Guideline of guidelines: management of recurrent urinary tract infections in women

被引:84
作者
Kwok, Michael [1 ,2 ,7 ]
McGeorge, Stephen [1 ,2 ]
Mayer-Coverdale, Johanna [3 ]
Graves, Bianca [3 ]
Paterson, David L. [4 ,5 ]
Harris, Patrick N. A. [5 ,6 ]
Esler, Rachel [1 ,2 ]
Dowling, Caroline [9 ]
Britton, Sumudu [4 ,8 ]
Roberts, Matthew J. [1 ,5 ,7 ]
机构
[1] Royal Brisbane & Womens Hosp, Dept Urol, Brisbane, Qld, Australia
[2] Univ Queensland, Fac Med, Brisbane, Qld, Australia
[3] Herston ID Inst HEIDI, Brisbane, Qld, Australia
[4] Royal Brisbane & Womens Hosp, Dept Infect Dis, Brisbane, Qld, Australia
[5] Univ Queensland, Fac Med, Ctr Clin Res, Brisbane, Qld, Australia
[6] Pathol Queensland, Cent Lab, Brisbane, Qld, Australia
[7] Redcliffe Hosp, Dept Urol, Redcliffe, Australia
[8] QIMR Berghofer Med Res Inst, Infect & Inflammat Program, Herston, Qld, Australia
[9] Eastern Hlth, Dept Urol, Melbourne, Vic, Australia
关键词
recurrent urinary tract infections; treatment; antibiotics; prophylaxis; prevention; #Urology; #UroUTI; INTRAVESICAL HYALURONIC-ACID; CHONDROITIN SULFATE; BACTERIAL CYSTITIS; PROPHYLAXIS; DIAGNOSIS; METAANALYSIS; ANTIBIOTICS; PREVENTION; ACUPUNCTURE; THERAPY;
D O I
10.1111/bju.15756
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objective To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and discrepancy. Methods PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched for rUTI guidelines in March 2022. Nine guidelines were included for review: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Results The definition and evaluation of rUTIs, and antibiotic prophylaxis strategies, were mostly consistent across guidelines, and emphasised the importance of obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Variable recommendations were noted for symptomatic treatment, self-initiated antibiotics, and antibiotic-sparing preventative strategies such as cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation, and phytotherapeutics. Recent randomised evidence supports the use of methenamine hippurate. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines. None of the guidelines were tailored to the management recurrent complicated UTI. Conclusion Multiple rUTI guidelines were identified and mostly limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis. Variation was noted, particularly in antibiotic-sparing preventative strategies. Some conflicting recommendations are due to more recent guidelines including updated evidence. Future guidelines should consider recommendations to assist management of complex patient groups, such as recurrent complicated UTI.
引用
收藏
页码:11 / 22
页数:12
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