背景：
復發性泌尿道感染常見於女性，隨著抗生素的使用增加，抗藥性的問題日趨嚴重。蔓越莓已被證實具有防止細菌(主要為大腸桿菌)附著於膀胱壁之效果，可能成為抗生素的替代品，減低抗生素的需求以克服抗藥性問題。本研究旨在評估蔓越莓萃取物預防女性非複雜性泌尿道感染復發之效果。
方法：
本研究採用系統性文獻回顧方法，以結構性文獻搜索策略，於電子資料庫搜尋相關的隨機對照試驗（最新搜尋日期爲2017年6月5日）。本研究僅納入健康參與者且一年內具有泌尿道感染病史的英文研究，完成研究品質評估及資料提取後，以固定效應模式進行統合分析，評估使用蔓越莓萃取物後女性非複雜性泌尿道感染復發之風險比。
結果：
本研究共納入3篇隨機對照臨床實驗文獻，樣本規模偏小（參與者為49-182人）。隨機對照試驗統合分析的結果顯示，蔓越莓萃取物降低婦女非複雜性泌尿道感染復發的風險具有統計意義，但存在高度異質性（RR = 0.68; 95％CI = 0.48-0.98; I2 = 78％）。
結論：
目前現有的證據尚不足以證明蔓越莓萃取物可以有效預防婦女非複雜性泌尿道感染的復發，需要更多研究針對此議題進行調查。

Background:
Recurrent UTIs (rUTIs) are common in women. Antibiotic resistance is gradually increasing with the increased use of antibiotics. Cranberry products have the potential as an alternative for antibiotics to overcome the problem of antibiotics resistance. We evaluated the effects of cranberry extract for the prevention of uncomplicated rUTIs in women.
Method:
Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, and Clinicaltrial.gov databases were systemically searched up to 5 June 2017 for randomized controlled trials of cranberry extract versus placebo or no treatment. The search was limited to English-language human studies. Two reviewers performed data extraction independently. Summary estimate of risk ratio was obtained using a fixed-effect model.
Results:
We identified three trials that met the inclusion criteria for data synthesis. The three studies are of small sample sizes, ranging from 49 to 182 participants. Overall, cranberry extract was statistically significantly associated with a reduction in the risk of uncomplicated rUTIs (RR=0.68; 95% CI=0.48-0.98; I2=78%), but heterogeneity was high.
Conclusions:
Our findings suggest that the strength of evidence is insufficient to prove the benefit of cranberry extract for the prevention of uncomplicated rUTIs in women. Whether cranberry extract can effectively prevent uncomplicated rUTIs in healthy women requires further studies.

論文審定書 i
誌謝 ii
中文摘要 iii
Abstract iv
目 錄 vi
Table Legends vii
Figure Legends vii
Background 1
Methods 3
Results 6
Discussion 8
Refferences 11
Appendix 1. Protocol 20
Appendix 2. Characteristics of the excluded studies 28
Appendix 3. Data Extraction Form and Risk of Bias Assessment tool 29
Appendix 4. Characteristics of included studies 38

Al-Badr 2013
Al-Badr A, Al-Shaikh G. Recurrent Urinary Tract Infections Management in Women: A review. Sultan Qaboos Univ Med J 2013; 13:359-367.
Barbosa-Cesnik 2011
Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clinical Infectious Diseases 2011; 52:23-30.
Beerepoot 2013
Beerepoot MA, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. The Journal of Urology 2013; 190:1981-1989.
Dueñas-Garcia 2016
Dueñas-Garcia OF, Sullivan G, Hall CD, Flynn MK, OʼDell K. Pharmacological Agents to Decrease New Episodes of Recurrent Lower Urinary Tract Infections in Postmenopausal Women. A Systematic Review. Female Pelvic Medicine Reconstructive Surgery 2016; 22:63-69.
Guay DR 2009
Guay DR. Cranberry and urinary tract infections. Drugs 2009; 69:775-807.
Higgins 2011
Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
Available from www.cochrane-handbook.org.
Howell 2010
Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, Matsumoto T, et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC infectious diseases 2010; 10:94-104.
Jepson 2012
Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. The Cochrane database of systematic reviews 2012;10:CD001321.
Liska 2016
Liska DJ, Kern HJ, Maki KC. Cranberries and Urinary Tract Infections: How Can the Same Evidence Lead to Conflicting Advice? Advances in Nutrition 2016; 7:498-506.

Luís 2017
Luís Â, Domingues F, Pereira L. Can Cranberries Contribute to Reduce the Incidence of Urinary Tract Infections? A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Clinical Trials. The Journal of Urology 2017; 10. pii:S0022-534739295-9 [Epub ahead of print]
Matuszkiewicz-Rowińska 2015
Joanna Matuszkiewicz-Rowińska, Jolanta Małyszko, Monika Wieliczko. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Archives of Medical Science 2015; 16; 11: 67–77.
Sánchez Ballester 2013
Sánchez Ballester F, Ruiz Vidal V, López Alcina E, Domenech Perez C, Escudero Fontano E, Oltra Benavent A, et al. Cysticlean® a highly pac standardized content in the prevention of recurrent urinary tract infections: an observational, prospective cohort study. BMC Urology 2013; 5; 13-28.
Sengupta 2011
Sengupta K, Alluri KV, Golakoti T, Gottumukkala GV, Raavi J, Kotchrlakota L, et al. A randomized, double blind, controlled, dose dependent clinical trial to evaluate the efficacy of a proanthocyanidin standardized whole cranberry (Vaccinium macrocarpon) powder on infections of the urinary tract. Current Bioactive Compounds 2011;7: 39–46.
Vasileiou 2013
Vasileiou I, Katsargyris A, Theocharis S, Giaginis C. Current clinical status on the preventive effects of cranberry consumption against urinary tract infections. Nutrition Research 2013; 33:595-607.
Vostalova 2015
Vostalova J, Vidlar A, Simanek V, Galandakova A, Kosina P, Vacek J, et al. Are High Proanthocyanidins Key to Cranberry Efficacy in the Prevention of Recurrent Urinary Tract Infection? Phytotherapy Research 2015; 29:1559-1567.
Wang 2012
Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations. Archives of Internal Medicine 2012; 172:988-996.
Wing 2015
Wing DA, Rumney PJ, Hindra S, Guzman L, Le J, Nageotte M. Pilot Study to Evaluate Compliance and Tolerability of Cranberry Capsules in Pregnancy for the Prevention of Asymptomatic Bacteriuria. The Journal of Alternative and Complementary Medicine 2015;21:700-706.