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Predictors of urinary tract infection after menopause: A prospective study

      Purpose

      To describe the incidence of and risk factors for acute cystitis among nondiabetic and diabetic postmenopausal women.

      Methods

      We conducted a population-based, prospective cohort study of 1017 postmenopausal women, aged 55 to 75 years, who were enrolled in a health maintenance organization and followed for 2 years. A wide range of behavioral and physiologic exposures were assessed at baseline interview and follow-up clinic visits; the main outcome measure was microbiologically confirmed acute symptomatic cystitis. Follow-up was 87% at 12 months and 81% at 24 months.

      Results

      During 1773 person-years of follow-up, 138 symptomatic urinary tract infections occurred (incidence, 0.07 per person-year). Independent predictors of infection included insulin-treated diabetes (hazard ratio [HR] = 3.4; 95% confidence interval [CI]: 1.7 to 7.0) and a lifetime history of urinary tract infection (HR for six or more infections = 6.9; 95% CI: 3.5 to 13.6). Borderline associations included a history of vaginal estrogen cream use in the last month (HR = 1.8; 95% CI: 1.0 to 3.4), a history of kidney stones (HR = 1.9; 95% CI: 1.0 to 3.7), and asymptomatic bacteriuria at baseline (HR = 1.8; 95% CI: 0.9 to 3.5). Sexual activity, urinary incontinence, parity, postcoital urination, vaginal dryness, use of cranberry juice, vaginal bacterial flora, and postvoid residual bladder volume were not associated with incident acute cystitis after multivariable adjustment.

      Conclusion

      Insulin-treated diabetes is a potentially modifiable risk factor for incident acute cystitis among postmenopausal women, whereas a lifetime history of urinary tract infection was the strongest predictor. Use of oral or vaginal estrogen was not protective, and a wide range of behavioral and physiologic factors was not associated with acute cystitis episodes in this generally healthy sample.
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      References

