinal Cord Injuries; Vaccinium macrocarpon
PubMed: 33194008
DOI: 10.1155/2020/9869851 -
The Cochrane Database of Systematic... Sep 2010Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications. (Review)
Review
BACKGROUND
Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications.
OBJECTIVES
To assess which antibiotic is most effective and least harmful as initial treatment for asymptomatic bacteriuria in pregnancy.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomized controlled trials comparing two antibiotic regimens for treating asymptomatic bacteriuria.
DATA COLLECTION AND ANALYSIS
Review authors independently screened the studies for inclusion and extracted data.
MAIN RESULTS
We included five studies involving 1140 women with asymptomatic bacteriuria. We did not perform meta-analysis; each trial examined different antibiotic regimens and so we were not able to pool results. In a study comparing a single dose of fosfomycin trometamol 3 g with a five-day course of cefuroxime, there was no significant difference in persistent infection (risk ratio (RR) 1.36, 95% confidence interval (CI) 0.24 to 7.75), shift to other antibiotics (RR 0.08, 95% CI 0.00 to 1.45), or in allergy or pruritus (RR 2.73, 95% CI 0.11 to 65.24). A comparison of seven-day courses of 400 mg pivmecillinam versus 500 mg ampicillin, both given four times daily, showed no significant difference in persistent infection at two weeks or recurrent infection, but there was an increase in vomiting (RR 4.57, 95% CI 1.40 to 14.90) and women were more likely to stop treatment early with pivmecillinam (RR 8.82, 95% CI 1.16 to 66.95). When cephalexin 1 g versus Miraxid(R) (pivmecillinam 200 mg and pivampicillin 250 mg) were given twice-daily for three days, there was no significant difference in persistent or recurrent infection. A one- versus seven-day course of nitrofurantoin resulted in more persistent infection with the shorter course (RR 1.76, 95% CI 1.29 to 2.40), but no significant difference in symptomatic infection at two weeks, nausea, or preterm birth. Comparing cycloserine with sulphadimidine, no significant differences in symptomatic, persistent, or recurrent infections were noted.
AUTHORS' CONCLUSIONS
We cannot draw any definite conclusion on the most effective and safest antibiotic regimen for the initial treatment of asymptomatic bacteriuria in pregnancy. One study showed advantages with a longer course of nitrofurantoin, and another showed better tolerability with ampicillin compared with pivmecillinam; otherwise, there was no significant difference demonstrated between groups treated with different antibiotics. Given this lack of conclusive evidence, it may be useful for clinicians to consider factors such as cost, local availability and side effects in the selection of the best treatment option.
Topics: Anti-Bacterial Agents; Bacteriuria; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic
PubMed: 20824868
DOI: 10.1002/14651858.CD007855.pub2 -
Annals of Internal Medicine Jul 2008Asymptomatic bacteriuria is common, and screening for this condition in pregnant women is a well-established, evidence-based standard of current medical practice.... (Review)
Review
BACKGROUND
Asymptomatic bacteriuria is common, and screening for this condition in pregnant women is a well-established, evidence-based standard of current medical practice. Screening other groups of adults has not been shown to improve outcomes.
PURPOSE
To review new and substantial evidence on screening for asymptomatic bacteriuria, to support the work of the U.S. Preventive Services Task Force.
DATA SOURCES
English-language studies of adults (age >18 years) indexed in PubMed and the Cochrane Library and published from 1 January 2002 through 30 April 2007.
STUDY SELECTION
For benefits of screening or treatment for screened populations, systematic reviews; meta-analyses; and randomized, controlled trials were included. For harms of screening, systematic reviews; meta-analyses; randomized, controlled trials; cohort studies; case-control studies; and case series of large multisite databases were included. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion.
DATA EXTRACTION
Two reviewers extracted data from studies on benefits of screening and treatment (including decreases in the incidence of adverse maternal and fetal outcomes, symptomatic urinary tract infections, hypertension, and renal function decline).
DATA SYNTHESIS
An updated Cochrane systematic review of 14 randomized, controlled trials of treatment supports screening for asymptomatic bacteriuria in pregnant women. A randomized, controlled trial and a prospective cohort study show that screening nonpregnant women with diabetes for asymptomatic bacteriuria is unlikely to produce benefits. No new evidence on screening men for asymptomatic bacteriuria or on harms of screening was found.
LIMITATION
The focused search strategy may have missed some smaller studies on the benefits and harms of screening for asymptomatic bacteriuria.
CONCLUSION
The available evidence continues to support screening for asymptomatic bacteriuria in pregnant women, but not in other groups of adults.
