泌尿系统感染的预防包括减少可改变的危险因素,例如避免杀精剂产品。
对于复发性泌尿系统感染的患者,可以通过低剂量抗生素预防治疗、性交前或性交后单剂量抗菌疗法或者自行启动治疗,降低泌尿系统感染的风险。绝经后妇女可通过使用局部阴道雌激素软膏降低复发率。
几乎没有证据支持性交后立即进行水化和排尿有助于预防泌尿系统感染。[15]Scholes D, Hooton TM, Roberts PL, et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177-1182.http://jid.oxfordjournals.org/content/182/4/1177.fullhttp://www.ncbi.nlm.nih.gov/pubmed/10979915?tool=bestpractice.com泌尿系统感染的预防:对于性交后立即排尿可以预防女性泌尿系统感染的说法,我们没有收集到足够的系统评价或随机对照试验以证实。低质量的观察性(队列)研究或者受试者<200名且方法学存在缺陷的随机对照临床试验(RCT)。
有相互矛盾的证据支持蔓越莓用于预防 UTI。[56]Avorn J, Monane M, Gurwitz JH, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271:751-754.http://www.ncbi.nlm.nih.gov/pubmed/8093138?tool=bestpractice.com[57]Nicolle LE. Urinary tract infection in long-term-care facility residents. Clin Infect Dis. 2000;31:757-761.http://www.ncbi.nlm.nih.gov/pubmed/11017826?tool=bestpractice.com[58]Miller JL, Krieger JN. Urinary tract infections: cranberry juice, underwear, and probiotics in the 21st century. Urol Clin North Am. 2002;29:695-699.http://www.ncbi.nlm.nih.gov/pubmed/12476532?tool=bestpractice.com一项 2012 年的 Cochrane 综述发现,对于感染数量的减少没有获益,[59]Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;(10):CD001321.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001321.pub5/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23076891?tool=bestpractice.com而另一项 meta 分析发现,蔓越莓与保护作用有关。[60]Wang CH, Fang CC, Chen NC, et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172:988-996.http://archinte.jamanetwork.com/article.aspx?articleid=1213845http://www.ncbi.nlm.nih.gov/pubmed/22777630?tool=bestpractice.com对于行良性妇科手术、需要导尿的女性患者,蔓越莓补充剂(每日剂量含原花青素 36 mg)可预防术后尿路感染。[61]Foxman B, Cronenwett AE, Spino C, et al. Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial. Am J Obstet Gynecol. 2015;213:194.e1-e8.http://www.sciencedirect.com/science/article/pii/S0002937815003555http://www.ncbi.nlm.nih.gov/pubmed/25882919?tool=bestpractice.com