Antimicrobial Prophylaxis for Postoperative Urinary Tract Infections in Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-analysis

The administration of antimicrobial prophylaxis (AMP) for postoperative urinary tract infections (UTIs) following transurethral resection of bladder tumors (TURB) is controversial. We aimed to systematically review evidence on the potential effect of AMP on postoperative UTI and asymptomatic bacteriuria (ABU).; We conducted a systematic search in Embase, Medline, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) and nonRCTs assessing the effect of any form of AMP in patients with TURB on postoperative UTI or ABU were included. Risk of bias was assessed using RoB 2.0 or the Newcastle-Ottawa Scale. Fixed- and random-effects meta-analyses were conducted. As a potential basis for a scoping review, we exploratorily searched Medline for risk factors for UTI after TURB. The protocol was registered on PROSPERO (CRD42019131733).; Of 986 screened publications, seven studies with 1,725 participants were included; the reported effect sizes varied considerably. We found no significant effect of AMP on UTI: the pooled odds ratio (OR) of the random-effects model was 1.55 (95%-CI: 0.73-3.31). The random-effects meta-analysis examining the effect of AMP on ABU showed an OR of 0.43 (0.18-1.04). Risk of bias was moderate. Our exploratory search identified three studies reporting age, preoperative pelvic radiation, preoperative hospital-stay, duration of operation, tumor size, preoperative ABU, and pyuria as risk factors for UTI following TURB.; We observed insufficient evidence supporting routine AMP in patients undergoing TURB for the prevention of postoperative UTIs; our findings may inform harmonization of international guidelines.