Topics: Adult; Bacteriuria; Female; Humans; Male; Mass Screening; Pregnancy; Pregnancy Complications, Infectious
PubMed: 18591632
DOI: 10.7326/0003-4819-149-1-200807010-00009-w1 -
Diabetes Care Jan 2011To evaluate whether asymptomatic bacteriuria (ASB) is more common in patients with diabetes than among control subjects. In addition, we wanted to clarify the clinical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate whether asymptomatic bacteriuria (ASB) is more common in patients with diabetes than among control subjects. In addition, we wanted to clarify the clinical significance of ASB in patients with diabetes.
RESEARCH DESIGN AND METHODS
We conducted a systematic review and meta-analysis of published data since 1966. Twenty-two studies fulfilled the inclusion criteria of the meta-analysis.
RESULTS
ASB was present in 439 of 3,579 (12.2%) patients with diabetes and in 121 of 2,702 (4.5%) healthy control subjects. ASB was more common both in patients with type 1 diabetes (odds ratio 3.0 [95% CI 1.1-8.0]) and type 2 diabetes (3.2 [2.0-5.2]) than in control subjects. The point prevalence of ASB was higher in both women (14.2 vs. 5.1%; 2.6 [1.6-4.1]) and men (2.3 vs. 0.8%; 3.7 [1.3-10.2]) as well as in children and adolescents (12.9 vs. 2.7%; 5.4 [2.7-11.0]) with diabetes than in healthy control subjects. Albuminuria was more common in patients with diabetes and ASB than those without ASB (2.9 [1.7-4.8]). History of urinary tract infections was associated with ASB (1.6 [1.1-2.3]).
CONCLUSIONS
We were able to show that the prevalence of ASB is higher in all patients with diabetes compared with control subjects. We also found that diabetic subjects with ASB more often had albuminuria and symptomatic urinary tract infections.
Topics: Adolescent; Adult; Aged; Albuminuria; Bacteriuria; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Young Adult
PubMed: 20937688
DOI: 10.2337/dc10-0421 -
International Urogynecology Journal Jan 2021Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated review of the literature, which advised on the premise of "a lack of good quality studies" and based on an assumed low incidence not consistently supported by the literature.
OBJECTIVES
This systematic review aims to update the assessment of the efficacy of antibiotic prophylaxis compared with placebo or no treatment for prevention of urinary tract infection in females over the age of 18 years undergoing UDS.
METHODS
MEDLINE, EMBASE, COCHRANE, DISSERTATIONS, conference proceedings and clinical trial registries were searched for relevant randomized controlled trials. Two authors independently screened and selected articles, assessed these for quality according to Cochrane guidelines and extracted their data.
RESULTS
A total of 2633 records were screened, identifying three relevant randomized controlled trials. The one study that was critically appraised as being the least likely biased showed a statistically significant effect of antibiotic prophylaxis in reducing bacteriuria post UDS in female patients. The other two studies included in the review did not. None of the studies included were powered to show a significant change in the incidence of urinary tract infection following UDS in female patients receiving antibiotic prophylaxis versus no prophylaxis.
CONCLUSIONS
Similar to the 2012 Cochrane review on this subject, this systematic review demonstrated that antibiotic prophylaxis may decrease bacteriuria in women post UDS; however, further research is required to assess its effect on urinary tract infections in this context.
Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteriuria; Female; Humans; Middle Aged; Urinary Tract Infections; Urodynamics
PubMed: 32845398
DOI: 10.1007/s00192-020-04501-3 -
Translational Andrology and Urology May 2018Urinary tract infection (UTI) is a source of morbidity and healthcare costs in adults with spina bifida (ASB). UTI prevention strategies are often recommended, but the... (Review)
Review
Urinary tract infection (UTI) is a source of morbidity and healthcare costs in adults with spina bifida (ASB). UTI prevention strategies are often recommended, but the evidence of various approaches remains unclear. We performed a systematic review to inform a best practice policy statement for UTI prevention in ASB. On behalf of the Neurogenic Bladder Research Group (NBRG.org), we developed an a priori protocol and searched the published English literature for 30 outcomes questions addressing UTI prevention in ASB. The questions spanned the categories of antibiotics, oral supplements, bladder management factors and social support. Where there was little literature in ASB, we included literature from similar populations with neurogenic bladder (NB). Data was abstracted and then reviewed with recommendations made by consensus of all authors. Level of Evidence (LoE) and Grade of Recommendation (GoR) were according to the Oxford grading system. Of 6,433 articles identified by our search, we included 99 publications. There was sufficient evidence to support use of the following: saline bladder irrigation (LoE 1, GoR B), gentamicin bladder instillation (LoE 3, GoR C), single-use intermittent catheterization (IC) (LoE 2, GoR B), hydrophilic catheters for IC (LoE 2, GoR C), intradetrusor onabotulinumtoxinA injection (LoE 3, GoR C), hyaluronic acid (HA) instillation (LoE 1, GoR B), and care coordination (LoE 3, GoR C). There was sufficient evidence to recommend against use of the following: sterile IC (LoE 1, GoR B), oral antibiotic prophylaxis (LoE 2, GoR B), treatment of asymptomatic bacteriuria (LoE 2, GoR B), cranberry (LoE 2, GoR B), methenamine salts (LoE 1, GoR B), and ascorbic acid (LoE1, GoR B). There was insufficient evidence to make a recommendation for other outcomes. Overall, there are few studies in UTI prevention in the specific population of ASB. Research in populations similar to ASB helps to guide recommendations for UTI prevention in the challenging patient group of ASB. Future studies in UTI prevention specific to ASB are needed and should focus on areas shown to be of benefit in similar populations.
