Prevention of Catheter-associated Urinary Tract Infection following Gynaecologic Surgery: a Systematic Review

Catheter-associated urinary tract infection (CAUTI) is the most common postoperative infection associated with gynaecologic procedures, and results in increased risks to patients and costs for hospitals. Currently, there is great variation in chemoprophylaxis used for prevention of postoperative CAUTI. The objective of this paper was to systematically review the efficacy of chemoprophylaxis for the prevention of CAUTI during short-term catheterisation following gynaecologic surgery. Evidence acquisition was undertaken by performing a systematic review of PubMed/Medline, Scopus, and the Cochrane Library in November 2013 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality assessment was performed using the Jadad and Newcastle-Ontario Scales. Nine studies met criteria for inclusion. Included publications used either antibiotics or methenamine hippurate for chemoprophylaxis. Chemoprophylaxis during catheterisation resulted in a statistically significant decrease in significant bacteriuria as compared to control groups in the majority of the studies. Symptomatic bacteriuria was also significantly decreased. A recommendation of a specific regimen for chemoprophylaxis cannot be made due to heterogeneity in study quality, dose, and duration of chemoprophylaxis, timing of urine culture, and study endpoints. Evidence examining cost-effectiveness and antibiotic resistance was limited. We reviewed the use of either antibiotics or methenamine hippurate for the prevention of CAUTI after gynaecologic surgery. Evidence suggests that chemoprophylaxis results in a decreased rate of bacteriuria and UTIs postoperatively. Further studies are required to determine the optimum regimen. Chemoprophylaxis is useful for the prevention of CAUTI during short-term catheterisation after gynaecologic surgery. Further research to determine the most effective type and dose of chemoprophylaxis, as well as cost-effectiveness and the potential development of antibiotic resistance, is needed.