Additionally, we examined all reference lists of identified trials and contacted manufacturers and researchers in the field. Selection Criteria: All randomized and quasi-randomized trials comparing catheter washout policies (e.g., washout vs. no washout, learn more different washout solutions, frequency, duration, volume, concentration,

method of administration) in adults (16 years and above) in any setting (i.e., hospital, nursing/residential home, community) with an indwelling urethral or suprapubic catheter in place for more than 28 days. Data Collection and Analysis: Data were extracted by three reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the trial data were not fully reported, clarification was sought from the authors. For categorical outcomes, the numbers reporting an outcome were related to

the numbers at risk in each group to derive a risk ratio (RR). For continuous outcomes, means, and standard deviations were used to derive weighted mean differences (WMD). No meta-analysis of study results was possible. Results: Five trials met the inclusion criteria involving 242 patients (132 completed) in two cross-over and three parallel-group randomized controlled trials. Only three of the eight comparisons pre-stated in the review protocol were addressed in these trials. Some trials addressed more than one comparison (e.g., washout vs. no washout and one type of washout solution vs. another). The analyses

reported for the two cross-over trials were inappropriate as they were based on differences Selleckchem CA4P between groups rather than differences within individuals receiving sequential interventions. Two parallel-group trials had limited value: one combined results for suprapubic and urethral catheters and one had data on only four participants. Only one trial was free of significant methodological limitations, but its sample size was small. Three trials compared no washout with CBL0137 nmr one or more washout solution (saline or acidic solutions) and authors tended to conclude no difference in clinical outcomes between washout and no washout. In the one trial which had data of sufficient quality to allow interpretation, no difference was detected between washout and no washout groups in the rate of symptomatic urinary tract infection or time to first catheter change. Three trials compared different types of solution: saline versus acidic solutions (two trials); saline versus acidic solution versus antibiotic solution (one trial). Authors tended to report no difference between different washout solutions but the data were too few to support their conclusions.

The one trial which warranted consideration concluded no difference between saline and an acidic solution in terms of symptomatic urinary tract infections or time to first cathter change.