Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
Research Unit and Section of General Practice, Dept of Public Health, University of Copenhagen, Copenhagen, Denmark.
Expert Rev Anti Infect Ther. 2023 Jul-Dec;21(12):1301-1308. doi: 10.1080/14787210.2023.2279104. Epub 2023 Nov 24.
Urinary tract infections (UTIs) are associated with 25-40% of antibiotics consumed in primary care and are, therefore, driving antibiotic resistance. The worldwide increase in antibiotic resistance especially in Escherichia coli has complicated the treatment choices for UTIs and absence of effective oral antibiotics may lead to increasing need for more effective treatments.
In this review we focus on the importance of the correct diagnosis of UTI as based on proof of urinary pathogens in the urine and discuss diagnostic measures including microscopy, dipstick, and culture. Antibiotic treatment can often await diagnostic measures with pain relief such as ibuprofen. The risk of an uncomplicated UTI leading to pyelonephritis is low (1-2%) and presence of bacteria in the bladder leaves some time for the immune system to react. Three antibiotics are recommended as based on their activity, and low propensity to select for resistance, i.e. nitrofurantoin, fosfomycin, and pivmecillinam, and in general, 3-5 days of treatment will suffice.
Understanding the usual benign course of uUTIs can help reduce antibiotic treatment in many cases, e.g. starting treatment by pain relief and awaiting the course of infection without antibiotics. Better rapid tests in primary care are urgently needed to enforce such policies.
尿路感染（UTI）与初级保健中 25-40%的抗生素使用有关，因此是导致抗生素耐药性的原因之一。抗生素耐药性在全球范围内的增加，特别是大肠杆菌的抗生素耐药性增加，使 UTI 的治疗选择变得复杂，缺乏有效的口服抗生素可能会导致对更有效治疗方法的需求增加。
在这篇综述中，我们重点关注基于尿液中尿病原体的证据正确诊断 UTI 的重要性，并讨论诊断措施，包括显微镜检查、尿试纸和培养。抗生素治疗通常可以等待诊断措施，如布洛芬缓解疼痛。无症状性尿路感染导致肾盂肾炎的风险较低（1-2%），且膀胱中的细菌存在一段时间后，免疫系统会作出反应。根据其活性和低耐药倾向，推荐三种抗生素，即呋喃妥因、磷霉素和匹美西林，一般来说，3-5 天的治疗就足够了。
了解常见的无症状性 UTI 良性病程有助于减少许多情况下的抗生素治疗，例如通过缓解疼痛开始治疗，并在没有抗生素的情况下等待感染过程。迫切需要在初级保健中使用更好的快速检测来执行此类政策。
