Medical School, University of Washington School of Medicine, Seattle, WA.
Department of Global Health, University of Washington School of Medicine, Seattle, WA.
Menopause. 2021 May 10;28(7):836-844. doi: 10.1097/GME.0000000000001769.
Current guidelines for postmenopausal recurrent urinary tract infection (rUTI) prevention recommend the use of vaginal topical estrogen products but not systemic estrogens. Studies show that vaginal estrogen decreases the risk of rUTI, but evidence against use of systemic estrogen is less convincing.
We performed a comprehensive literature review to evaluate the effect of systemic estrogen on UTI occurrence among postmenopausal women.
MEDLINE (PubMed), EMBASE, and CINAHL were searched for manuscripts published in English between January 1990 and July 2020. The search terms were "urinary tract infection" and "estrogen." Inclusion criteria were studies of postmenopausal women who received systemic estrogen therapy (any regimen) that reported UTI frequency during any follow-up period. Case studies, commentaries, and reviews were excluded. A priori specifications of seven study criteria were set representing the ideal study for assessing efficacy of systemic estrogen for rUTI prevention and were used to evaluate each included study.
Searches identified 281 results, and after deduplication and review, 8 studies met inclusion criteria: 4 randomized controlled trials, 1 secondary analysis of a randomized controlled trial, 1 prospective cohort study, 1 case-control study, and 1 cross-sectional study. Of the eight included studies, only two enrolled postmenopausal women with a rUTI diagnosis, four had sufficient sample size to detect a clinically meaningful difference between systemic estrogen versus placebo, two used dosage regimens anticipated to achieve a therapeutic effect, and three assessed UTI rates for an adequate duration of 6 months or more (the standard minimum duration of time needed to make a diagnosis of rUTI). Overall, none of the studies met all predefined criteria for the ideal study to assess the efficacy of systemic estrogen for rUTI prevention.
UTIs will continue to be a significant cause of morbidity and hospitalizations in postmenopausal women unless more research is done to better understand the role of estrogen on UTI rates. The evidence arguing use (or abandonment) of systemic estrogen for the prevention of rUTI is based on few studies with substantial methodologic limitations; there is significant room for improvement.
目前针对绝经后复发性尿路感染 (rUTI) 预防的指南建议使用阴道局部雌激素产品，但不建议使用全身雌激素。研究表明，阴道雌激素可降低 rUTI 的风险，但反对使用全身雌激素的证据则不太令人信服。
我们进行了全面的文献综述，以评估全身雌激素对绝经后妇女尿路感染发生的影响。
在 1990 年 1 月至 2020 年 7 月期间，使用 MEDLINE（PubMed）、EMBASE 和 CINAHL 搜索发表在英语文献中的手稿。搜索词为“urinary tract infection”和“estrogen”。纳入标准为接受全身雌激素治疗（任何方案）的绝经后妇女的研究，报告了任何随访期间的尿路感染频率。排除病例研究、评论和综述。预先规定了七个研究标准，这些标准代表了评估全身雌激素预防 rUTI 疗效的理想研究，并用于评估每个纳入的研究。
搜索共确定了 281 项结果，经过去重和审查，有 8 项研究符合纳入标准：4 项随机对照试验、1 项随机对照试验的二次分析、1 项前瞻性队列研究、1 项病例对照研究和 1 项横断面研究。在这 8 项纳入的研究中，只有 2 项研究纳入了绝经后 rUTI 诊断的妇女，4 项研究的样本量足以检测全身雌激素与安慰剂之间的临床有意义差异，2 项研究使用了预计能达到治疗效果的剂量方案，3 项研究评估了尿路感染的发生率达到 6 个月或更长时间（诊断 rUTI 所需的最短时间）。总体而言，没有一项研究完全符合评估全身雌激素预防 rUTI 疗效的理想研究的所有预先规定标准。
除非进行更多研究以更好地了解雌激素对尿路感染率的作用，否则尿路感染仍将成为绝经后妇女发病率和住院率的重要原因。支持使用（或放弃）全身雌激素预防 rUTI 的证据基于少数存在严重方法学局限性的研究；仍有很大的改进空间。
