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Recurrent Urinary Tract Infection in Women


Purpose of Review

The purpose of this review is to discuss the pathophysiology, diagnosis, treatment, and prevention of recurrent urinary tract infection (UTI) in the setting of antimicrobial stewardship.

Recent Findings

Although recurrent UTI was traditionally thought to occur by repeated ascension of uropathogenic colonizers, newer evidence suggests that a subset of bacteria becomes internalized within uroepithelial cells forming quiescent intracellular reservoirs. These quiescent reservoirs do not elicit an immune response and persist after treatment of acute infection. In time, epithelial turnover results in release of these bacteria potentially leading to recurrent infection. Given the rise in antimicrobial resistance, the concept of antimicrobial stewardship has been developed to promote appropriate use of antimicrobials, improve patient outcomes, decrease microbial resistance, and reduce the spread of infections caused by multidrug-resistant organisms. This has sparked interest in non-antimicrobial measures for UTI prevention. Although cranberry products and probiotics may prevent UTI, the data for their efficacy are limited. Current evidence supports vaginal estrogen use for UTI prevention in postmenopausal women. Daily or post-coital low-dose antimicrobial prophylaxis may also be beneficial, particularly for women who develop UTI despite non-antimicrobial measures. Nevertheless, studies demonstrating the efficacy of antimicrobial prophylaxis are > 10 years old when antibiotic resistance was less common.


Prevention of recurrent UTI requires identifying and addressing risk factors for infection. Non-antimicrobial strategies should be recommended whenever possible given increasing antimicrobial resistance. However, more studies are needed to define the ideal populations that may benefit from current non-antimicrobial strategies and to identify other potential ways UTI may be prevented.

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Correspondence to Jeannine M. Miranne.

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Conflict of Interest

Dr. Miranne reports personal fees from the American Congress of Obstetricians and Gynecologists and a grant from Brigham and Women’s Hospital Department of Obstetrics, Gynecology, and Reproductive Biology outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Urogynecology

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Miranne, J.M. Recurrent Urinary Tract Infection in Women. Curr Obstet Gynecol Rep 6, 282–289 (2017).

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  • Recurrent urinary tract infection
  • Antimicrobial stewardship
  • Risk factors for urinary tract infection
  • Prevention of recurrent urinary tract infection