Abstract: Background Recurrent urinary tract infections（rUTI） are a common condition among female patients.It affects patients' quality of life，incurs the medical burden，and is associated with global antibiotic resistance. Currently，European and American countries have established clinical guidelines of rUTI to address the clinical issues. However，there is still a lack of consensus in the management of rUTI in China. Objective To summarize the existing evidence and guideline recommendations for the diagnosis，treatment，prevention of rUTI that can be used in China. Methods We conducted a systematic search in Chinese and English databases such as CNKI，VIP，Wanfang Data Knowledge Service Platform，PubMed，and Web of Science，as well as the official websites of urology，nephrology，and obstetrics and gynecology societies. We included guidelines related to female rUTI and the main randomized controlled trials and observational studies mentioned in these guidelines from 2014 to 2024. Results A total of 274 articles were included in the review，encompassing 98 systematic reviews and meta-analyses，129 Randomized Controlled Trials，15 observational studies，and 32 expert opinions/guidelines. In symptom management，guidelines generally recommend routine urine culture during acute exacerbations. For acute-phase antibiotic therapy，most guidelines recommended fosfomycin and nitrofurantoin，etc. Prevention strategies such as estrogen replacement，continuous low-dose antibiotic prophylaxis，immunoactive prophylaxis，and methenamine hippurate were with relatively strong evidence. Conclusion Most current guidelines mainly focused on the female population with uncomplicated cystitis. Clinical guidelines from different countries demonstrate consistency in antibiotic protocols for acute infection management，yet exhibit divergence in their recommendations for infection prevention strategies. Future guidelines should consider a broader scope，especially for rUTI populations with complicative factors such as diabetes and kidney diseases，to optimize the assessment and management of rUTI.

Key words: Recurrent urinary tract infections, Urinary tract infections, Female patients, Guidelines, Interventional measures

摘要： 背景 复发性尿路感染（rUTI）是女性患者常见疾病，严重影响患者生活质量、增加医疗负担，并与全球抗生素耐药相关。目前欧美国家针对女性rUTI带来的临床问题形成独立的诊疗指南，但国内仍缺乏相关共识。目的 总结对rUTI诊断评估、治疗策略选择、预防方案等现有证据及指南推荐，探索可供国内使用的诊疗策略。方法 检索中国知网、维普网、万方数据知识服务平台、PubMed、Web of Science等中英文数据库及泌尿外科、肾科、妇产科等学会官方网页系统检索。纳入2014—2024年关于女性rUTI相关指南及指南中提及的主要随机对照试验及观察性研究。结果 共纳入274篇文献进行综述总结，包括98篇系统评价和Meta分析、129篇随机对照试验、15篇观察性研究以及32篇专家意见/指南。对比目前国内外rUTI临床指南，在症状管理层面，各指南普遍推荐急性发作时常规进行中段尿培养。在急性发作期抗生素治疗方面，指南推荐呋喃妥因、磷霉素和复方磺胺甲恶唑（TMP-SMX）等。足量饮水、雌激素替代、持续的低剂量抗生素疗法、免疫激活物疗法、马尿酸乌洛托品是目前证据较充分的预防措施。结论 目前多数指南的建议主要针对非复杂性膀胱炎的女性群体，各国指南在急性感染时采用的抗生素方案较为一致，但在预防感染的措施存在不同推荐。未来的指南版本应考虑更广泛，特别是合并糖尿病、肾脏疾病等存在复杂性因素的rUTI人群，以优化rUTI的评估及管理。

关键词: 复发性尿路感染, 泌尿道感染, 女性, 指南, 干预措施