Bacterial Vaccines for the Management of Recurrent Urinary Tract Infections: A Systematic Review and Meta-analysis

Quentin Mak; Julian Greig; Prokar Dasgupta; Sachin Malde; Nicholas Raison

doi:10.1016/j.euf.2024.04.002

Bacterial Vaccines for the Management of Recurrent Urinary Tract Infections: A Systematic Review and Meta-analysis

Eur Urol Focus. 2024 Apr 20:S2405-4569(24)00054-3. doi: 10.1016/j.euf.2024.04.002. Online ahead of print.

Authors

Quentin Mak¹, Julian Greig², Prokar Dasgupta³, Sachin Malde⁴, Nicholas Raison⁵

Affiliations

¹ GKT School of Medical Education, King's College London, London, UK. Electronic address: quentinmak@proton.me.
² Birmingham Medical School, University of Birmingham, Birmingham, UK.
³ School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK; Department of Urology, Guy's and St Thomas' NHS Trust, London, UK.
⁴ Department of Urology, Guy's and St Thomas' NHS Trust, London, UK.
⁵ School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.

PMID: 38644097
DOI: 10.1016/j.euf.2024.04.002

Abstract

Background and objective: Several bacterial immunisations have been developed to reduce the socioeconomic burden of urinary tract infections (UTIs) and the use of prophylactic antibiotics in the management of recurrent UTIs (rUTIs). This systematic review evaluates the effectiveness of vaccinations in preventing rUTIs.

Methods: Medline, Embase, and Web of Science were searched from inception to December 2023. Data were collected from cohort studies with a comparator arm and randomised controlled trials (RCTs) investigating vaccination efficacy in adult rUTI patients according to predefined selection criteria (PROSPERO registration: CRD42022356662). A pooled analysis took place for RCTs, with a subgroup analysis for vaccine types and booster regimens. Other studies were synthesised narratively. The risk of bias was assessed using Cochrane Risk-of-Bias tools. The Grading of Recommendations, Assessment, Development, and Evaluations framework evaluated the quality of evidence.

Key findings and limitations: Fourteen comparative studies were selected, including 2822 patients across five vaccination types. The pooled risk ratio of eight placebo-controlled studies of the percentage of patients UTI free in the short term (6-12 mo) was 1.52 (95% confidence interval [CI] 1.05-2.20) with a number needed to treat of 6.45 (95% CI 2.80-64.80). There is substantial heterogeneity and a slight risk of a publication bias.

Conclusions and clinical implications: There is limited evidence to suggest that vaccinations are effective at reducing UTI recurrence in adult female patients in the short term. Owing to low quality of evidence, the literature requires further long-term RCTs with large sample sizes utilising standardised definitions for conclusive evidence of the long-term efficacy of vaccination in rUTI prevention.

Patient summary: We explored whether vaccines could help stop urinary tract infections (UTIs) from happening again. The latest information shows that these vaccines are safe and may help lower the chances of women getting UTIs again for about 6-12 mo.

Keywords: ExPEC4V; Immunostimulants; OM-89; Recurrent urinary tract infections; Solco-Urovac; Strovac; Urinary tract infections; UroVaxom; Uromune; Vaccines.

Publication types

Review