Garcia-Perdomo Herney Andres, Jimenez-Mejias Eladio, Lopez-Ramos Hugo
University of Valle, Colombia, CO.
University of Granada, España.
Int Braz J Urol. 2015 May-Jun;41(3):412-24; discussion 424. doi: 10.1590/S1677-5538.IBJU.2014.0198.
To estimate the efficacy of antibiotic prophylaxis to prevent urinary tract infection in patients (both gender) who undergo a cystoscopy with sterile urine.
Search strategy (January 1980-December 2013) in Medline via PubMed, CENTRAL, and EMBASE. Additionally, we searched databases for registered trials and conference abstracts, as well as reference lists of systematic reviews and included studies. Seven published randomized clinical trials (January 1, 1980 to December 31, 2013) were included in quantitative analyses with no language restrictions. Two independent reviewers collected data. Risk of bias was evaluated with the Cochrane Collaboration tool. We performed a fixed effect analyses due to statistical homogeneity. The primary outcome was urinary tract infection and the secondary was asymptomatic bacteriuria. The effect measure was the risk difference (RD) with 95% confidence interval. The planned interventions were: Antibiotic vs placebo; Antibiotic vs no intervention and Antibiotic vs any other intervention.
3038 patients were found in seven studies. For the primary outcome, we included 5 studies and we found a RR 0.53 CI95% (0.31, 0.90) and a RD-0.012 CI95% (-0.023,-0.002), favoring antibiotic prophylaxis. For asymptomatic bacteriuria we included 6 studies and we found a RR 0.28 CI95% (0.20, 0.39) and a RD-0.055 CI95% (-0.07,-0.039), was found favoring prophylaxis. According to GRADE evaluation, we considered moderate quality of evidence for both outcomes. The subgroup analysis showed that only two studies were classified as having low risk of bias: Cam 2009 and Garcia-Perdomo 2013. They showed no statistical differences (RD-0.009 CI95% -0.03, 0.011).
Based on studies classified as low risk of bias, we found moderate evidence to not recommend the use of antibiotic prophylaxis to prevent urinary tract infection and asymptomatic bacteriuria in patients who undergo cystoscopy with sterile urine in an ambulatory setting.
评估抗生素预防措施对无菌尿液患者（无论性别）进行膀胱镜检查后预防尿路感染的疗效。
通过PubMed、CENTRAL和EMBASE在Medline中进行检索（1980年1月至2013年12月）。此外，我们还检索了注册试验数据库和会议摘要，以及系统评价的参考文献列表和纳入研究。纳入7项已发表的随机临床试验（1980年1月1日至2013年12月31日）进行定量分析，无语言限制。两名独立的评审员收集数据。使用Cochrane协作工具评估偏倚风险。由于统计同质性，我们进行了固定效应分析。主要结局是尿路感染，次要结局是无症状菌尿。效应量是风险差（RD）及其95%置信区间。计划的干预措施为：抗生素与安慰剂；抗生素与不干预；抗生素与任何其他干预。
在7项研究中发现了3038例患者。对于主要结局，我们纳入了5项研究，发现RR为0.53，95%CI（0.31，0.90），RD为-0.012，95%CI（-0.023，-0.002），支持抗生素预防。对于无症状菌尿，我们纳入了6项研究，发现RR为0.28，95%CI（0.20，0.39），RD为-0.055，95%CI（-0.07，-0.039），支持预防。根据GRADE评估，我们认为这两个结局的证据质量为中等。亚组分析表明，只有两项研究被归类为偏倚风险低：Cam 2009和Garcia-Perdomo 2013。它们未显示出统计学差异（RD为-0.009，95%CI为-0.03，0.011）。
基于归类为低偏倚风险的研究，我们发现有中等证据不建议在门诊环境中对无菌尿液患者进行膀胱镜检查后使用抗生素预防措施来预防尿路感染和无症状菌尿。
