Szlachta-McGinn Alec, Stothers Lynn, Ackerman A Lenore
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL (Szlachta-McGinn).
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Urology, University of California, Los Angeles, Los Angeles, CA (Stothers and Ackerman).
AJOG Glob Rep. 2025 Jun 2;5(3):100524. doi: 10.1016/j.xagr.2025.100524. eCollection 2025 Aug.
Urinary tract infection is among the most common bacterial infection among adults, and women are significantly more likely to experience urinary tract infection than men. The prevalence of urinary tract infection in women increases with age, as does the prevalence of noninfectious lower urinary tract symptoms and asymptomatic bacterial colonization of the urinary tract, known as asymptomatic bacteriuria. Distinguishing among these 3 entities is challenging without a complete clinical evaluation, including history, physical examination, and urine culture data. Existing literature demonstrates high misclassification of nonspecific symptoms, such as urinary tract infection, among women. In addition, less than one-fifth of diagnoses meet evidence-based criteria for urinary tract infection. Therefore, women are burdened by several healthcare inequities, including delays in care for potentially life-threatening conditions, antibiotic resistance and antibiotic-associated adverse events because of overreliance on antibiotics for noninfectious symptoms, and distrust of medical care. Profit-driven pressures imposed by our healthcare system, which reward providers for increasing clinical volume at the expense of quality patient-provider interactions, are a major culprit driving these inequities. In addition, lack of provider knowledge regarding urinary tract infection-confusable diagnoses, discomfort with pelvic examinations, and inappropriate use of automated question-based algorithms to diagnose and treat urinary tract infection are to blame. An evidence-based approach incorporating a focused history and physical examination that is concordant with the patient's chief complaint in addition to urine culture data only in cases of suspected urinary tract infection is the only way to reduce urinary tract infection-related healthcare inequities unfairly confronting women.
尿路感染是成年人中最常见的细菌感染之一，女性比男性更易患尿路感染。女性尿路感染的患病率随年龄增长而增加，非感染性下尿路症状和尿路无症状细菌定植（即无症状菌尿）的患病率也随之增加。如果没有包括病史、体格检查和尿培养数据在内的完整临床评估，区分这三种情况具有挑战性。现有文献表明，女性中诸如尿路感染等非特异性症状的误诊率很高。此外，不到五分之一的诊断符合尿路感染的循证标准。因此，女性面临着多种医疗保健不公平问题，包括对潜在危及生命的疾病治疗延迟、由于对非感染性症状过度依赖抗生素导致的抗生素耐药性和抗生素相关不良事件，以及对医疗保健的不信任。我们的医疗保健系统施加的利润驱动压力，即以牺牲医患之间高质量互动为代价奖励医疗服务提供者增加临床工作量，是导致这些不公平现象的主要原因。此外，医疗服务提供者缺乏关于可与尿路感染混淆的诊断的知识、对盆腔检查感到不适以及不恰当地使用基于问题的自动算法来诊断和治疗尿路感染也是原因之一。一种循证方法，包括结合重点病史和体格检查，并使其与患者的主要诉求相一致，仅在疑似尿路感染的情况下加上尿培养数据，这是减少女性不公平面临的与尿路感染相关的医疗保健不公平现象的唯一途径。
