Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA.
Female Pelvic Med Reconstr Surg. 2021 May 1;27(5):275-280. doi: 10.1097/SPV.0000000000001065.
The aims of this study were to determine the proportion of women presenting for recurrent urinary tract infections (UTIs) who met the diagnostic criteria (culture-proven UTI ≥3 in 1 year or ≥2 in 6 months) and to assess advanced testing utilization, preventive therapy use, and risk factors.
This is a retrospective chart review of women seen as new urogynecology consults for recurrent UTI (rUTI) between April 1, 2017, and April 1, 2018, followed through April 1, 2019. Exclusion criteria included catheter use, cancer treatment within 2 years, and prior organ transplant, urinary diversion, conduit, or bladder augmentation.
Of 600 women, 71% had follow-up with a median of 179 days. Urinary tract infection symptoms included frequency (50%), dysuria (46%), urgency (43%), and malodorous urine (7%). One third met the rUTI diagnostic criteria. Two hundred thirty-four (39%) underwent advanced testing, and 9% (21/234) of women who underwent advanced testing had a change in clinical care. Preventive therapy use increased after consultation (P < 0.001), with vaginal estrogen (47%) being most common. Compared with women not meeting the rUTI criteria, women meeting the rUTI criteria were more likely to be older (adjusted odds ratio [aOR], 1.03/year; 95% confidence interval [CI], 1.02-1.04), have a prior history of gynecologic cancer (aOR, 4.07; 95% CI, 1.02-16.25), or report UTI symptoms of dysuria (aOR, 2.27; 95% CI, 1.57-3.27), or malodorous urine (aOR, 2.96; 95% CI, 1.47-5.94) and, while equally likely to be receiving preventive treatment prior to consultation, were more likely after consultation (OR, 3.06; 95% CI, 2.05-4.55).
Thirty-seven percent of women seen for rUTI met the diagnostic criteria. Advanced imaging rarely changed care. Education about diagnostic criteria and preventive therapy is warranted.
本研究旨在确定就诊于泌尿科以治疗复发性尿路感染（rUTI）的女性中，符合诊断标准（经培养证实的 UTI≥3 次/年或≥2 次/6 个月）的比例，并评估高级检测的利用情况、预防治疗的应用以及风险因素。
这是一项回顾性图表分析，纳入 2017 年 4 月 1 日至 2018 年 4 月 1 日就诊的新泌尿科 rUTI 患者，并随访至 2019 年 4 月 1 日。排除标准包括导管使用、2 年内癌症治疗以及既往器官移植、尿流改道、导管或膀胱扩大术。
600 名女性中，71%的女性有随访，中位数随访时间为 179 天。尿路感染症状包括尿频（50%）、尿痛（46%）、尿急（43%）和尿液有异味（7%）。三分之一的女性符合 rUTI 的诊断标准。234 名（39%）女性接受了高级检测，其中 9%（21/234）接受高级检测的女性的临床治疗发生了变化。咨询后预防性治疗的应用增加（P<0.001），阴道雌激素（47%）最为常见。与不符合 rUTI 标准的女性相比，符合 rUTI 标准的女性更有可能年龄较大（调整后的优势比[OR]，1.03/年；95%置信区间[CI]，1.02-1.04）、有妇科癌症既往史（OR，4.07；95%CI，1.02-16.25）或报告尿痛（OR，2.27；95%CI，1.57-3.27）或尿液有异味（OR，2.96；95%CI，1.47-5.94），且尽管在咨询前接受预防治疗的可能性相同，但在咨询后接受治疗的可能性更高（OR，3.06；95%CI，2.05-4.55）。
37%的 rUTI 就诊女性符合诊断标准。高级影像学检查很少改变治疗方案。有必要对诊断标准和预防治疗进行教育。
