Increased fluid intake to prevent urinary tract infections

systematic review and meta-analysis

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: Approximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.

AIM: To assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).

DESIGN AND SETTING: A systematic review.

METHOD: The authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.

RESULTS: Eight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.

CONCLUSION: Given the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

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Urinary Tract Infections
Meta-Analysis
Confidence Intervals
Odds Ratio
Patient Harm
Recurrence
Microbial Drug Resistance
PubMed
Registries
Randomized Controlled Trials
Anti-Bacterial Agents
Research

Cite this

@article{7ae4906e110441b591fe2f8e914dc619,
title = "Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis",
abstract = "BACKGROUND: Approximately 15{\%} of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AIM: To assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).DESIGN AND SETTING: A systematic review.METHOD: The authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.RESULTS: Eight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95{\%} confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95{\%} CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95{\%} CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95{\%} CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95{\%} CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.CONCLUSION: Given the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.",
author = "Scott, {Anna Mae} and Justin Clark and Mar, {Chris Del} and Paul Glasziou",
note = "{\circledC} British Journal of General Practice 2020.",
year = "2020",
month = "1",
day = "27",
doi = "10.3399/bjgp20X708125",
language = "English",
journal = "Journal of the Royal College of General Practitioners",
issn = "0960-1643",
publisher = "ROYAL COLL GENERAL PRACTITIONERS",

}

TY - JOUR

T1 - Increased fluid intake to prevent urinary tract infections

T2 - systematic review and meta-analysis

AU - Scott, Anna Mae

AU - Clark, Justin

AU - Mar, Chris Del

AU - Glasziou, Paul

N1 - © British Journal of General Practice 2020.

PY - 2020/1/27

Y1 - 2020/1/27

N2 - BACKGROUND: Approximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AIM: To assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).DESIGN AND SETTING: A systematic review.METHOD: The authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.RESULTS: Eight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.CONCLUSION: Given the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

AB - BACKGROUND: Approximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AIM: To assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).DESIGN AND SETTING: A systematic review.METHOD: The authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.RESULTS: Eight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.CONCLUSION: Given the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

U2 - 10.3399/bjgp20X708125

DO - 10.3399/bjgp20X708125

M3 - Article

JO - Journal of the Royal College of General Practitioners

JF - Journal of the Royal College of General Practitioners

SN - 0960-1643

ER -