Advertisement

Increased fluid intake for the prevention of urinary tract infection in adults and children in all settings: a systematic review

  • O. Fasugba
    Correspondence
    Corresponding author. Address: Nursing Research Institute, Australian Catholic University & St Vincent's Health Australia Sydney, St Vincent's Hospital, Level 5 DeLacy Building, Victoria Road, Darlinghurst 2010, NSW, Australia. Tel.: +61 2 6209 1325.
    Affiliations
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia

    Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
    Search for articles by this author
  • B.G. Mitchell
    Affiliations
    Faculty of Arts, Nursing, and Theology, Avondale College of Higher Education, Wahroonga, New South Wales, Australia

    School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
    Search for articles by this author
  • E. McInnes
    Affiliations
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia
    Search for articles by this author
  • J. Koerner
    Affiliations
    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
    Search for articles by this author
  • A.C. Cheng
    Affiliations
    Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia

    School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
    Search for articles by this author
  • H. Cheng
    Affiliations
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia
    Search for articles by this author
  • S. Middleton
    Affiliations
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia
    Search for articles by this author
Published:August 23, 2019DOI:https://doi.org/10.1016/j.jhin.2019.08.016

      SUMMARY

      Background

      Non-antibiotic interventions for urinary tract infection (UTI) prevention have been investigated as a strategy to reduce antibiotic prescribing for UTI and subsequent antibiotic resistance. Increased hydration is widely advocated for preventing UTI; however, evidence for its effectiveness is unknown.

      Aim

      To systematically review the published literature on the effectiveness of increased fluid intake as a preventive intervention for UTI in adults and children in any setting.

      Methods

      Five electronic databases were searched from inception to February 2019 to identify published randomized controlled trials (RCTs) and quasi-experimental studies evaluating the effectiveness of high (≥1.5 L/24 h) versus normal/low (<1.5 L/24 h) fluid intake for UTI prevention. The outcome was UTI incidence. Risk of bias was assessed using the Cochrane Collaboration's tool. Due to the small number of studies identified, meta-analysis was not possible. Hence a narrative synthesis was undertaken.

      Findings

      Of the 2822 potentially relevant papers, two were eligible for inclusion: an RCT (individual randomization) and a cluster-RCT. Both studies differed regarding participants, setting, sample size, UTI definition, and intervention. The RCT was assessed as having a low risk of bias whereas the cluster-RCT had a high risk of bias. Only the RCT, which included healthy premenopausal women visiting primary care clinics, demonstrated statistical significance for the effect of high fluid intake for UTI prevention.

