Han Zeyu, Yi Xianyanling, Li Jin, Liao Dazhou, Ai Jianzhong
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu, 610041, China.
Infection. 2025 Apr;53(2):535-546. doi: 10.1007/s15010-024-02357-z. Epub 2024 Aug 2.
Recent guidelines indicated that, in addition to antibiotics, nonantibiotic interventions serve as available preventive options for urinary tract infections (UTIs). This study aimed to compare the efficacy and safety of various nonantibiotic interventions in preventing UTIs.
The authors systematically searched databases for eligible studies. The inclusion criteria encompassed randomized controlled trials (RCTs) focusing on one or more nonantibiotic interventions for UTI prevention, with the incidence of UTIs being a key outcome measure. Subgroup analyses were performed according to age, sex, and follow-up.
50 RCTs comprising 10,495 subjects and investigating 14 interventions, were included. Nearly 80% of the RCTs utilized double-blind or triple-blind designs. In the whole group, D-mannose (risk ratio [RR] 0.34, 0.21 to 0.56), vaccine (RR 0.65, 0.52 to 0.82), probiotics (RR 0.69, 0.50 to 0.94), cranberry (RR 0.72, 0.60 to 0.87), and triple therapy (cranberry plus probiotics plus vitamin A) (RR 0.27, 0.09 to 0.87), exhibited a significant reduction in UTI incidence compared to the placebo. Probiotics (RR 0.50, 0.28 to 0.89) were the most effective in the nonadult group, while vitamin D (RR 0.46, 0.27 to 0.81) showed the highest efficacy in the long follow-up group (≥ 1 year). There was no significant difference in the incidence of adverse events between the interventions and the placebo group.
D-mannose, triple therapy, vaccine, probiotics, and cranberry serve as potential nonantibiotic intervention options for clinical UTI prevention.
近期指南指出，除抗生素外，非抗生素干预措施是预防尿路感染（UTIs）的可用选项。本研究旨在比较各种非抗生素干预措施预防UTIs的疗效和安全性。
作者系统检索数据库以查找符合条件的研究。纳入标准包括聚焦一种或多种预防UTIs的非抗生素干预措施的随机对照试验（RCTs），UTIs发病率为关键结局指标。根据年龄、性别和随访情况进行亚组分析。
纳入了50项RCTs，涉及10495名受试者，研究了14种干预措施。近80%的RCTs采用双盲或三盲设计。在整个组中，与安慰剂相比，D-甘露糖（风险比[RR]0.34，0.21至0.56）、疫苗（RR 0.65，0.52至0.82）、益生菌（RR 0.69，0.50至0.94）、蔓越莓（RR 0.72，0.60至0.87）和三联疗法（蔓越莓加益生菌加维生素A）（RR 0.27，0.09至0.87）的UTIs发病率显著降低。益生菌（RR 0.50，0.28至0.89）在非成人组中最有效，而维生素D（RR 0.46，0.27至0.81）在长期随访组（≥1年）中显示出最高疗效。干预措施组与安慰剂组之间不良事件的发生率没有显著差异。
D-甘露糖、三联疗法、疫苗、益生菌和蔓越莓是临床预防UTIs的潜在非抗生素干预选项。
