Eighteen RCTs (n=7167) were included in the analysis.
A number of the included RCTs had methodological problems including small sample sizes and high drop-out rates. Peto odds ratios and 95% CIs were calculated for each included RCT. All odds ratios (ORs) shown are based on the results of a single trial, unless otherwise stated.
1. Catheterisation technique. There was no significant difference in infection rate between groups receiving clean catheterisation and those receiving sterile catheterisation (1 trial: OR 0.85 (95% CI: 0.30, 2.38)).
2. Meatal care. There were no significant differences in bacteriuria between povidone-iodine (PVI) meatal care and standard care (OR 1.35 (95% CI: 0.76, 2.37)) or between green soap and water and standard care (OR 1.57 (95% CI: 0.86, 2.89)). There was no significant difference in bacteriuria between PVI meatal care and green soap and water (OR 1.37 (95% CI: 0.79, 2.36)). No overall significant differences were found between standard care and noemycin-polymixin beta-bactracin ointment (OR 0.87 (95%CI: 0.41, 1.82)) or polyantibiotic cream (1 trial: OR 0.65 (95% CI: 0.39, 1.08)).
3. Catheter composition. There were no significant differences between silicone and latex catheters for bacteriuria (1 trial: OR 1.07 (95% CI: 0.21, 5.54)). Incidence of infection with silver coated latex foley catheters was significantly lower than with teflonised latex foley catheters (1 trial: OR 0.23 (95% CI: 0.10, 0.53)).
4. Bladder irrigation. PVI bladder instillation significantly reduced bacteriuria compared to no instillation (1 trial: OR 0.17 (95% CI: 0.04, 0.70)).
5. Drainage systems - physical adapters. Overall (2 combined trials), sealed drainage systems did not significantly reduce infection rate compared with unsealed drainage systems (OR 0.90 (95% CI: 0.70, 1.16)). One of these trials did show a reduced incidence of infection among patients not taking antibiotics with sealed catheters versus unsealed catheters (OR 0.32 (95% CI: 0.16, 0.63)). Patients with a hydrophilic coated silicone catheter had a significantly lower rate of bacteriuria than those with a catheter with exchangeable bags (OR 0.12 (95% CI: 0.03, 0.51)).
6. Drainage systems - solutions. There was no significant reduction in bacteriuria in patients who had disinfectants added to their drainage bags. This was true for chlorhexidine (OR 1.31 (95% CI: 0.47, 3.64)) and hydrogen peroxide (OR 1.22 (95% CI: 0.74, 2.02)). A significant reduction in infection rates was seen for added trichloroisocyanuric acid when combined with a silver oxide coated catheter and adapter (OR 0.32 (95% CI: 0.12, 0.18)).
7. Drainage systems - combined seal and solution. A closed drainage system with PVI releasing cartridge, hydrophilic surface coated catheter, anti reflux mechanism and tamper discouraging seal significantly reduced UTI compared to a closed drainage system with only one preventative measure (1 trial: OR 0.26 (95% CI: 0.09, 0.75)).
8. Indwelling vs. intermittent catheterisation. There appeared to be a slightly reduced level of bacteriuria with 'in-out' catheters (1 trial: OR 2.56 (95% CI: 1.00, 7.08)).
9. Care delivery. There was no significant difference in bacteriuria between one day and three days of post operative catheterisation following either vaginal plastic surgery (0.67 (95% CI: 0.30, 1.49)) or retropubic incontinence surgery (0.48 (95% CI: 0.19, 1.20)).