Urinary diversion procedures frequently result in bacterial colonisation. There is an increased incidence of developing urinary tract infections (UTIs) in this patient population. Current guidelines, however, recommend against treating this colonisation. This systematic review aimed to determine when and how to test, monitor, and treat bacteriuria in patients with urinary diversion.

A systematic search strategy was conducted based on keywords “urinary diversion” and “bacteriuria”, on MEDLINE, Embase, and Google Scholar. Articles were screened and included only if they reported on (i) testing methods for bacteriuria, (ii) surveillance of bacteriuria over time, or (iii) when and how to treat bacteriuria. Results were summarised and reported using a narrative synthesis.

Altogether, 26 studies were included in this review. Inconsistencies were noted in the definitions of bacteriuria, with most studies reporting bacteriuria as > 104 cfu/mL (8/17 studies). Bacteriuria prevalence varied greatly (range 9.1-100%). Monitoring bacteriuria over time may help detect a reduction in bacteriuria, as demonstrated in three studies (follow-up range 5-18 months; sample size 18-56). The link between preceding bacteriuria and subsequent UTIs has not been fully explored yet. Short-term antimicrobial therapy may be useful in the immediate post-operative setting; however, long-term prophylactic treatment is ineffective in preventing bacteriuria.

We recommend consistent reporting of bacteriuria definitions, the benefits of monitoring bacteriuria over time, and use of short-term antimicrobial therapy; bacteriuria should not be treated with long-term therapy.

World journal of urology. 2019 Sep 27 [Epub ahead of print]

Liang G Qu, Ahmed Adam, Weranja Ranasinghe, Nathan Lawrentschuk

Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia. ., Division of Urology, University of the Witwatersrand, Johannesburg, South Africa., University of Texas, MD Anderson Cancer Center, Houston, TX, USA., Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia.