复发性尿路感染的诊断、治疗和预防。

IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Guido Schmiemann, Jennifer Kranz, Falitsa Mandraka, Sören Schubert, Florian Wagenlehner, Ildikó Gágyor
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引用次数: 0

摘要

背景:尿路感染在女性中的一年发病率为 11%,是向初级保健医生就诊和接受抗生素处方的最常见原因之一。对于复发性尿路感染(rUTI),人们对进一步的检查、治疗和预防措施存在疑问:方法:为更新德国无并发症尿路感染临床实践指南(043-044)而进行的系统性文献检索(截至 2022 年 2 月),并对临床试验进行了选择性检索(截至 2023 年 8 月):结果:尿培养和超声波检查是尿路感染诊断评估的合理步骤。建议对男性进行进一步的侵入性检查,但不作为女性的常规检查项目。抗生素是最有效的预防措施之一(风险比 [RR] 0.15,95% 置信区间 [0.1; 0.3]),但副作用风险较高。蔓越莓汁(RR 0.74 [0.5; 0.99])、甘露糖(RR 0.23 [0.14; 0.37])和阴道雌激素(RR,0.42 [0.30; 0.59])等非抗生素制剂也能降低感染率,而且副作用风险较低。增加每日液体摄入量可在短期内降低感染率(几率比[OR] 0.13 [0.07; 0.25]);对排便或排尿后使用卫生的擦拭方法的研究很少,但可以在没有风险的情况下实施。结论:急性尿路感染给治疗医生带来了挑战,必须因人而异地考虑应采取的措施。老年患者等弱势群体需要特别关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Diagnosis, Treatment, and Prevention of Recurrent Urinary Tract Infection.

Background: Urinary tract infection has a one-year prevalence of 11% in women and ranges among the most common reasons for consulting a primary care physician and for receiving a prescription for antibiotics. In the case of recurrent urinary tract infection (rUTI), there are questions about the further work-up, treatment, and preventive measures.

Methods: The systematic literature search performed for the update of the German clinical practice guideline on uncomplicated urinary tract infection (043-044) (up to February 2022) was supplemented with a selective search for clinical trials (up to August 2023).

Results: Urine culture and ultrasonography are reasonable steps in the diagnostic evaluation of rUTI. Further invasive testing is suggested for men but is not routinely indicated for women. Antibiotics are among the most effective preventive measures (risk ratio [RR] 0.15, 95% confidence interval [0.1; 0.3]) but carry a high risk of side effects. Non-antibiotic preparations such as cranberry juice (RR 0.74 [0.5; 0.99]), mannose (RR 0.23 [0.14; 0.37]), and vaginal estrogen (RR, 0.42 [0.30; 0.59]) can also reduce the infection rate, with a low risk of side effects. Increased daily fluid intake has been shown to lower infection rates in the short term (odds ratio [OR] 0.13 [0.07; 0.25]); the use of hygienically advisable wiping techniques after passing stool or urine has been little studied but can be implemented with no risk.

Conclusion: rUTI poses a challenge for the treating physician. The measures to be taken must be considered on an individual basis. Vulnerable groups, such as older patients, need special attention.

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来源期刊
Deutsches Arzteblatt international
Deutsches Arzteblatt international 医学-医学:内科
CiteScore
4.10
自引率
5.20%
发文量
306
审稿时长
4-8 weeks
期刊介绍: Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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