Evolving Enterococcus faecalis Biofilms and Urinary Tract Infection Relapse: Does Vaginal Estrogen Matter?

Area of Science:

• Urology
• Gynecology
• Infectious Diseases

Background:

• Recurrent Enterococcus faecalis urinary tract infections (UTIs) are prevalent in postmenopausal women.
• Biofilm formation by E. faecalis may reduce antibiotic efficacy.
• The influence of local vaginal estrogen therapy on UTI susceptibility is not well understood.

Purpose of the Study:

• To compare the treatment outcomes of relapsing E. faecalis UTIs in postmenopausal women, with and without vaginal estrogen therapy, to those in premenopausal women.
• To investigate the role of vaginal estrogen in managing recurrent E. faecalis UTIs.

Main Methods:

• Secondary analysis of a retrospective cohort study (n=71) of female patients with symptomatic, recurrent E. faecalis UTIs.
• Comparison of antibiotic retreatment rates between postmenopausal (estrogen users and non-users) and premenopausal patient groups.
• Descriptive statistics and Fisher exact test were used for data analysis.

Main Results:

• No statistically significant difference in the need for additional antibiotics was observed between postmenopausal and premenopausal patients (10.8% vs 14.3%, P=0.72).
• Rates of additional antibiotic use were similar when comparing postmenopausal estrogen users to premenopausal patients (20% vs 14.3%, P=0.70).
• No significant difference was found between postmenopausal estrogen users and non-users (20% vs 0%, P=0.11).

Conclusions:

• A small proportion of patients with recurrent E. faecalis UTIs required additional antibiotics for relapse.
• Vaginal estrogen therapy did not demonstrate a statistically significant impact on the need for retreatment in postmenopausal women compared to premenopausal women.
• Estrogen status does not appear to significantly influence treatment outcomes for recurrent E. faecalis UTIs.