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Impact of Vaginal Estrogen on Serious Adverse Outcomes in Postmenopausal Women with Recurrent Urinary Tract Infections: A Retrospective Study
Brennan Wells, Bachelor of Science1, Joseph Visingardi, PharmD
2, Elise JB De, MD
2, Paul J. Feustel, MEng, PhD
2.
1Eastern Virginia Medical School, Norfolk, VA, USA,
2Albany Medical College, Albany, NY, USA.
Background Recurrent urinary tract infections (rUTI) are a significant health concern among women, affecting quality of life and resulting in a substantial healthcare burden. Among postmenopausal women, the incidence of rUTI is particularly high, due to physiological changes, including estrogen deficiency, which can lead to alterations in the microbiomes, pH changes, cellular architecture, and coaptation, all of which contribute to vulnerability. Vaginal estrogen reduces UTI recurrence; however, data on its effect in mitigating serious adverse outcomes—such as sepsis and mortality are only just emerging.
Methods IRB approval was obtained. Epic Cosmos data (a cloud-based research platform developed by Epic that aggregates de-identified patient records from Epic EHR systems across multiple healthcare organizations) was used to query 3 year data on 11,054906 female patients with recurrent UTI using versus not using vaginal estrogen along the following adverse outcomes: sepsis, hospital admission, and mortality. Chi-square tests were employed to determine the differences in outcomes.
Results Women over 55 with recurrent UTI who were on vaginal estrogen experienced lower rates of hospitalization, sepsis (10.6% vs 19.4%), and death (0.42% and 1.54%). Aside from an equal, small change in hospitalization rates, these differences were not seen in premenopausal women with rUTI.
Conclusions Women greater than 55 years old with recurrent UTIs who are on vaginal estrogen experience significantly lower rates of hospitalization, sepsis, and mortality.
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