Introduction Pediatric patients undergoing extensive urological surgery often need indwelling urinary catheters, increasing their risk of CAUTI. CAUTIS cause illness, prolonged hospitalizations, antibiotic use and higher healthcare costs. Adults can avoid issues, but children undergoing surgery have little evidence of their efficacy or safety. This systematic review examined pediatric catheter-associated urinary tract infections (CAUTIs) prevention strategies after major urological surgery. Methods PRISMA was followed for this review. From inception to May ۲۰۲۴, PubMed, Embase, CENTRAL, CINAHL and Scopus were searched extensively. We searched for "catheter-associated urinary tract infection," "CAUTI," "pediatric," "child," "urologic surgical procedures," "postoperative complications," "infection control," "prevention," and "bundle." In patients under ۱۸, randomized controlled trials (RCTs), non-randomized controlled studies and comparative observational studies examined CAUTI prevention strategies like antimicrobial catheters, catheter care bundles and early removal protocols. Adult case reports, reviews and studies were excluded. Bias was assessed using the Cochrane RoB ۲ tool for randomized controlled trials and ROBINS-I for non-randomized studies. Where applicable, a random-effects model was used to calculate pooled risk ratios (RR) with ۹۵% confidence intervals after narrative data synthesis. Results ۱۲ studies (۳ randomized controlled trials, ۹ cohort studies) with ۴,۲۱۸ pediatric patients were identified from ۳,۴۵۲ records. Antimicrobial-impregnated silver-coated/hydrogel catheters, standardized catheter care bundles (aseptic insertion, securement, perineal care, closed system maintenance) and protocol-driven early catheter removal were prevention methods. A meta-analysis of seven studies found that bundled interventions reduced CAUTI rates in favor of the intervention groups (pooled RR: ۰.۵۲; ۹۵% CI: ۰.۳۸ to ۰.۷۱; n=۲,۸۴۵ participants). Antimicrobial catheter evidence was scarce and ambiguous. One randomized controlled trial showed a non-significant reduction (relative risk: ۰.۸۱; ۹۵% CI: ۰.۴۴ to ۱.۴۹). Prevention strategies did not cause adverse events. Conclusion Protocol-based catheter care bundles with multiple components reduce CAUTIS in pediatric urological surgery patients. This suggests standardizing catheter management during surgery for high-risk patients. Evidence supporting technological solutions like antimicrobial catheters is unclear and needs further study. The high variability of interventions emphasizes the need for rigorous randomized controlled trials (RCTs) to determine the essential components of an effective catheter-associated urinary tract infection (CAUTI) prevention bundle and its cost-effectiveness in pediatric surgery.
