Institute for Evidence-Based Healthcare (IEBH), Bond University, Robina, Queensland, Australia.
Br J Gen Pract. 2020 Feb 27;70(692):e200-e207. doi: 10.3399/bjgp20X708125. Print 2020 Mar.
Approximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.
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).
A systematic review.
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.
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, = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, <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, = 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, <0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, = 0.08). Paucity of data precluded meta-analysing symptoms.
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.
约有 15%的社区处方抗生素用于治疗尿路感染（UTI）。抗生素耐药性的增加需要考虑替代方案。
评估增加尿路感染风险个体的液体摄入量对 UTI 复发（主要结局）、抗生素使用和 UTI 症状（次要结局）的影响。
系统评价。
作者于 2019 年 1 月检索了 PubMed、Cochrane 中心对照试验注册库、EMBASE、两个试验注册库，并对纳入研究进行了前瞻性和回溯性引用搜索。纳入了尿路感染风险个体的随机对照试验；排除了与抗生素的比较。主要结局比较了不同时间点（≤6 个月和 12 个月）。使用 Cochrane 偏倚风险工具评估了偏倚风险。对≥3 项研究报告了相同结局的研究进行了荟萃分析。
纳入了 8 项研究；其中 7 项进行了荟萃分析。与对照组相比，12 个月时增加液体摄入组的任何 UTI 复发患者数量在统计学上无显著减少（比值比[OR]0.39，95%置信区间[CI]0.15 至 1.03，=0.06）；≤6 个月时减少具有统计学意义（OR0.13，95%CI0.07 至 0.25，<0.001）。排除液体量低（<200 ml）的研究后，增加液体摄入显著有利（OR0.25，95%CI0.11 至 0.59，=0.001）。增加液体摄入降低了所有复发性 UTI 的总体发生率（率比[RR]0.46，95%CI0.40 至 0.54，<0.001）；抗生素使用无差异（OR0.52，95%CI0.25 至 1.07，=0.08）。数据匮乏限制了对症状的荟萃分析。
鉴于潜在危害最小，复发性 UTI 患者可被建议多喝水以减少复发性 UTI。需要进一步研究以确定最佳的增加液体量和类型。
