Efficacy of vaginal estrogens in the prevention of recurrent urinary tract infections in hypoestrogenic women.
This multicenter retrospective review investigated the effect of vaginal estrogen on the incidence of recurrent urinary tract infection (UTI) in 5638 women.Vaginal estrogen causes 51.9% reduction in urinary tract infections (Frequency, 3.9 vs 1.8; P < 0.001). Interestingly, the high adherence group had the least reduction in the number of UTIs.
For women with recurrent UTIs, it is reasonable to add vaginal estrogen to the treatment plan. More research is needed to determine the exact treatment options that are most effective in reducing UTIs.
Vaginal estrogens for the prevention of recurrent urinary tract infections
To analyze the relationship between vaginal estrogen use and the frequency of culture-confirmed urinary tract infections (UTIs) in women with: hypoestrogenism.
Estrogen receptor concentrations were similar in the urethra and distal vagina. Conditions leading to estrogen deficiency lead to decreased vaginal lactobacilli, elevated pH, and subsequent colonization with Gram-negative uropathogens.Topical estrogen reintroduction reduces vaginal pH and promotes colonization Lactic acid bacteria.
The cohort included 5,638 women with a mean age of 70.4 ± 11.9 years, a BMI of 28.5 ± 6.3 kg/m², and a baseline UTI rate of 3.9 ± 1.3 per year (defined as at least one uropathogen with at least 1000 colonies) – forming units). per mL, separated from another culture by at least 14 days).
main result
women with recurrent urinary tract infection People who took at least one vaginal estrogen prescription (including rings, creams and tablets) had a 52 percent reduction in the frequency of UTIs over the following year.
Baseline frequency of UTIs, age greater than 75 years, urinary incontinence or retention, and diabetes mellitus were associated with an increased risk of post-prescription UTIs.
Participants with the highest adherence to vaginal estrogen showed the smallest relative reduction in UTI frequency, which may be due to selection bias, unmeasured confounders, and attrition bias.
This study adds to the external validity of existing clinical practice guideline data and supports the use of vaginal estrogens as prophylactic treatment in women with recurrent UTIs, which can ease the use of both curative and prophylactic antibiotics.
summarize
background
Vaginal estrogen considered standard treatment for preventing recurrent urinary tract infections in women hypoestrogenism. However, the literature supporting its use is limited to small clinical trials with limited generalizability.
Purpose
The aim of this study was to assess the relationship between vaginal estrogen prescriptions and the frequency of urinary tract infections in the following year in different groups of women with low estrogen levels. Secondary objectives included assessing medication adherence and predictors of post-prescription urinary tract infection.
study plan
This multicenter retrospective review included women who were treated with vaginal estrogen for recurrent urinary tract infection between January 2009 and December 2019.
this recurrent urinary tract infection Defined as ≥3 positive urine cultures (at least 14 days apart) within the 12 months preceding vaginal estrogen prescription. Patients were required to fill their prescriptions and continue to receive care within the Kaiser Permanente system of Southern California for at least one year.