      Conclusion

      The lack of enough adequately powered and robust RCTs highlights the need for further research on the effectiveness of this intervention for UTI prevention.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hooton T.M.
        Uncomplicated urinary tract infection.
        N Engl J Med. 2012; 366: 1028-1037
        • Foxman B.
        Epidemiology of urinary tract infections: incidence, morbidity, and economic costs.
        Dis Mon. 2003; 49: 53-70
        • Dolk F.C.K.
        • Pouwels K.B.
        • Smith D.R.
        • Robotham J.V.
        • Smieszek T.
        Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions?.
        J Antimicrob Chemother. 2018; 73: ii2-ii10
        • Nicolle L.E.
        Managing recurrent urinary tract infections in women.
        Women's Health. 2005; 1: 39-50
        • Costelloe C.
        • Metcalfe C.
        • Lovering A.
        • Mant D.
        • Hay A.D.
        Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis.
        BMJ. 2010; 340: c2096
        • Fasugba O.
        • Gardner A.
        • Mitchell B.G.
        • Mnatzaganian G.
        Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies.
        BMC Infect Dis. 2015; 15: 545
        • Beetz R.
        Mild dehydration: a risk factor of urinary tract infection?.
        Eur J Clin Nutr. 2003; 57: S52
        • Tian Y.
        • Cai X.
        • Wazir R.
        • Wang K.
        • Li H.
        Water consumption and urinary tract infections: an in vitro study.
        Int Urol Nephrol. 2016; 48: 949-954
        • Sihra N.
        • Goodman A.
        • Zakri R.
        • Sahai A.
        • Malde S.
        Nonantibiotic prevention and management of recurrent urinary tract infection.
        Nat Rev Urol. 2018; : 1
        • Beerepoot M.
        • Geerlings Sv
        • Van Haarst E.
        • Van Charante N.M.
        • Ter Riet G.
        Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials.
        J Urol. 2013; 190: 1981-1989
        • Ghouri F.
        • Hollywood A.
        • Ryan K.
        A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy.
        BMC Pregn Childbirth. 2018; 18: 99
        • Jones L.F.
        • Meyrick J.
        • Bath J.
        • Dunham O.
        • McNulty C.A.M.
        Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review.
        J Hosp Infect. 2019; 102: 200-218
        • Fasugba O.
        • Koerner J.
        • Mitchell B.G.
        • Gardner A.
        Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections.
        J Hosp Infect. 2017; 95: 233-242
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Higgins J.
        • Green S.
        Cochrane handbook for systematic reviews of interventions version 5.1.0.
        ([updated March 2011]) Cochrane Collaboration, 2011
        • European Food Safety Authority (EFSA)
        Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific opinion on dietary reference values for water.
        EFSA J. 2010; 8: 1459
        • Cochrane Collaboration
        Data collection form.
        2014 (Available at:) ([last accessed March 2019])
        • Popay J.
        • Roberts H.
        • Sowden A.
        • Petticrew M.
        • Arai L.
        • Rodgers M.
        • et al.
        Guidance on the conduct of narrative synthesis in systematic reviews.
        ESRC Methods Programme, Swindon2006
        • Hooton T.M.
        • Vecchio M.
        • Iroz A.
        • Tack I.
        • Dornic Q.
        • Seksek I.
        • et al.
        Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: a randomized clinical trial.
        JAMA Intern Med. 2018; 178: 1509-1515
        • Mentes J.C.
        • Culp K.
        Reducing hydration-linked events in nursing home residents.
        Clin Nurs Res. 2003; 12: 210-225
        • Puffer S.
        • Torgerson D.J.
        • Watson J.
        Cluster randomized controlled trials.
        J Eval Clin Pract. 2005; 11: 479-483
        • Taylor A.L.
        Implementation of an evidence-based hydration toolkit to improve bowel and bladder function in the older population within a long-term care unit: a DNP project.
        ([Dissertation]) Southeastern Louisiana University, Hammond, LA2015
        • Kalra O.P.
        • Raizada A.
        Approach to a patient with urosepsis.
        J Glob Infect Dis. 2009; 1: 57-63
        • Abernethy J.
        • Guy R.
        • Sheridan E.
        • Hopkins S.
        • Kiernan M.
        • Wilcox M.H.
        • et al.
        Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme.
        J Hosp Infect. 2017; 95: 365-375
        • Hoban D.J.
        • Nicolle L.E.
        • Hawser S.
        • Bouchillon S.
        • Badal R.
