Urinary Tract Infection in Neurologic Patients Undergoing Intermittent Catheterization: A Systematic Review and Meta-Analysis of Catheter Type and Technique

Intermittent urinary catheterization (IUC) is one of the recommended methods for bladder emptying in patients with bladder disorders. To our knowledge, no meta-analysis has yet evaluated the risk of urinary tract infections (UTIs) in adult neurological patients according to the type of catheter and IUC method. To address this knowledge gap, a systematic review of the literature was conducted using the PubMed, Embase, and Cochrane Trials CENTRAL databases, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. We included randomized clinical trials and cohort studies comparing at least two types of catheters and/or two IUC strategies in adult patients. Only studies published in French or English were considered. Heterogeneity was assessed using the I² statistic. A random-effects model was applied to estimate the pooled effect size across studies. Publication bias was assessed using the Luis Furuya-Kanamori (LFK) index and the Doi plot. All statistical analyses were performed using R software, version 4.3.2 (The R Foundation for Statistical Computing, Vienna, Austria). The study was registered with PROSPERO (CRD42023481012). Nine studies were included in the systematic review, of which seven (six randomized controlled trials and one cohort study) were eligible for meta-analysis. The estimated pooled odds ratio based on the random-effects model was 0.53 (95% CI: 0.34-0.84), with moderate heterogeneity (I² = 49%). Publication bias was substantial. These findings suggest that hydrophilic catheters are associated with a lower risk of symptomatic UTI compared with uncoated ones. Further research is needed to evaluate reusable catheter strategies, considering economic and environmental factors.