The etiology and management of recurrent urinary tract infections in postmenopausal women

Abstract

Urinary tract infections (UTIs) are one of the most common infections and affect up to 50% of women in their lifetime, with almost half of these women experiencing a recurrence in 6–12 months. Menopause predisposes women to recurrent UTI (rUTI), as normally lower levels of estrogen lead to changes in the urogenital epithelium and subsequently urogenital microbiome. The recently discovered urobiome is now known to have different compositions in both healthy and unhealthy bladders, including a role in the pathophysiology of rUTI, and may be a therapeutic target for prevention and treatment options for rUTI. In postmenopausal women with frequent UTI, the diagnosis of acute UTI should be made using a combination of the symptom assessment and urine diagnostic studies. The choice of UTI antibiotic should include consideration of efficacy, collateral effects, and side-effects. Some women may be candidates for self-start therapy, in which the patient accurately recognizes her UTI symptoms and then starts previously prescribed antibiotics. A large component of the management of women with rUTI is prevention. Urobiome research for bladder health and disease is a young field of investigation with significant potential to improve care for postmenopausal women affected by rUTI through novel, evidence-based prevention and treatment strategies.

摘要

尿路感染（UTIs）是最常见的感染之一, 高达50%的妇女在其一生中感染过, 其中近一半的妇女经历6 - 12个月内的复发。更年期容易使妇女发生复发性UTI（rUTI）, 因为正常情况下较低水平的雌激素会导致泌尿生殖上皮细胞的变化, 进而导致泌尿生殖道微生物群的变化。最近研究表明, 尿路微生物群在健康和不健康的膀胱中其分布及成分是不同的, 发现其在引起rUTI的病理生理学中起着重要作用, 同时其也是rUTI预防和治疗选择的治疗目标。对于绝经后复发性UTI的妇女中, 应结合症状评估和尿路诊断学研究对急性UTI作出诊断。UTI抗生素的选择考虑应包括疗效、间接作用和副作用。一些女性开始自我诊治, 在这个过程中, 患者能够准确地识别出自己的UTI症状, 然后开始用之前开过的抗生素。rUTI妇女管理的一个重要组成部分是预防。膀胱健康和疾病的尿路微生物学研究是一个年轻的研究领域, 通过新的、基于证据的预防和治疗策略, 对改善绝经后受rUTI影响的妇女的管理具有潜在的重要意义。

Keywords:

• Urinary microbiome
• urinary tract infection
• urobiome
• bladder
• bladder health

Conflict of interest

The authors report no conflict of interest.

Source of funding

Nil.