        Antimicrobial susceptibility of global inpatient urinary tract isolates of Escherichia coli: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program: 2009–2010.
        Diagn Microbiol Infect Dis. 2011; 70: 507-511
        • Lee L.C.
        • Noronha M.
        When plenty is too much: water intoxication in a patient with a simple urinary tract infection.
        BMJ Case Rep. 2016; 2016 (bcr2016216882)
        • Lotan Y.
        • Daudon M.
        • Bruyère F.
        • Talaska G.
        • Strippoli G.
        • Johnson R.J.
        • et al.
        Impact of fluid intake in the prevention of urinary system diseases: a brief review.
        Curr Opin Nephrol Hypertens. 2013; 22: S1-S10
        • Nygaard I.
        • Linder M.
        Thirst at work – an occupational hazard?.
        Int Urogynecol J. 1997; 8: 340-343
        • El-Sharkawy A.M.
        • Sahota O.
        • Maughan R.J.
        • Lobo D.N.
        The pathophysiology of fluid and electrolyte balance in the older adult surgical patient.
        Clin Nutr. 2014; 33: 6-13
        • Rowe T.A.
        • Juthani-Mehta M.
        Urinary tract infection in older adults.
        Aging Health. 2013; 9
        • Lindeman R.D.
        • Romero L.J.
        • Liang H.C.
        • Baumgartner R.N.
        • Koehler K.M.
        • Garry P.J.
        Do elderly persons need to be encouraged to drink more fluids?.
        J Gerontol A Biol Sci Med Sci. 2000; 55 (M361–M365)
        • Picetti D.
        • Foster S.
        • Pangle A.K.
        • Schrader A.
        • George M.
        • Wei J.Y.
        • et al.
        Hydration health literacy in the elderly.
        Nutr Healthy Aging. 2017; 4: 227-237
        • European Food Safety Authority
        Dietary Reference Values for nutrients Summary report.
        EFSA Supporting Publ. 2017; 14: e15121E
        • Mody L.
        • Miller D.K.
        • McGloin J.M.
        • Freeman M.
        • Marcantonio E.R.
        • Magaziner J.
        • et al.
        Recruitment and retention of older adults in aging research.
        J Am Geriatr Soc. 2008; 56: 2340-2348
        • Cutler D.M.
        Behavioral health interventions: what works and why?.
        in: Anderson N.B. Bulatao R.A. Cohen B. Critical perspectives on racial and ethnic differences in health in late life. National Academies Press, Washington DC2004: 17
        • Craig P.
        • Dieppe P.
        • Macintyre S.
        • Michie S.
        • Nazareth I.
        • Petticrew M.
        Developing and evaluating complex interventions: the new Medical Research Council guidance.
        BMJ. 2008; 337: a1655
        • Grimshaw J.
        • Freemantle N.
        • Wallace S.
        • Russell I.
        • Hurwitz B.
        • Watt I.
        • et al.
        Developing and implementing clinical practice guidelines.
        Qual Health Care. 1995; 4: 55
        • Rosenman R.
        • Tennekoon V.
        • Hill L.G.
        Measuring bias in self-reported data.
        Int J Behav Healthcare Res. 2011; 2: 320-332
        • Atkins L.
        • Francis J.
        • Islam R.
        • O'Connor D.
        • Patey A.
        • Ivers N.
        • et al.
        A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems.
        Implement Sci. 2017; 12: 77
        • Davis R.
        • Campbell R.
        • Hildon Z.
        • Hobbs L.
        • Michie S.
        Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review.
        Health Psychol Rev. 2015; 9: 323-344
        • Beller E.M.
        • Gebski V.
        • Keech A.C.
        Randomisation in clinical trials.
        Med J Aust. 2002; 177: 565-567
        • Ferreira-Pêgo C.
        • Guelinckx I.
        • Moreno L.A.
        • Kavouras S.A.
        • Gandy J.
        • Martinez H.
        • et al.
        Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide.
        Eur J Nutr. 2015; 54: 35-43
        • Omar F.
        • Khan A.
        • Wilson P.
        • Montanheiro K.
        • Taylor I.
        • Wiley E.
        Preventing Escherichia coli bacteraemia through optimized hospital hydration: an inpatient survey on drinks consumption on care of elderly wards.
        J Hosp Infect. 2019; (Mar 27 [Epub ahead of print])
        • Culp K.
        • Mentes J.
        • Wakefield B.
        Hydration and acute confusion in long-term care residents.
        West J Nurs Res. 2003; 25: 251-266
        • Stephenson J.
        • Imrie J.
        Why do we need randomised controlled trials to assess behavioural interventions?.
        BMJ. 1998; 316 (611–13)
        • Beard E.
        • Lewis J.J.
        • Copas A.
        • Davey C.
        • Osrin D.
        • Baio G.
        • et al.
        Stepped wedge randomised controlled trials: systematic review of studies published between 2010 and 2014.
        Trials. 2015; 16: 353