Cranberry capsules to prevent bacteriuria after pelvic surgery. #BlueJC

We will discuss Cranberry capsules to prevent nosocomial urinary tract bacteriuria after pelvic surgery: a randomized controlled trial by Letouzey and co-authors on the 22nd February for 7 days. This paper is open access

Start date: 22 February 2017. The discussion will continue for 7 days until 1st March 2017.

First hosted discussion session(s) on Twitter starts at GMT 8pm (3pm EST/12 noon PST) on 22 February 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are attached below:

Scenario

A 43 year-old woman is scheduled to undergo a vaginal hysterectomy. After a previous hysteroscopy she developed a bothersome urinary tract infection (UTI). She wonders if cranberry capsules could help prevent another UTI during her upcoming surgery. Would you recommend cranberry capsules to prevent postoperative bacteriuria?

cranberry-capsulesopt

 

 

 

 

 

 

 

Description of Research:

Participants Women undergoing pelvic surgery requiring urinary catheter for at least 24 postoperative hours.
Intervention Prophylactic cranberry juice capsule proanthocyanidins (PAC) 36 mg from day 0 to day 10.
Comparison Placebo from day 0 to day 10.
Outcomes Postoperative culture-proven bacteriuria within 15 days after surgery.
Study design Double-blind, Randomized Controlled Trial (RCT)
Authors’ conclusion PAC prophylaxis does not reduce the risk of postoperative bacteriuria in patients undergoing pelvic surgery.

 

Discussion Points:

  • What are your current practices for reducing urinary tract infections after pelvic surgery?
  • Do you think the primary outcome (bacteriuria within 15 days of operation) is a valid surrogate for urinary tract infection? Why, or why not?
  • This study was, in the end, underpowered to detect a difference in the primary outcome. List the reasons why.
  • Many participants were excluded or dropped out after randomization, how might a high dropout rate (1) affect power, and (2) introduce bias?
  • If you were asked to design this trial, what effect size (reduction in bacteriuria) would you say is sufficient to consider routine use of cranberry capsules for prevention of postoperative UTIs? (10%? 25%? 50%?)
  • How do you interpret these results, considering the totality of evidence in the literature as outlined by the authors?
  • Summarise this trial’s results in the form of a tweet. (140 characters)
  • Will your practice change because of this study?

Suggested reading

  1. Newgard CD and Lewis RJ. Missing Data: How to Best Account for What is Not Known. JAMA 2015;314(9):940-941. DOI: 10.1001/jama.2015.10516 – Link
  2. Pocock SJ and Stone GW. The Primary Outcome Fails – What Next? N Eng J Med 2016;375:861-870. DOI: 10.1056/NEJMra1510064 
- Link

 

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