Purple urine bag syndrome: A systematic review with meta-analysis

IntroductionPurple urine bag syndrome (PUBS) is secondary to bacterial urinary tract infections in long-term catheterized patients. Our objective was to perform a systematic review of the literature to assess its predisposing factors, clinical presentation, management and outcomes.MethodsThe terms “purple AND urine” were searched in MEDLINE, EMBASE, LILACS, SciELO, Google Scholar and OpenGrey. A meta-analysis with individual patient-level data and another one with aggregate-level data were performed.ResultsOut of 6793 citations, 140 were included. A meta-analysis was done with 169 PUBS cases: 63.5% women, median age 78 years (IQR: 70-85), 59.4% asymptomatic. Outcome (n = 117): 7.7% deaths, 21.4% recurrence. Dementia was the only factor associated with recurrence (OR: 5.44; P = 0.046). In an aggregate-level data, meta-analysis (281 PUBS cases) prevalence of PUBS in chronically-catheterized patients was 11.7%. Escherichia coli and Proteus mirabilis were the microorganisms most frequently isolated.ConclusionPUBS usually affects chronically-catheterized women. Neither antibiotics nor catheter removal were associated with better outcomes.