Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh, Pittsburgh, PA.
Am J Obstet Gynecol. 2020 Aug;223(2):265.e1-265.e13. doi: 10.1016/j.ajog.2020.05.048. Epub 2020 Jun 1.
We performed a systematic review and meta-analysis to determine whether D-mannose reduces urinary tract infection recurrence (ie, cumulative incidence) in adult women with recurrent urinary tract infection compared with other prevention agents. Secondary outcomes included side effects and compliance with D-mannose use.
Ovid Medline 1946-, Embase 1947-, Scopus 1823-, Cochrane Library, Web of Science 1900-, and ClinicalTrials.gov were searched through 4/15/2020.
Systematic review inclusion: randomized controlled trials, prospective cohorts, and retrospective cohorts written in English of women ≥18 years old with recurrent urinary tract infection in which D-mannose was utilized as an outpatient prevention regimen. Systematic review exclusion: lab or animal-based research, study protocols only, and conference abstracts. Meta-analysis inclusion: stated D-mannose dose, follow-up time ≥6 months, a comparison arm to D-mannose, and data available from women ≥18 years of age.
Two independent reviewers made abstract, full text, and data extraction decisions. Study methodologic quality was assessed using the Cochrane Risk of Bias tool. Relative risks, confidence intervals, and heterogeneity were computed.
Searches identified 776 unique citations. Eight publications met eligibility: 2 using D-mannose only; 6 using D-mannose combined with another treatment. Seven studies were prospective: 2 randomized controlled trials, 1 randomized cross-over trial, and 4 prospective cohort studies. One retrospective cohort study was included. Three studies met meta-analysis eligibility (1 randomized controlled trial, 1 randomized cross-over trial, and 1 prospective cohort). Pooled relative risk of urinary tract infection recurrence comparing D-mannose to placebo was 0.23 (95% confidence interval, 0.14-0.37; heterogeneity=0%; D-mannose n=125, placebo n=123). Pooled relative risk of urinary tract infection recurrence comparing D-mannose to preventative antibiotics was 0.39 (95% confidence interval, 0.12-1.25; heterogeneity=88%; D-mannose n=163, antibiotics n=163). Adverse side effects were reported in 2 studies assessing D-mannose only (1 study (n=10) reported none; the other reported a low incidence (8/103 participants) of diarrhea). Two studies reported compliance, which was high.
D-mannose appears protective for recurrent urinary tract infection (vs placebo) with possibly similar effectiveness as antibiotics. Overall, D-mannose appears well tolerated with minimal side effects-only a small percentage experiencing diarrhea. Meta-analysis interpretation must consider the small number of studies with varied study design and quality and the overall small sample size.
我们进行了一项系统评价和荟萃分析，以确定 D-甘露糖是否能降低复发性尿路感染（即累积发病率）成年女性的尿路感染复发率，与其他预防剂相比。次要结局包括副作用和 D-甘露糖使用的依从性。
通过 4 月 15 日检索 Ovid Medline 1946-、Embase 1947-、Scopus 1823-、Cochrane Library、Web of Science 1900-和 ClinicalTrials.gov。
系统评价纳入标准：随机对照试验、前瞻性队列研究和回顾性队列研究，研究对象为年龄≥18 岁的复发性尿路感染女性，门诊预防方案中使用 D-甘露糖。系统评价排除标准：实验室或动物研究、仅研究方案和会议摘要。荟萃分析纳入标准：明确的 D-甘露糖剂量、随访时间≥6 个月、与 D-甘露糖的比较臂以及≥18 岁女性的数据。
两名独立评审员对摘要、全文和数据提取做出决定。使用 Cochrane 偏倚风险工具评估研究方法学质量。计算相对风险、置信区间和异质性。
检索共确定了 776 个独特的引文。8 篇文献符合入选标准：2 篇仅使用 D-甘露糖；6 篇使用 D-甘露糖联合其他治疗。7 项研究为前瞻性：2 项随机对照试验、1 项随机交叉试验和 4 项前瞻性队列研究。纳入 1 项回顾性队列研究。3 项研究符合荟萃分析入选标准（1 项随机对照试验、1 项随机交叉试验和 1 项前瞻性队列研究）。与安慰剂相比，D-甘露糖治疗尿路感染复发的相对风险为 0.23（95%置信区间，0.14-0.37；异质性=0%；D-甘露糖 n=125，安慰剂 n=123）。与预防性抗生素相比，D-甘露糖治疗尿路感染复发的相对风险为 0.39（95%置信区间，0.12-1.25；异质性=88%；D-甘露糖 n=163，抗生素 n=163）。2 项仅评估 D-甘露糖的研究报告了不良反应（1 项研究（n=10）报告无不良反应；另一项研究报告腹泻发生率较低（103 名参与者中的 8 名））。2 项研究报告了依从性，依从性较高。
D-甘露糖似乎对复发性尿路感染有保护作用（与安慰剂相比），其有效性可能与抗生素相似。总体而言，D-甘露糖耐受性良好，副作用极小，只有一小部分人出现腹泻。荟萃分析的解释必须考虑到研究设计和质量差异以及总体样本量较小的少数研究。
