摘要：尿路感染发病普遍，复发率高，超过半数的女性有过一次以上尿路感染的经历。因此对于女性复发性单 纯性尿路感染患者而言，规范性地预防和治疗具有极其重要的意义。本文对美国泌尿外科协会 （American Urological Association，AUA）、加拿大泌尿外科协会 （Canadian Urological Association，CUA） 及尿动力 学、女性盆腔医学和泌尿生殖重建学会 （Society of Urodynamics，Female Pelvic Medicine and Urogenital Reconstruction，SUFU） 2022年更新的女性复发性单纯性尿路感染指南进行了解读，并结合相关的循证医学证 据进行了总结，以期对女性复发性单纯性尿路感染的临床预防与治疗有所帮助。

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文杰,贾莫涵,双卫兵.《2022 AUA/CUA/SUFU 指南：女性复发性单纯性尿路感染》的非抗生素治疗[J]. 泌尿外科杂志（电子版）,2022,14(4):37-42. DOI:10.20020/j.CNKI.1674-7410.2022.04.08

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尿路感染 （urinary tract infection, UTI） 在微生物学上被定义为尿路上皮对微生物病原体的炎症 反应，是仅次于中耳炎的第二常见细菌感染性疾 病，全世界范围内每年影响着约 1.5亿人的健康，其 发病高峰在 20 岁左右的青年和 85 岁以上的老年 人[1- 2] 。复发性单纯性尿路感染 （recurrent urinary tract infections，rUTI），单纯性的定义是患者的尿 道解剖和功能正常，且没有易患尿路感染的已知因 素[3] ；复发性的定义为半年内至少发生 2 次或 1 年至 少发生 3 次尿路感染[4-5] 。有研究表明，女性有症状 的尿路感染的终生风险高达 50%，而且成年女性更容易患尿路感染，其6个月后复发率为20%~40%[6-7] 。尿路感染作为一种常见病，影响着所有年 龄段和种族的女性，并且给患者也带来了沉重的经济 负担[8] 。2019年 5月，美国泌尿外科协会 （American Urological Association，AUA）、加拿大泌尿外科协会（Canadian Urological Association，CUA）及尿动 力学、女性盆腔医学和泌尿生殖重建学会 （Society of Urodynamics，Female Pelvic Medicine and Urogenital Reconstruction，SUFU） 共同合作，发布了女性复发性单纯性尿路感染（Recurrent Uncomplicated Urinary Tract Infections in Women） 的指南[3] ，旨在为 rUTI的评估和管理提供指导，通过减少 UTI事件的复发来改善患有 rUTI 的女性的临床结果和生活质量，避免不合理使用抗生素，并减少抗生素耐药性和相关不良事件的风险。2022年9月，AUA/CUA/SUFU 更新了 2019 年女性复发性单纯性尿路感染的指南[9] ，补充了非抗生素对在预防与治疗方面重要作用。

1 rUTI 治疗现状

2 rUTI 的非抗生素治疗
    2.1 乌洛托品
    2.2 蔓越莓
    2.3 雌激素

3 小结

3 小结 

日趋严重的抗生素耐药性和不良反应问题使得 人们不得不寻求其替代品。近些年来，人们对于非 抗生素治疗的探索取得了一系列积极的临床结果， 非抗生素展现了十分可观的临床治疗潜力和应用前 景，但目前的相关研究仍存在着风险偏倚高、证据 级别低以及临床数据不全面等的问题。因此，在临 床上，非抗生素治疗尚无法取代抗生素治疗。距离 非抗生素类药物成为临床一线用药，未来还需要更 多、更全面、偏倚更小，证据级别更高的相关临床 研究。

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