LAUSR

Abstract Introduction Purple 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. Methods The 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. Results Out 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. Conclusion PUBS usually affects chronically-catheterized women. Neither antibiotics nor catheter removal were associated with better outcomes.