Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania.
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
J Urol. 2018 Dec;200(6):1174-1191. doi: 10.1016/j.juro.2018.04.088. Epub 2018 Jun 22.
Recurrent lower urinary tract infections in women are a highly prevalent and burdensome condition for which best practice guidelines for treatment and prevention that minimize harm and optimize well-being are greatly needed. To inform development of practice recommendations, a rapid literature review of original research, systematic reviews, meta-analyses and practice guidelines was conducted.
PubMed®, Embase®, Opus, Scopus®, Google Scholar, The Cochrane Library and the U.S. National Guideline Clearinghouse electronic databases were searched from inception to September 22, 2017. Articles and practice guidelines were included if they were in English, were peer reviewed, included women, involved treatment or prevention strategies for recurrent urinary tract infection and reported an outcome related to recurrence rates of urinary tract infection. Critical appraisal of original studies was conducted using the Cochrane risk of bias tool, and of systematic reviews using the AMSTAR 2 tool.
Of 1,582 citations identified 74 met our study inclusion criteria. These comprised 49 randomized controlled trials, 23 systematic reviews (16 with meta-analyses) and 2 practice guidelines. No study reported a multi-targeted treatment approach. There was a lack of high quality studies and systematic reviews evaluating prevention strategies for recurrent urinary tract infection.
We recommend an algorithmic approach to care that includes education on lifestyle and behavioral modifications, and addresses specific populations of women with antimicrobial based and nonantibiotic alternatives. This approach includes the use of vaginal estrogen with or without lactobacillus containing probiotics in postmenopausal women, low dose post-coital antibiotics for recurrent urinary tract infection associated with sexual activity in premenopausal women, low dose daily antibiotic prophylaxis in premenopausal women with infections unrelated to sexual activity, and methenamine hippurate and/or lactobacillus containing probiotics as nonantibiotic alternatives. Future research should involve consistent use of terminology, validated instruments to assess response to interventions and patient perspectives on care. Our treatment algorithm is based on the best available evidence, and fills a gap in the literature and practice regarding effective strategies to prevent recurrent urinary tract infection in women.
女性复发性下尿路感染是一种高发且负担沉重的疾病，非常需要制定最佳的治疗和预防实践指南，以最大限度地减少危害并优化健康状况。为了为制定实践建议提供信息，我们对原始研究、系统评价、荟萃分析和实践指南进行了快速文献回顾。
从创建到 2017 年 9 月 22 日，我们在 PubMed、Embase、Opus、Scopus、Google Scholar、Cochrane 图书馆和美国国家指南清除中心电子数据库中搜索了原始研究、系统评价、荟萃分析和实践指南。如果文章和实践指南为英文、同行评审、包含女性、涉及复发性尿路感染的治疗或预防策略，并报告与尿路感染复发率相关的结果，则将其纳入研究。使用 Cochrane 偏倚风险工具对原始研究进行了批判性评估，使用 AMSTAR 2 工具对系统评价进行了评估。
在 1582 条引文中，有 74 条符合我们的研究纳入标准。这些研究包括 49 项随机对照试验、23 项系统评价（16 项有荟萃分析）和 2 项实践指南。没有研究报告多目标治疗方法。缺乏评估复发性尿路感染预防策略的高质量研究和系统评价。
我们建议采用一种算法方法进行护理，包括对生活方式和行为改变的教育，并针对具有抗菌和非抗生素替代物的特定女性人群。这种方法包括在绝经后妇女中使用阴道雌激素，联合或不联合含有乳杆菌的益生菌；在绝经前妇女中，性行为相关复发性尿路感染时使用小剂量性交后抗生素；在与性行为无关的感染中，在绝经前妇女中使用小剂量每日抗生素预防；在非抗生素替代物中使用三聚氰胺尿酸盐和/或含有乳杆菌的益生菌。未来的研究应涉及术语的一致使用、评估干预反应的有效工具以及患者对护理的看法。我们的治疗算法基于现有最佳证据，填补了文献和实践中关于预防女性复发性尿路感染有效策略的空白。
