Vaginal Estrogen Prescription is Associated with Reduced Risk of Serious Adverse Outcomes in Women of All Age Groups with Recurrent Urinary Tract Infection: An Epic Cosmos Database Analysis

Abstract

Objective To explore rates of serious adverse outcomes (sepsis, hospital admission, and death) in women with rUTI who were prescribed vs not prescribed vaginal estrogen. Methods We used the Epic Cosmos database to identify women with rUTI, which we defined as 2 separate coded UTIs within 1-6 months. Vaginal estrogen prescription classification was either (1) never received or (2) received within 2 months of the second UTI. Outcomes were assessed within 8 years of inclusion (second UTI with or without a documented prescription) and included sepsis, hospital admission, and all-cause mortality. Age-stratified odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results Of 1,891,956 females with rUTI, 97,109 (5.1%) received a prescription within 2 months and 1,794,847 (94.9%) did not. Across age groups (20-39, 40-54, 55-69, and 70-99 years), vaginal estrogen prescription was associated with lower odds of sepsis, hospitalization, and death. Sepsis occurred in 4.2%-10.4% of estrogen recipients vs 8.5%-24.1% of nonrecipients (OR 0.2-0.5 across age groups). Hospitalization occurred in 7.5%-12.0% of recipients compared with 15.7%-27.5% of nonrecipients (OR 0.3-0.6). Mortality increased with age in both groups but remained lower among estrogen recipients at 0.3%-3.9% vs 0.8%-9.6% in nonrecipients (OR 0.2-0.4 across age groups). Conclusion Vaginal estrogen prescription within 2 months of rUTI diagnosis is associated with lower odds of serious adverse outcomes across age groups.