PubMed: 29928619
DOI: 10.21037/tau.2018.04.21 -
Arab Journal of Urology Sep 2016To review the existing literature on when and how to treat patients with asymptomatic bacteriuria (AB) who undergo urological surgery, as uncertainty about this issue... (Review)
Review
OBJECTIVE
To review the existing literature on when and how to treat patients with asymptomatic bacteriuria (AB) who undergo urological surgery, as uncertainty about this issue persists.
METHODS
A systematic review was conducted to compare the different timing of administration of antibiotic prophylaxis in patients with AB undergoing urological surgery. We used predefined inclusion and exclusion criteria, and we also developed a specific quality scale to assess the quality of the papers included.
RESULTS
Nine studies met the inclusion criteria. Of the nine studies included, eight evaluated antibiotic prophylaxis regardless of the presence of AB, as their purpose was to evaluate the effectiveness of antibiotic prophylaxis for urological procedures. Of these, four studies showed a significant reduction in the rate of infections in the intervention group compared with placebo, or with the same antibiotic therapy but using different durations of therapy. Four studies found no significant differences in infectious complications between the intervention and comparison arms. Only one study assessed the duration of antibiotic prophylaxis in patients with AB.
CONCLUSIONS
With the available evidence, antibiotic therapy should be considered only for procedures in which studies have shown a clinical benefit in the prevention of infection. It is important to establish the duration and type of treatment for antimicrobial therapy for surgical prophylaxis in patients with AB who are going to receive urological invasive procedures.
PubMed: 27547467
DOI: 10.1016/j.aju.2016.05.002 -
British Journal of Anaesthesia Jul 2022Antimicrobial prophylaxis is widely used to prevent surgical site infection. Amid growing concern about antimicrobial resistance, we determined the effectiveness of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Antimicrobial prophylaxis is widely used to prevent surgical site infection. Amid growing concern about antimicrobial resistance, we determined the effectiveness of antimicrobial prophylaxis.
METHODS
We searched MEDLINE, EMBASE, CENTRAL, and WHO-ICTRP between January 1, 1990 and January 1, 2020 for trials randomising adults undergoing surgery to liberal (more doses) or restrictive (fewer or no doses) perioperative antimicrobial prophylaxis. Pairs of researchers reviewed articles and extracted data, and a senior author resolved discrepancies. The primary outcome measure was surgical site infection or bacteriuria for urological procedures. We calculated average risk difference (RD) with 95% confidence intervals and prediction intervals (PI) using random effects models, and present risk ratios (RR). We assessed evidence certainty using GRADE methodology, and risk of bias using the Cochrane Risk of Bias tool (PROSPERO: CRD42018116946).
RESULTS
From 6593 records, we identified 294 trials including 86 146 patients. Surgical site infection occurred in 2237/44 113 (5.1%) patients receiving liberal prophylaxis vs 2889/42 033 (6.9%) receiving restrictive prophylaxis (RD -0.01 [-0.02 to -0.01]; relative risk 0.72 [0.67-0.77]; I=52%, PI -0.05-0.02). There was a small benefit of prophylaxis in 161 trials comparing no prophylaxis with ≥1 dose (RD -0.02 [-0.03 to -0.02]; RR 0.58 [0.52-0.65]; I=62%, PI -0.06-0.02). Treatment effect varied from a strong effect in urology to no benefit in 7/19 specialities. Tests for publication bias suggest 62 unreported trials and evidence certainty was very low. Treatment harms were reported in 43/294 trials.
CONCLUSIONS
A systematic review and meta-analysis of randomised trials revealed that more liberal antimicrobial prophylaxis is associated with a small reduction in the risk of surgical site infection, although antimicrobial harms are poorly reported. Further evidence about the risks of antimicrobial prophylaxis to inform current widespread use is urgently needed.
Topics: Adult; Anti-Bacterial Agents; Humans; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 35644677
DOI: 10.1016/j.bja.2022.04.013 -
Clinical Infectious Diseases : An... Nov 2017Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS.
METHODS
We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (<37 weeks' gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases.
RESULTS
We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99-1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P < .001).
CONCLUSIONS
From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials.
Topics: Carrier State; Female; Global Health; Humans; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Streptococcal Infections; Streptococcus agalactiae
PubMed: 29117329
DOI: 10.1093/cid/cix661