Impact of Menopausal Status on Uropathogen Prevalence and Antimicrobial Resistance Profiles

Abstract

Objectives The unique factors associated with urinary tract infections (UTIs) in postmenopausal (PMP) women have been significantly less investigated as compared with premenopausal (PreMP) women. Our objective was to compare the prevalence of uropathogens and antibiotic resistance patterns between PreMP and PMP women with UTIs. Methods This was a cross-sectional analysis of PreMP and PMP women treated for a UTI in a urogynecologic practice between November 2016 and November 2017. Diagnostic criteria for UTI included lower urinary tract symptoms and a positive urine culture. Our primary outcome was proportion of non–Escherichia coli UTIs between groups. Results We had 370 women with mean (SD) age of 66.7 (12.8) years and body mass index of 29.1 (7.1) kg/m2. Most women were PMP (88.6%). Postmenopausal status did not increase the proportion of non–E. coli UTI (42.7% PMP vs 33.3% PreMP, P = 0.25) or decrease the proportion of pansensitive UTI (36.0% PMP vs 42.9% PreMP, P = 0.38). In multivariable analysis, women with a history of rUTI were at higher odds of having a non–E. coli UTI (adjusted odds ratio, 1.93; 95% confidence interval, 1.21–3.08; P = 0.01) and at lower odds of pansensitive urine culture (adjusted odds ratio, 0.37; 95% confidence interval, 0.22–0.63; P < 0.01) as compared with those without rUTI, when controlling for confounders. Postmenopausal women with a history of rUTI had the highest proportion of non–E. coli UTIs (51.1%, P < 0.01) and lowest proportion of pansensitive uropathogens (29.1%, P < 0.01) as compared with other PMP women and PreMP without a history of rUTI. Conclusions In a urogynecologic population, a history of rUTI, more than menopausal status, significantly impacted the prevalence of specific uropathogens and resistant organisms.

Sporadic compared to recurrent urinary tract infections: Considerations for urogynecologic patients

“…Together, these factors increase the chance that microbes with uropathogenic capability establish residence in the vagina. 6 There are mixed results in the literature regarding the impact of menopausal status on uropathogen prevalence and antimicrobial resistance profiles 7,8 and further investigation is necessary.…”

Home urinary tract infection testing: patient experience and satisfaction with polymerase chain reaction kit

“…Additionally, our results surrounding proportion of uropathogens are consistent with the literature, despite a small sample size. Studies from our institution that evaluated urine cultures in symptomatic UTI patients revealed similar uropathogens with high resistance patterns, especially in women with rUTI [ 10 , 11 ]. Additional research to compare traditional urine cultures with the multiplex PCR home UTI test is necessary along with prospective studies to determine symptomatic response after treatment.…”