Hooton T M
University of Washington School of Medicine, Harborview Medical Center, Madison Clinic, 325 9th Avenue, Seattle, WA 98104-2499, USA.
Int J Antimicrob Agents. 2001 Apr;17(4):259-68. doi: 10.1016/s0924-8579(00)00350-2.
Recurrent urinary tract infections (UTI) are common among young healthy women even though they generally have anatomically and physiologically normal urinary tracts. Women with recurrent UTI have an increased susceptibility to vaginal colonization with uropathogens, which is due to a greater propensity for uropathogenic coliforms to adhere to uroepithelial cells. Risk factors for recurrent UTI include sexual intercourse, use of spermicidal products, having a first UTI at an early age, and having a maternal history of UTIs. Inherited factors may be important in some women with recurrent UTI. Many factors thought to predispose to recurrent UTI in women, such as pre- and post-coital voiding patterns, frequency of urination, wiping patterns, and douching have not been proven to be risk factors for UTI. In contrast to the predominantly behavioral risk factors for young women, mechanical and/or physiological factors that affect bladder emptying are most strongly associated with recurrent UTI in healthy postmenopausal women. The management of recurrent UTI is the same as that for sporadic UTI except that the likelihood of infection with an antibiotic resistant uropathogen is higher in women who have received recent antimicrobials. Strategies to prevent recurrent UTI in young women should include education about the association of recurrent UTI with frequency of sexual intercourse and the usage of spermicide-containing products. Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment with antimicrobials have all been demonstrated to be effective in managing recurrent uncomplicated UTIs in women. Estrogen use is very effective in preventing recurrent UTI in post-menopausal women. Exciting new approaches to prevent recurrent UTI include the use of probiotics and vaccines. Further understanding of the pathogenesis of UTI will lead to more effective and safer methods to prevent these frequent infections.
复发性尿路感染（UTI）在年轻健康女性中很常见，尽管她们的尿路在解剖学和生理学上通常是正常的。复发性UTI女性更容易被尿路致病菌定植于阴道，这是由于尿路致病性大肠埃希菌更倾向于黏附于尿道上皮细胞。复发性UTI的危险因素包括性交、使用杀精产品、早年首次发生UTI以及母亲有UTI病史。遗传因素在一些复发性UTI女性中可能很重要。许多被认为易导致女性复发性UTI的因素，如性交前后排尿模式、排尿频率、擦拭方式和灌洗，尚未被证实是UTI的危险因素。与年轻女性主要的行为危险因素不同，影响膀胱排空的机械和/或生理因素与健康绝经后女性的复发性UTI关联最为密切。复发性UTI的治疗与散发性UTI相同，只是近期接受过抗菌药物治疗的女性感染耐抗生素尿路致病菌的可能性更高。预防年轻女性复发性UTI的策略应包括教育她们了解复发性UTI与性交频率以及含杀精剂产品使用之间的关联。低剂量抗菌药物持续预防或性交后预防，或抗菌药物间歇性自我治疗，均已被证明对管理女性复发性单纯性UTI有效。雌激素的使用对预防绝经后女性复发性UTI非常有效。预防复发性UTI的令人兴奋的新方法包括使用益生菌和疫苗。对UTI发病机制的进一步了解将带来更有效、更安全的方法来预防这些常见感染。
