Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Parkinsons Dis. 2022;12(3):743-757. doi: 10.3233/JPD-213103.
Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson's disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.
尿路感染（UTI）是帕金森病（PD）患者急性神经功能恶化的常见诱因，也是导致谵妄、功能下降、跌倒和住院的主要原因。PD 的各种临床特征，包括自主神经功能障碍和尿动力学改变、虚弱和认知障碍，以及对膀胱导管插入术的需求，增加了 UTI 的风险。由于 UTI 导致的败血症是未经治疗或治疗不足的 UTI 的可怕后果，也是 PD 发病率的主要原因。新出现的研究表明，免疫介导的脑损伤可能是 UTI 导致 PD 症状恶化的发病机制。预防 PD 患者 UTI 的现有策略包括使用局部雌激素、预防性补充剂、抗生素膀胱冲洗、清洁导管技术和预防性口服抗生素，而针对常见 UTI 病原体的细菌干扰和疫苗/免疫刺激剂则是目前正在研究的潜在策略。需要进一步研究以减轻 UTI 在 PD 中的有害影响。
