Empirical antibiotic use in nonsurgical patients with indwelling urinary catheters: a systematic review

Aim This systematic review aimed to assess the effect of empirical antibiotics in comparison with no antibiotics or alternative regimens on the prevention/resolution of catheter-associated urinary tract infection (UTIs) and catheter-associated asymptomatic bacteriuria among nonsurgical patients with indwelling urinary catheters (IUCs).Materials and methods A literature search was performed across five databases. Evidence synthesis adhered to the Synthesis Without Meta-analysis guidelines (SWiM).Results Four studies involving 4,907 participants were analyzed. The bacteriological resolution of catheter-associated UTIs varied, showing no significant difference between the treated group (meropenem) and the untreated group (p > 0.05), and achieving up to 53.6% clearance with fosfomycin. Significantly, the rate of repeat positive urine cultures differed between the antibiotic groups (p = 0.000), with the highest recurrence in the fosfomycin group. Two studies examining clinical outcomes reported no significant differences between the antibiotic groups.Conclusion The overall direction of effect indicated either no significant difference between antibiotic groups or outcomes favoring non-carbapenem therapy. The evidence remains insufficient for definitive conclusions on the effect of empirical antibiotic therapy on the resolution of catheter-associated infection among persons with IUC.Prospero protocol registration https://www.crd.york.ac.uk/prospero/ identifier is CRD420251062752.