Dwyer Peter L, O'Reilly Mary
Department of Urogynaecology, Mercy Hospital for Women & Royal Women's Hospital, Melbourne, Australia.
Curr Opin Obstet Gynecol. 2002 Oct;14(5):537-43. doi: 10.1097/00001703-200210000-00016.
Recurrent urinary tract infection is a common problem and can affect women of all ages, particularly the elderly and pregnant women. Obstetricians and gynaecologists need to have up-to-date knowledge of the diagnosis, pathophysiology and management of this condition.
The diagnosis of urinary tract infection is made on the basis of symptoms and bacteriuria of more than 103 bacteria per ml. Host and bacterial virulence factors are important in the pathogenesis of recurrent urinary tract infections. General host factors predisposing to recurrent infection are genetic factors, ageing, the menopause, urogenital dysfunction, sexual behaviour, and previous pelvic surgery. Urinary tract infection is common in pregnancy, and recent studies have suggested an association with mental retardation and developmental delay. Women with recurrent urinary tract infection in pregnancy should be considered for long-term antibiotic prophylaxis. Intravaginal oestrogens and cranberry juice have been found to be effective for prevention, although more research is required. Women with recurrent urinary tract infection should have at least a 3-day course of trimethoprim or cotrimoxazole, or a 5-day course of beta-lactams or nitrofurantoin, with perhaps a 10-day course in the elderly. Women with frequent urinary tract infection (more than three episodes per year) should be offered prophylactic antibiotics, which can be patient-initiated, postcoital, or long-term low-dose therapy. In the future, vaccines against specific uropathogenic bacteria may be useful in urinary tract infection prophylaxis.
More research is required, by all medical disciplines, on various aspects of urinary tract infection.
复发性尿路感染是一个常见问题，可影响各年龄段女性，尤其是老年人和孕妇。妇产科医生需要掌握该疾病诊断、病理生理学及管理方面的最新知识。
尿路感染的诊断基于症状以及每毫升尿液中细菌数超过10³ 。宿主和细菌毒力因子在复发性尿路感染的发病机制中很重要。易引发复发性感染的一般宿主因素包括遗传因素、衰老、绝经、泌尿生殖功能障碍、性行为及既往盆腔手术。尿路感染在孕期很常见，近期研究表明其与智力发育迟缓及发育延迟有关。孕期复发性尿路感染的女性应考虑长期使用抗生素预防。已发现阴道内使用雌激素和蔓越莓汁对预防有效，不过仍需更多研究。复发性尿路感染的女性应接受至少3天的甲氧苄啶或复方新诺明疗程，或5天的β - 内酰胺类或呋喃妥因疗程，老年人可能需10天疗程。频繁发生尿路感染（每年超过3次发作）的女性应给予预防性抗生素，可采用患者自行用药、性交后用药或长期低剂量治疗。未来，针对特定尿路致病性细菌的疫苗可能对预防尿路感染有用。
所有医学学科都需要对尿路感染的各个方面进行更多研究。
