A systematic review and meta-analysis evaluating the incidence, microbiological profile and risk factors associated with urinary tract infection after radical cystectomy.

We aimed to evaluate the incidence, microbiological patterns and risk factors of UTIs following radical cystectomy (RC). The study was registered with PROSPERO (CRD42024586612). We searched the PubMed/MEDLINE and Embase databases for articles published until December 2024. The selected records consisted of observational studies with at least two of the following main outcomes: UTI incidence, urosepsis rate, positive urine culture rate, isolated pathogens in urine culture and UTI-associated factors in the 90-day period after RC. Risk of bias was assessed for single-arm and nonrandomised comparative studies. We identified 1845 records and included 17 studies, comprising 18,976 patients who underwent RC. Overall, the pooled 90-day UTI incidence after RC was 21% (95% CI, 17%-25%). Among patients who develop UTI, pooled incidence of urosepsis was 25% (95% CI, 19%-32%). Pooled urine culture positivity reached 79% (95% CI, 74%-84%), with a 25% (95% CI, 17%-34%) and 11% (95% CI, 6%-18%) rate of polymicrobial and fungal infections, respectively. Pooled prevalence of common bacterial isolates obtained from urine cultures was 26% (95% CI, 18%-35%) for Escherichia coli, 26% (95% CI, 17%-35%) for Enterococcus spp. and 12% (95% CI, 8%-16%) for Klebsiella pneumoniae. Risk factors for 90-day UTI after RC included estimated glomerular filtration rate <60 ml/min/1.73 m2 (RR 1.75, 95% CI, 1.44-2.12), orthotopic neobladder (RR 2.02, 95% CI, 1.17-3.48), postoperative hydronephrosis (RR 1.73, 95% CI, 1.28-2.34) and ureterointestinal stricture (RR 1.98, 95% CI, 1.65-2.38). UTIs are common after RC and clinically present as urosepsis in nearly 25% of cases. A high rate of mixed infections is observed, and the rate of fungal infection can reach 10%. These findings are important for patient counselling and may be utilised to guide empirical antibiotic treatment in everyday clinical practice.