Use of Cranberry Extract for the prevention of UTIs in an at-risk population

USE OF CRANBERRY EXTRACT FOR THE PREVENTION OF
URINARY TRACT INFECTION (UTI) IN AN AT-RISK POPULATION

PURPOSE
We attempted to answer the question, “Can cranberry extract make the urinary tract less susceptible to bacterial infection for a high-risk population?”
BACKGROUND AND SIGNIFICANCE
Subjects were randomly selected from a long-term care, 48-bed Subacute Unit of El Camino Hospital to receive 400mg of cranberry extract twice daily. All patients had tracheostomies, G or J-Tubes, incontinence of bowel; 20% were ventilator dependent, 20% catheterized and 10% utilized a condom catheter. The majority of patients were diapered and most were mentally impaired. The incidence of multi-drug resistant urinary tract infections has led to investigation of prevention methods that would pose minimal risk to this vulnerable patient population, decreasing the overall use of antibiotics and the development of multi-drug resistant organisms. Previous studies using cranberry extract for prevention of UTIs have shown encouraging results.^2,5,6 In patients with a permanent indwelling urinary catheter and recurring UTIs, evidence indicated that cranberry products may prevent UTIs through proanthocyanidins blocking the adherence of P-Fimbriated e coli⁷. Past and more recent studies have focused on the use of cranberry juice for prevention and have found non-conclusive results⁸. Statistically significant studies have shown a decrease in incidence of UTIs with daily inclusion of 200-400mg cranberry extract given over several months. Research showed the cost effectiveness of cranberry tablets to be twice that of cranberry juice, with significant decrease in UTIs².
METHODS AND PROCEDURES
The study was a random non-blinded study. 39 patients were randomly selected to receive or not receive cranberry extract 400mg twice a day through their Gastrostomy or Jejunostomy tube or orally. 24 patients, (13 females, 11 males) received the cranberry extract. There were 15 patients in the control group (7 females, 8 males). No other changes in care were introduced during the study period. Statistical analysis was completed comparing the study group to the control group, focusing on the incidence of UTIs in the two groups, antibiotic use, and incidence of multi-drug resistant organisms in each group. 
FINDINGS
The study was conducted over a 12-month period. Data were gathered through a chart review to determine previous UTIs and UTIs recorded during the time of the study. UTIs were calculated per 1000 patient days to obtain statistically relevant data. UTI was confirmed by >100,000 organisms with not >2 organisms present. UTI rate was higher but not significantly different for the intervention group compared to the control group, using a Student t-test.
IMPLICATIONS AND POTENTIAL BENEFITS
The study should be replicated using a larger cohort with less co-morbidity over a longer time period to obtain further data. UTIs and multi-drug resistant infections have been a persistent problem for many high-risk patients, who could benefit by having an effective addition to their regimen. Research data have shown a significant reduction in UTIs in patients that have less co-morbidity than the population of this study.⁸