Randomized trial of concentrated proanthocyanidins (PAC) for acute reduction of bacteriuria in male veterans with spinal cord injury utilizing clean intermittent catheterization

Spinal Cord Series and Cases, 2018 · DOI: https://doi.org/10.1038/s41394-018-0087-2 · Published: May 13, 2018

Simple Explanation

This study investigated whether a concentrated cranberry supplement could quickly reduce bacteria in the urine of male veterans with spinal cord injuries who use catheters. The goal was to see if the supplement could improve urine quality and reduce infection risk. Participants were given either the cranberry supplement or a placebo for 15 days. Researchers then monitored their urine for bacteria levels, white blood cell counts (indicating inflammation), and subjective reports on urine quality. The study found that the cranberry supplement did not significantly reduce bacteria or white blood cells in the urine, nor did it improve the participants' subjective ratings of their urine quality compared to the placebo group.

Study Duration

15 days

Participants

13 male veterans with SCI

Evidence Level

Level I, Double-blind, placebo-controlled randomized trial

Key Findings

1
There was no significant decrease in colony forming units per milliliter (cfu/ml) in the treatment vs. the control group.
2
There was no signiﬁcant difference in leukocyturia able to be detected between the two cohorts over the study period
3
Patients receiving concentrated PACs rated the clarity, odor, color, sediment, and overall satisfaction of their urine as insigniﬁcantly improved compared to placebo.

Research Summary

This study evaluated the acute effects of concentrated proanthocyanidins (PACs) on bacteriuria, leukocyturia, and subjective urine quality in catheter-dependent veterans with SCI. The results showed no significant reduction of bacteriuria and pyuria or improvement in subjective urine quality for SCI patients treated with daily concentrated PACs over a 15-day period. The authors suggest that future studies should consider a larger sample size, more frequent dosing, and a longer study period to further investigate the potential benefits of PACs.

Practical Implications

Limited Efficacy of Acute PAC Treatment

Daily concentrated PACs may not provide an acute benefit in reducing bacteriuria, pyuria, or improving subjective urine quality in SCI patients with NLUTD using intermittent catheterization.

Need for Further Research

Larger, longer-term studies with more frequent dosing are needed to fully evaluate the potential of PACs for UTI prevention in this population.

Informed Clinical Decision-Making

Clinicians should be aware of the current evidence, or lack thereof, when recommending PAC supplements for SCI patients with urinary issues.

Study Limitations

1
Premature termination of the study due to recruitment and funding difficulties resulted in an under-powered study.
2
The reporting of bacterial colony counts in defined ranges limited the precision of the data.
3
The study population consisted of only male veterans, limiting the generalizability of the findings to women.

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