EURURO Vol. 72 No. 6

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Two RCTs and two retrospective studies compared the
effect of antibiotic treatment with that of no treatment in
patients with renal transplants (Supplementary Table 1). A
meta-analysis of the two RCTs did not show benefit in terms
of reducing symptomatic UTIs (200 patients, RR = 0.86, 95%
CI 0.51–1.45; very low–quality evidence; E). Further-
more, there were no significant differences in the rate of
ABU clearance, graft loss, or change in renal function during
longer-term follow-up.
Two RCTs and two prospective nonrandomised studies
(Supplementary Table 1) including 167 patients compared
the effect of antibiotic treatment with that of no treatment
before transurethral resection. A meta-analysis of RCT data
showed that treatment reduced the rate of postoperative
symptomatic UTI (RR = 0.20, 95% CI 0.05–0.86; very low–
quality evidence; F). Similarly, the rates of postopera-
tive fever and septicaemia were significantly lower in
patients who received antibiotic treatment compared with
those receiving no treatment.
We identified one RCT (471 patients) and one multi-
centre cohort study (303 patients) comparing the treatment
of ABU with no treatment prior to hip or knee arthroplasty
(Supplementary Table 1). Neither of the studies showed
benefit for antibiotic treatment regarding prosthetic joint
infection (moderate-quality evidence). The cohort study
reported no significant difference in the rate of postopera-
tive symptomatic UTI (very low–quality evidence).
In the current era of increasing antibiotic resistance
reducing unnecessary antibiotic usage is of utmost impor-
tance and is emphasised by all antibiotic stewardship
programmes. Despite this clear message, treatment of
ABU remains common practice. The demonstration of lack
of benefit in most clinical situations shown by this thorough
and methodologically robust systematic review and meta-
analysis supports our recommendation of not to treat ABU
ABU should only be treated prior to transurethral
resection surgery. In addition, short-course treatment of
ABU should continue to be recommended for pregnant
women, although this is challenged by the results of a recent
high-quality study finding no difference in neonatal out-
comes .
Author contributions: Bela Ko¨ves had full access to all the data in the
study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Ko¨ves, Cai, Veeratterapillay, Pickard, Bartoletti,
Bruyere, Wagenlehner, Pilatz, Geerlings, Lam, Bonkat, Wullt, Hoffman.
Acquisition of data: Ko¨ves, Cai, Veeratterapillay, Yuan.
Analysis and interpretation of data: Ko¨ves, Cai, Veeratterapillay, Seisen,
Yuan, Lam, Wullt.
Drafting of the manuscript: Ko¨ves, Cai, Veeratterapillay, Seisen, Lam,
Wullt.
Critical revision of the manuscript for important intellectual content: Seisen,
Bartoletti, Bruyere, Geerlings, Wagenlehner, Pilatz, Lam, Bonkat, Wullt.
Statistical analysis: Ko¨ves, Cai, Veeratterapillay, Pradere.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: Wullt, Pickard.
Other: None.
Financial disclosures: Bela Ko¨ves certifies that all conflicts of interest,
including specific financial interests and relationships and affiliations
relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria,
stock ownership or options, expert testimony, royalties, or patents filed,
received, or pending), are the following: The conflict of interest
statements of all members of the EAU Urological Infections Guideline
Panel can be found at
All coauthors who are not members of the panel (Seisen,
Lam, Yuan, and Hofmann) do not have any conflicts of interest.
Funding/Support and role of the sponsor: None.
Acknowledgements: The authors thank Steven Maclennan for his
methodological help and Emma Jane Smith for her excellent assistance
during the review process.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at
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