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Randomized Controlled Trial
. 2022 Jan 1;28(1):20-26.
doi: 10.1097/SPV.0000000000001051.

Impact of Vaginal Estrogen on the Urobiome in Postmenopausal Women With Recurrent Urinary Tract Infection

Carrie E Jung  1 , Mehrbod Estaki  2 , Jessica Chopyk  3 , Bryn C Taylor  2 , Antonio Gonzalez  4 , Daniel McDonald  4 , Jenny Shin  3 , Kimberly Ferrante  1 , Erika Wasenda  1 , Quinn Lippmann  1 , Rob Knight, David Pride  3 , Emily S Lukacz  1
Affiliations
Randomized Controlled Trial

Impact of Vaginal Estrogen on the Urobiome in Postmenopausal Women With Recurrent Urinary Tract Infection

Carrie E Jung et al. Female Pelvic Med Reconstr Surg. .

Abstract

Objective: The aim of this study was to describe effects of vaginal estrogen (VE) on the urogenital microbiome in postmenopausal women with recurrent urinary tract infections (rUTIs).

Methods: This is a secondary analysis of 17 participants enrolled in a randomized controlled trial of VE versus placebo on urinary tract infection recurrence in postmenopausal women with rUTIs. Paired clean-catch urine samples were collected at baseline and after 6 months of VE and sequenced using 16S rRNA gene sequencing. Sequence reads were analyzed using Quantitative Insights Into Microbial Ecology 2. Changes in α diversity, β diversity, and differentially abundant genera were measured between paired baseline and 6-month samples and between those with a urinary tract infection at 6 months (failures) and those without (successes).

Results: Of the 17 women, 11 were successes and 6 were failures after 6 months of VE treatment. There was a significant change in α diversity from baseline to month 6 in samples overall (Kruskal-Wallis χ2 = 3.47, P = 0.037) and in the treatment success group (Yuen T = -2.53, P = 0.035). The increase in relative abundance of Lactobacillus crispatus, Lactobacillus gasseri, and Lactobacillus iners AB-1 was correlated with month 6. A relative bloom of L. crispatus compared with L. gasseri was associated with treatment success (Kruskal-Wallis χ2 = 4.9, P = 0.0014).

Conclusions: Lactobacillus increases in the urogenital microbiome of postmenopausal women with rUTI after 6 months of VE. However, only the relative increase in L. crispatus specifically may be associated with treatment success.

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Conflict of interest statement

K.F. received grant/research support from Valencia Technologies. E.S.L. is a consultant in Axonics and received grant/research support from Boston Scientific, Cogentix/Uroplasty, and Pfizer, and UpToDate Royalties. The remaining others have declared they have no conflicts of interest.

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