Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among OlderWomen in Nursing Homes A Randomized Clinical Trial

IMPORTANCE Bacteriuria plus pyuria is highly prevalent among older women living in nursing homes. Cranberry capsules are an understudied, nonantimicrobial prevention strategy used in this population.

OBJECTIVE To test the effect of 2 oral cranberry capsules once a day on presence of bacteriuria plus pyuria among women residing in nursing homes.

DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized, placebo-controlled efficacy trial with stratification by nursing home and involving 185 English-speakingwomen aged65 years or older, with or without bacteriuria plus pyuria at baseline, residing in 21 nursinghomes located within 50 miles (80 km) ofNewHaven, Connecticut (August 24, 2012-October 26, 2015).

INTERVENTIONS Two oral cranberry capsules, each capsule containing 36mg of the active ingredient proanthocyanidin (ie, 72mg total, equivalent to 20 ounces of cranberry juice) vs placebo administered once a day in 92 treatment and 93 control group participants.

MAIN OUTCOMES AND MEASURES Presence of bacteriuria (ie, at least 105 colony-forming units [CFUs] per milliliter of 1 or 2 microorganisms in urine culture) plus pyuria (ie, any number of white blood cells on urinalysis) assessed every 2 months over the 1-year study surveillance; any positive finding was considered to meet the primary outcome. Secondary outcomes were symptomatic urinary tract infection (UTI), all-cause death, all-cause hospitalization, all multidrug antibiotic–resistant organisms, antibiotics administered for suspected UTI, and total antimicrobial administration.

RESULTS Of the 185 randomized study participants (mean age, 86.4 years [SD, 8.2], 90.3% white, 31.4%with bacteriuria plus pyuria at baseline), 147 completed the study. Overall adherencewas 80.1%. Unadjusted results showed the presence of bacteriuria plus pyuria in 25.5%(95%CI, 18.6%-33.9%) of the treatment group and in 29.5%(95%CI, 22.2%-37.9%) of the control group. The adjusted generalized estimating equations model that accounted for missing data and covariates showed no significant difference in the presence of bacteriuria plus pyuria between the treatment group vs the control group (29.1%vs 29.0%;OR, 1.01; 95%CI,
0.61-1.66; P = .98). Therewere no significant differences in number of symptomaticUTIs (10 episodes in the treatment group vs 12 in the control group), rates of death (17 vs 16 deaths; 20.4 vs 19.1 deaths/100 person-years; rate ratio [RR], 1.07; 95%CI, 0.54-2.12), hospitalization (33 vs 50 admissions; 39.7 vs 59.6 hospitalizations/100 person-years; RR, 0.67; 95%CI, 0.32-1.40), bacteriuria associatedwithmultidrug-resistant gram-negative bacilli (9 vs 24 episodes; 10.8 vs 28.6 episodes/100 person-years; RR, 0.38; 95%CI, 0.10-1.46), antibiotics administered for suspected UTIs (692 vs 909 antibiotic days; 8.3 vs 10.8 antibiotic days/person-year; RR, 0.77; 95%CI, 0.44-1.33), or total antimicrobial utilization (1415 vs 1883 antimicrobial days; 17.0 vs 22.4 antimicrobial days/person-year; RR, 0.76; 95%CI, 0.46-1.25).

CONCLUSIONS AND RELEVANCE Among olderwomen residing in nursing homes, administration of cranberry capsules vs placebo resulted in no significant difference in presence of bacteriuria plus pyuria over 1 year.

TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01691430

JAMA. 2016;316(18):1879-1887. doi:10.1001/jama.2016.16141 Published online October 27, 2016.

Authors: Manisha Juthani-Mehta, MD; Peter H. Van Ness, PhD, MPH; Luann Bianco, BA; Andrea Rink, RN; Sabina Rubeck, MPH; Sandra Ginter, BSN;
Stephanie Argraves, MS; Peter Charpentier, MPH; Denise Acampora, MPH; Mark Trentalange, MD, MPH; Vincent Quagliarello, MD; Peter Peduzzi, PhD

Author Affiliations: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (Juthani-Mehta, Quagliarello); Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (Van Ness, Bianco, Rink, Rubeck, Ginter, Argraves, Charpentier, Acampora, Trentalange); Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut (Peduzzi). Corresponding Author: Manisha Juthani-Mehta, MD, Section of Infectious Diseases, Department of Internal Medicine Yale University School of Medicine, PO Box 208022, New Haven, CT 06520
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