        • Foxman B.
        • Barlow R.
        • D’Arcy H.
        • et al.
        Urinary tract infection.
        Ann Epidemiol. 2000; 10: 509-515
      1. Trends in aging—United States and worldwide.
        MMWR Morb Mortal Wkly Rep. 2003; 52 (106): 101-104
        • Hooton T.M.
        • Scholes D.
        • Hughes J.P.
        • et al.
        A prospective study of risk factors for symptomatic urinary tract infection in young women.
        N Engl J Med. 1996; 335: 468-474
        • Raz R.
        • Gennesin Y.
        • Wasser J.
        • et al.
        Recurrent urinary tract infections in postmenopausal women.
        Clin Infect Dis. 2000; 30: 152-156
        • Foxman B.
        • Somsel P.
        • Tallman P.
        • et al.
        Urinary tract infection among women aged 40 to 65.
        J Clin Epidemiol. 2001; 54: 710-718
        • Hu K.K.
        • Boyko E.J.
        • Scholes D.
        • et al.
        Risk factors for urinary tract infections in postmenopausal women.
        Arch Intern Med. 2004; 164: 989-993
        • Brown J.S.
        • Vittinghoff E.
        • Kanaya A.M.
        • et al.
        Urinary tract infections in postmenopausal women.
        Obstet Gynecol. 2001; 98: 1045-1052
        • Counts G.W.
        • Stamm W.E.
        • McKevitt M.
        • et al.
        Treatment of cystitis in women with a single dose of trimethoprim-sulfamethoxazole.
        Rev Infect Dis. 1982; 4: 484-490
        • Gupta K.
        • Stapleton A.E.
        • Hooton T.M.
        • et al.
        Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections.
        J Infect Dis. 1998; 178: 446-450
        • Goode P.S.
        • Locher J.L.
        • Bryant R.L.
        • et al.
        Measurement of postvoid residual urine with portable transabdominal bladder ultrasound scanner and urethral catheterization.
        Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11: 296-300
        • Fuse H.
        • Yokoyama T.
        • Muraishi Y.
        • Katayama T.
        Measurement of residual urine volume using a portable ultrasound instrument.
        Int Urol Nephrol. 1996; 28: 633-637
        • Andersen P.K.
        • Gill R.D.
        Cox’s regression model for counting processes.
        Ann Stat. 1982; 10: 1110-1120
        • Lin D.Y.
        • Wei L.J.
        The robust inference for the Cox proportional hazards model.
        J Am Stat Assoc. 1989; 84: 1074-1078
        • Boyko E.J.
        • Fihn S.D.
        • Scholes D.
        • et al.
        Diabetes and the risk of acute urinary tract infection among postmenopausal women.
        Diabetes Care. 2002; 25: 1778-1783
        • Forland M.
        • Thomas V.
        • Shelokov A.
        Urinary tract infections in patients with diabetes mellitus. Studies on antibody coating of bacteria.
        JAMA. 1977; 238: 1924-1926
        • Ingberg C.M.
        • Palmer M.
        • Schvarcz E.
        • Aman J.
        Prevalence of urinary tract symptoms in long-standing type 1 diabetes mellitus.
        Diabetes Metab. 1998; 24: 351-354
        • Stapleton A.
        Urinary tract infections in patients with diabetes.
        Am J Med. 2002; 113: 80S-84S
        • Patterson J.E.
        • Andriole V.T.
        Bacterial urinary tract infections in diabetes.
        Infect Dis Clin North Am. 1997; 11: 735-750
        • Geerlings S.E.
        • Meiland R.
        • van Lith E.C.
        • et al.
        Adherence of type 1-fimbriated Escherichia coli to uroepithelial cells.
        Diabetes Care. 2002; 25: 1405-1409
        • Geerlings S.E.
        • Meiland R.
        • Hoepelman A.I.
        Pathogenesis of bacteriuria in women with diabetes mellitus.
        Int J Antimicrob Agents. 2002; 19: 539-545
        • Pabich W.L.
        • Fihn S.D.
        • Stamm W.E.
        • et al.
        Prevalence and determinants of vaginal flora alterations in postmenopausal women.
        J Infect Dis. 2003; 188: 1054-1058
        • Hooton T.M.
        • Scholes D.
        • Stapleton A.E.
        • et al.
        A prospective study of asymptomatic bacteriuria in sexually active young women.
        N Engl J Med. 2000; 343: 992-997
        • Bengtsson C.
        • Bengtsson U.
        • Bjorkelund C.
        • et al.
        Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden.
        Scand J Urol Nephrol. 1998; 32: 284-289
        • Harding G.K.
        • Zhanel G.G.
        • Nicolle L.E.
        • Cheang M.
        Antimicrobial treatment in diabetic women with asymptomatic bacteriuria.
        N Engl J Med. 2002; 347: 1576-1583
        • Raz R.
        • Stamm W.E.
        A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.
        N Engl J Med. 1993; 329: 753-756
        • Eriksen B.
        A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women.
        Am J Obstet Gynecol. 1999; 180: 1072-1079
        • Rossouw J.E.
        • Anderson G.L.
        • Prentice R.L.
        • et al.
        Risks and benefits of estrogen plus progestin in healthy postmenopausal women.
        JAMA. 2002; 288: 321-333
        • Rapp S.R.
        • Espeland M.A.
        • Shumaker S.A.
        • et al.
        Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial.
        JAMA. 2003; 289: 2663-2672
        • Shumaker S.A.
        • Legault C.
        • Thal L.
        • et al.
        Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial.
        JAMA. 2003; 289: 2651-2662
        • Oliveria S.A.
        • Klein R.A.
        • Reed J.I.
        • et al.
        Estrogen replacement therapy and urinary tract infections in postmenopausal women aged 45–89.
        Menopause. 1998; 5: 4-8
        • Shortliffe L.M.
        • McCue J.D.
        Urinary tract infection at the age extremes.
        Am J Med. 2002; 113: 55S-66S