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Temas

Study flow diagram
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Figure 1

Study flow diagram

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study
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Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study

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Comparison 1 Any washout versus no washout, Outcome 1 Number of participants with symptomatic UTI.
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Analysis 1.1

Comparison 1 Any washout versus no washout, Outcome 1 Number of participants with symptomatic UTI.

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Comparison 1 Any washout versus no washout, Outcome 2 weeks to first catheter change.
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Analysis 1.2

Comparison 1 Any washout versus no washout, Outcome 2 weeks to first catheter change.

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Comparison 1 Any washout versus no washout, Outcome 3 Number of participants needing catheter replacement.
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Analysis 1.3

Comparison 1 Any washout versus no washout, Outcome 3 Number of participants needing catheter replacement.

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Comparison 1 Any washout versus no washout, Outcome 4 Mean number of episodes of high temperature.
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Analysis 1.4

Comparison 1 Any washout versus no washout, Outcome 4 Mean number of episodes of high temperature.

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Comparison 1 Any washout versus no washout, Outcome 5 Mean number of episodes of high temperature of poss urinary origin.
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Analysis 1.5

Comparison 1 Any washout versus no washout, Outcome 5 Mean number of episodes of high temperature of poss urinary origin.

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Comparison 2 One washout solution versus another, Outcome 1 Number of participants with symptomatic UTI.
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Analysis 2.1

Comparison 2 One washout solution versus another, Outcome 1 Number of participants with symptomatic UTI.

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Comparison 2 One washout solution versus another, Outcome 2 weeks to first catheter change.
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Analysis 2.2

Comparison 2 One washout solution versus another, Outcome 2 weeks to first catheter change.

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Summary of findings for the main comparison. Any washout compared to no washout for participants with long‐term indwelling urinary catheterisation

Any washout compared to no washout for participants with long‐term indwelling urinary catheterisation

Patient or population: Long‐term indwelling urinary catheterisation in adults
Settings: Hospital and home
Intervention: Any washout
Comparison: No washout

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No washout

Any washout

Symptomatic UTI

(Number of participants with symptomatic UTI, citric acid or saline washout versus no washout)

0 per 1000

0 per 1000

(0 to 0)

Not

estimable

53
(1 study)

⊕⊕⊝⊝
low1

No participants met the study criteria for symptomatic UTI

Symtomatic UTI

Mean number of episodes of high temperature (saline washout versus no washout)

‐

The mean number of episodes of high temperature (saline washout versus no washout) in the intervention groups was:

0.78 (‐0.14 to 1.70)

Not estimable

23
(1 study)

⊕⊝⊝⊝
very low4,5

Symptomatic UTI

Mean number of episodes of high temperature due to possible urinary origin (saline washout versus no washout)

‐

The mean number of episodes of high temperature of possible urinary origin (saline washout versus no washout) in the intervention groups was:

1.80 (1.02 to 2.58)

Not estimable

23
(1 study)

⊕⊝⊝⊝
very low4,6

Number of catheters used

(Number of participants needing catheter replacement, saline washout versus no washout)

526 per

1000

353 per 1000 (179 to 689)

RR 0.67
(0.34 to 1.31)

40
(1 study)

⊕⊝⊝⊝
very low2,3

Length of time each catheter was in situ

Not estimable

Not reported

No data available

Catheter removal rates due to blockage/infection

Not estimable

Not reported

No data available

Rates of asymptomatic bacteriuria

Not estimable

Not reported

No data available

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded two levels: The sample size was small (N = 53). Personnel not blinded to allocation of treatment. Blinding of outcome assessment not clear.
2 Downgraded two levels: The sample size was small (N = 40). The following were judged to be unclear: Random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessor, incomplete outcome data and selective reporting).
3 Downgraded one level for imprecision (95% CI was very wide: 0.34 to 1.31).
4 Downgraded two levels: The sample size was small (N = 23). The following domains were judged to be unclear: Random sequence generation, allocation concealment, and blinding of outcome assessor. Blinding of participants and personnel was judged to be at high risk of bias. Incomplete outcome data and selective reporting was judged to be at low risk of bias).
5 Downgraded one level for imprecision (95% CI ‐0.14 to 1.70). CI was very wide and crossed the line of no effect
6 Downgraded one level for imprecision (95% CI 1.02 to 2.58).

Figuras y tablas -
Summary of findings for the main comparison. Any washout compared to no washout for participants with long‐term indwelling urinary catheterisation
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Summary of findings 2. One washout solution versus another for participants with long‐term indwelling urinary catheterisation

One washout solution versus another for participants with long‐term indwelling urinary catheterisation

Patient or population: Long‐term indwelling urinary catheterisation in adults
Settings: Hospital
Intervention: One washout solution versus another

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

One washout solution versus another

Symptomatic UTI

Number of participants with symptomatic UTI (citric acid versus saline)

0 per 1000

0 per 1000

(0 to 0)

Not estimable

33
(1 study)

⊕⊕⊝⊝
low1

No participants met the study criteria for symptomatic UTI

Symtomatic UTI

Mean number of episodes of high temperature

Not estimable

Not reported

No data available

Symptomatic UTI

Mean number of episodes of high temperature due to possible urinary origin

Not estimable

Not reported

No data available

Number of catheters used

Number of participants needing catheter replacement

Not estimable

Not reported

No data available

Length of time each catheter was in situ

Not estimable

Not reported

No data available

Catheter removal rates due to blockage/infection

Not estimable

Not reported

No data available

Rates of asymptomatic bacteriuria

Not estimable

Not reported

No data available

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded two levels: The sample size was small (N = 33). Personnel not blinded to allocation of treatment. Blinding of outcome assessment not clear.

Figuras y tablas -
Summary of findings 2. One washout solution versus another for participants with long‐term indwelling urinary catheterisation
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Comparison 1. Any washout versus no washout

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of participants with symptomatic UTI Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 any washout versus no washout

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 saline washout versus no washout

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 citric acid washout versus no washout

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 weeks to first catheter change Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 any washout versus no washout

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 saline washout versus no washout

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 citric acid washout versus no washout

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of participants needing catheter replacement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 saline washout versus no washout

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.34, 1.31]

4 Mean number of episodes of high temperature Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

5 Mean number of episodes of high temperature of poss urinary origin Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Any washout versus no washout
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Comparison 2. One washout solution versus another

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of participants with symptomatic UTI Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 citric acid verus saline

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 weeks to first catheter change Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 citric acid verus saline

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 2. One washout solution versus another
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