title: Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial.
abstract: 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.
  
  
  
  To test the effect of 2 oral cranberry capsules once a day on presence of bacteriuria plus pyuria among women residing in nursing homes.
  
  
  
  Double-blind, randomized, placebo-controlled efficacy trial with stratification by nursing home and involving 185 English-speaking women aged 65 years or older, with or without bacteriuria plus pyuria at baseline, residing in 21 nursing homes located within 50 miles (80 km) of New Haven, Connecticut (August 24, 2012-October 26, 2015).
  
  
  
  Two oral cranberry capsules, each capsule containing 36 mg of the active ingredient proanthocyanidin (ie, 72 mg total, equivalent to 20 ounces of cranberry juice) vs placebo administered once a day in 92 treatment and 93 control group participants.
  
  
  
  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.
  
  
  
  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 adherence was 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). There were no significant differences in number of symptomatic UTIs (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 associated with multidrug-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).
  
  
  
  Among older women residing in nursing homes, administration of cranberry capsules vs placebo resulted in no significant difference in presence of bacteriuria plus pyuria over 1 year.
  
  
  
  clinicaltrials.gov Identifier: NCT01691430.
authors: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Manisha
authors: M
authors: Juthani-Mehta
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Peter H
authors: PH
authors: Van Ness
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Luann
authors: L
authors: Bianco
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Andrea
authors: A
authors: Rink
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Sabina
authors: S
authors: Rubeck
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Sandra
authors: S
authors: Ginter
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Stephanie
authors: S
authors: Argraves
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Peter
authors: P
authors: Charpentier
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Denise
authors: D
authors: Acampora
authors: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Mark
authors: M
authors: Trentalange
authors: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Vincent
authors: V
authors: Quagliarello
authors: Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors: Peter
authors: P
authors: Peduzzi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001437:Bacteriuria / Q000188:drug therapy* / Q000401:mortality; D002214:Capsules; D004311:Double-Blind Method; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D009735:Nursing Homes; D008517:Phytotherapy / Q000379:methods*; D010936:Plant Extracts / Q000627:therapeutic use*; D011776:Pyuria / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy; D029799:Vaccinium macrocarpon
chemical_list: D000900:Anti-Bacterial Agents; D002214:Capsules; D010936:Plant Extracts