The Cochrane review from 2013 by Jepson et al. 2013 was unable to recommend cranberry juice to prevent urinary tract infection (UTI). They furthermore identified a lack of evidence for the efficacy of other cranberry preparations (such as powders). New studies are, however, continuously added to the total weight of clinical evidence and the latest examples suggest that there may be benefits in this traditional remedy.
Two recently published meta-analyses examine the combined efficacy reported by many studies. Both conclude that there is a risk reduction associated with the use of cranberry. For example, the analyses report a risk reduction of 69% in children and 29% in patients with recurrent UTI. Other research points to the positive consequences of this effect. Cranberry supplements seem to be able to reduce the number of symptomatic catheter-associated UTIs and therefore also the rate of antibiotic resistance.
This is important as it can mean continued protection of our modern health system with available effective antibiotics, but it is also a way to reduce costs. One new study from the US modeled the use of cranberry treatment regimens in hospitals and concluded that this would be a potential way to avoid Medicare reimbursement reductions.
Last but not least, using cranberry products is not the only way of preventing UTIs. A new study once again highlights the fact that the highest UTI incidence rates are seen among people using an indwelling catheter. When patients abandon indwelling catheters, for example in favor of intermittent catheterization, a significant UTI reduction from 1.65 to 0.83 events per 100 person-days can be detected. In general, it appears to be important to assess and treat bladder and bowel dysfunction among those with UTIs, as highlighted in a new consensus statement from the International Children’s Continence Society.
Summary of Publications
The Role of Cranberry in Preventing Urinary Tract Infection in Children; a Systematic Review and Meta-Analysis.
http://dx.doi.org/10.22038/ijp.2017.27041.2327
Author and Origin
Roshdibonab F, Mohammadbager FazlJoo S, Torbati M, Mohammadi Gh, Asadloo M, Noshad H. Iran
Summary
Meta-analysis investigating the efficacy of cranberry in reducing urinary tract infections in children.
Conclusions
A UTI risk reduction associated with cranberry of 69% (Odds Ratio 0.31 [0.21, 0.46]) was identified and the preventive effect seemed similar to that of antibiotics.
Comments
Study indicating positive effect of cranberry supplements in reducing UTIs in children.
Effectiveness of Cranberry Ingesting for Prevention of Urinary Tract Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
https://www.waset.org/downloads/15/papers/18nl050083[2].pdf
Author and Origin
Huang YC, Chen PS, Tung TH. Taiwan
Summary
Meta-analysis investigating the efficacy of cranberry in reducing urinary tract infections.
Conclusions
A general UTI risk reduction associated with cranberry of 25% (Risk Ratio 0.75 [0.63, 0.88]) was identified. A greater risk reduction was seen in children (47%) and in patients with recurrent UTI (29%).
Comments
Study indicating positive effect of cranberry supplements in reducing UTIs.
Does cranberry have a role in catheter-associated urinary tract infections?
http://dx.doi.org/10.5489/cuaj.4472
Author and Origin
Thomas D, Rutman M, Cooper K, Abrams A, Finkelstein J, Chughtai B. US
Summary
Observational prospective study of 22 patients with long-term indwelling catheters and recurrent symptomatic catheter-associated urinary tract infections (CAUTI) taking daily cranberry supplement.
Conclusions
Cranberry supplements seemed to reduce the number of symptomatic CAUTIs. Reductions of resistance to antibiotics (28%) and colony counts (59%) were observed.
Comments
Study indicating positive effect of cranberry supplements in reducing CAUTIs.
The Hospital-Acquired Conditions (HAC) Reduction Program: using cranberry treatment to reduce catheter-associated urinary tract infections and avoid Medicare payment reduction penalties.
https://www.ncbi.nlm.nih.gov/pubmed/29064320
Author and Origin
Saitone TL, Sexton RJ, Sexton-Ward A. US
Summary
Modeling study analyzing catheter-associated urinary tract infections (CAUTI) rates after implementation of a cranberry-treatment regimen, and its effect on Medicare reimbursement reductions.
Conclusions
Most US hospitals are likely to avoid Medicare reimbursement reductions if CAUTI reductions associated with cranberry treatment regimens can be realized as proposed by existing literature.
Comments
Model suggesting that cranberry regimens in hospitals have the potential to reduce CAUTI rates and Medicare reimbursement penalties.
The effect of optimum bladder management on the prevalence of urinary tract infections in spinal cord injury patients.
http://dx.doi.org/10.1111/bju.13951
Author and Origin
Hennessey DB, Maclellan L, Alexander JL, Millard MS, Byrne CE, Gani J, Nunn A. Australia
Summary
Observational study of bladder management method and urinary tract infection (UTI) rates in 143 newly admitted spinal cord injury patients.
Conclusions
Lowest UTI incidence rates were seen once transurethral indwelling catheterization was abandoned. For example, the incidence rate reduced from 1.65 to 0.83 per 100 person-days and a significant UTI reduction (p = 0.018) was associated with intermittent catheter use.
Comments
Conference abstract indicating that UTIs can be reduced with the correct bladder management method for people with spinal cord injury.
Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society.
https://www.ncbi.nlm.nih.gov/pubmed/28915233
Author and Origin
Yang S, Chua ME, Bauer S et al. Taiwan
Summary
Review and consensus view from the International Children’s Continence Society (ICCS) on the evaluation and management of bladder and bowel dysfunction in children with urinary tract infection (UTI).
Conclusions
The review stresses the importance of treating children with UTI. Bladder and bowel dysfunction should be assessed to avoid complications. Conservative treatment alternatives are recommended as a first step.
Comments
Consensus statement from the International Children’s Continence Society about how to manage and assess bladder and bowel dysfunction in children with UTI.
This blog post is an extract of the Science Alert from Nov 2017 (76040-USX-1711)
