Efficacy of Vaginal Estrogen for Recurrent Urinary Tract Infection Prevention in Hypoestrogenic Women
Abstract
BACKGROUND
Vaginal estrogen is considered the standard of care for recurrent urinary tract infection prevention in hypoestrogenic women. However, the literature supporting its use is limited to small clinical trials with narrow generalizability.
OBJECTIVES
The primary objective of this study was to assess the association between vaginal estrogen prescription and the frequency of urinary tract infections over the following year in a diverse population of hypoestrogenic women. Secondary objectives included evaluation of medication adherence and predictors of post-prescription urinary tract infection.
STUDY DESIGN
This multicenter retrospective review included women who were prescribed vaginal estrogen for the indication of recurrent urinary tract infection from January 2009 through December 2019. Recurrent urinary tract infection was defined as three or more positive urine cultures (separated by at least 14 days) in the 12 months preceding index vaginal estrogen prescription. Patients were confirmed to fill their prescriptions and continue care within Kaiser Permanente Southern California for at least one year. Exclusion criteria included anatomic abnormalities, malignancy, or mesh erosion of the genitourinary tract. Data on demographics, medical comorbidities, and surgical history were collected. Adherence was captured through refill data after the index prescription. Low adherence was defined as no refills; moderate adherence was defined as one refill; high adherence was…
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