Dr Oyebola Fasugba1,2, Professor Brett Mitchell3,4, Professor Elizabeth McInnes1, Professor Allen Cheng5,6, Dr Jane Koerner7, Ms Heilok Cheng1, Professor Sandy Middleton1
1Nursing Research Institute, St Vincent’s Health Australia Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Darlinghurst, Australia,
2Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, Australia,
3Faculty of Arts, Nursing, and Theology, Avondale College of Higher Education, , Wahroonga, Australia,
4School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia,
5Infection Prevention and Healthcare Epidemiology Unit, Alfred Health , Melbourne , Australia,
6School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia,
7School of Nursing, Midwifery and Paramedicine, Australian Catholic University , Canberra, Australia
Urinary tract infection (UTI) is a common reason for antibiotic prescribing in hospital and community settings. Global increases in antibiotic resistance necessitate consideration of non-antibiotic prevention strategies for UTI. Despite inconsistency in evidence, the practice of increasing hydration for UTI prevention is widely recommended. This study aimed to systematically review the literature on the efficacy of high fluid intake as a preventive intervention for UTI.
Cochrane Library, PubMed, EMBASE, CINAHL and Medline databases were searched from inception to February 2019 to identify randomized controlled trials (RCTs) and quasi-experimental studies evaluating the effectiveness of high (≥1.5 litres/day) versus low (<1.5 litres/day) fluid intake for prevention of UTI. Risk of bias was assessed using Cochrane Collaboration’s tool. Due to limited number of studies identified, meta-analysis was not possible hence narrative synthesis was undertaken.
Of the 2822 potentially relevant papers, two were eligible for inclusion. One study was a RCT and other study was characterised as a cluster-RCT. Both studies differed in regards to participants, setting, sample size, UTI definition and intervention. The RCT was assessed as having a low risk of bias while 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.
Current evidence is insufficient to make recommendations on the efficacy of increased fluid intake for UTI prevention. Rigorous and sufficiently powered RCTs are needed to further evaluate the effectiveness of this intervention.
Dr Bola Fasugba works as a research officer in the Nursing Research Institute, St Vincent’s Health Australia Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University. She has a PhD from Australian Catholic University and a Masters degree in Public Health and Tropical Medicine from James Cook University. Her background is in medicine and public health research. Her main research focus is infection control and antimicrobial resistance.