GKT School of Medical Education, King's College London, London, UK.
Birmingham Medical School, University of Birmingham, Birmingham, UK.
Eur Urol Focus. 2024 Sep;10(5):761-769. doi: 10.1016/j.euf.2024.04.002. Epub 2024 Apr 21.
Several bacterial immunisations have been developed to reduce the socioeconomic burden of urinary tract infections (UTIs) and the use of prophylactic antibiotics in the management of recurrent UTIs (rUTIs). This systematic review evaluates the effectiveness of vaccinations in preventing rUTIs.
Medline, Embase, and Web of Science were searched from inception to December 2023. Data were collected from cohort studies with a comparator arm and randomised controlled trials (RCTs) investigating vaccination efficacy in adult rUTI patients according to predefined selection criteria (PROSPERO registration: CRD42022356662). A pooled analysis took place for RCTs, with a subgroup analysis for vaccine types and booster regimens. Other studies were synthesised narratively. The risk of bias was assessed using Cochrane Risk-of-Bias tools. The Grading of Recommendations, Assessment, Development, and Evaluations framework evaluated the quality of evidence.
Fourteen comparative studies were selected, including 2822 patients across five vaccination types. The pooled risk ratio of eight placebo-controlled studies of the percentage of patients UTI free in the short term (6-12 mo) was 1.52 (95% confidence interval [CI] 1.05-2.20) with a number needed to treat of 6.45 (95% CI 2.80-64.80). There is substantial heterogeneity and a slight risk of a publication bias.
There is limited evidence to suggest that vaccinations are effective at reducing UTI recurrence in adult female patients in the short term. Owing to low quality of evidence, the literature requires further long-term RCTs with large sample sizes utilising standardised definitions for conclusive evidence of the long-term efficacy of vaccination in rUTI prevention.
We explored whether vaccines could help stop urinary tract infections (UTIs) from happening again. The latest information shows that these vaccines are safe and may help lower the chances of women getting UTIs again for about 6-12 mo.
为了减轻尿路感染（UTI）的社会经济负担，并减少复发性尿路感染（rUTI）管理中预防性抗生素的使用，已经开发了多种细菌免疫制剂。本系统评价评估了疫苗预防 rUTI 的有效性。
从建库到 2023 年 12 月，检索了 Medline、Embase 和 Web of Science 数据库。根据预定义的选择标准（PROSPERO 注册：CRD42022356662），收集了针对成人 rUTI 患者疫苗疗效的队列研究和随机对照试验（RCT）的数据。对 RCT 进行了汇总分析，并对疫苗类型和加强免疫方案进行了亚组分析。其他研究则进行了叙述性综合。使用 Cochrane 风险偏倚工具评估风险偏倚。使用推荐评估、制定与评价分级（GRADE）框架评估证据质量。
选择了 14 项对照研究，涵盖了 5 种疫苗类型的 2822 名患者。8 项安慰剂对照研究中，短期（6-12 个月）无 UTI 的患者百分比的汇总风险比为 1.52（95%置信区间[CI] 1.05-2.20），需要治疗的人数为 6.45（95%CI 2.80-64.80）。存在较大的异质性和轻微的发表偏倚风险。
现有证据有限，表明疫苗在短期内可有效降低成年女性患者的 UTI 复发率。由于证据质量较低，文献需要进一步开展长期 RCT，纳入大样本量，使用标准化定义，以获得疫苗预防 rUTI 的长期疗效的确凿证据。
我们探讨了疫苗是否可以帮助防止尿路感染（UTI）再次发生。最新信息表明，这些疫苗是安全的，可能有助于降低女性在 6-12 个月内再次发生 UTI 的几率。
