Lower urinary tract infections and the effects of hormone therapy in postmenopausal women in the Zagreb region [Infekcije donjeg dijela mokraćnog sustava i utjecaj hormonskog liječenja u žena u postmenopauzi na području Zagreba]

Hunjak, Blaženka and Findri-Guštek, Štefica and Kolarić, Branko and Fistonić, Ivan and Lukić-Grlić, Amarela and Vojnović, Gordana (2012) Lower urinary tract infections and the effects of hormone therapy in postmenopausal women in the Zagreb region [Infekcije donjeg dijela mokraćnog sustava i utjecaj hormonskog liječenja u žena u postmenopauzi na području Zagreba]. Collegium Antropologicum, 36 (3). pp. 841-846. ISSN 0350-6134

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Abstract

Urinary tract infections (UTI) remain one of the most common bacterial infections seen in adult women of all ages. In postmenopausal women, the aging process contributes to local complaints in the lower urogenital tissue, including UTI. Our study was conducted at gynecological practices of the health centers in the Zagreb region, Croatia, during 2009. The study included postmenopausal women with urinary symptoms divided into two groups: hormone therapy (HT) users and controls. The objectives were to estimate microbiologically proven lower UTIs (LUTIs) in postmenopausal women with urinary symptoms and the effect of regular HT use on microbiologically confirmed LUTIs. Out of 2338 postmenopausal patients, there was a significantly higher rate of women with urinary symptoms in HT users, namely 64.4% (143/221), compared to the control group at 4.8% (102/2116). Of the 245 patients with urinary symptoms, in 58.8% (144/245) the infection was microbiologically confirmed. Hormone therapy users showed a statistically significant lower rate of microbiologically proven LUTIs (46.9%, 67/143) compared to controls (75.5%, 77/102, p < 0.001). Data analysis also showed the efficacy of local as well as systemic HT treatment compared with the control group (p < 0.00, p = 0.049). But there was a significant difference in the frequency of LUTIs between patients who used local (30.3%, 20/66) and systemic (61.1%, 47/77) HT (p < 0.001). The patients who, regulary used therapy, in the local HT group as well as in the group on systemic HT showed a lower incidence of LUTIs compared to controls (p < 0.00, p = 0.006). In patients who did not regulary use therapy, there were no significant differences between either local (63.6%, 7/11)) or systemic (76.9%, 20/26) HT non- regular users and the control group (75. 5%, 77/102) (p = 0.917, p = 0.625). The high percentage of patients with non-microbiologically confirmed LUTIs (41.2%, 101/245) suggested the significant role microbiological testing has in LUTI diagnosis. Both local and systemic HT use was related to LUTI reduction.

Abstract in Croatian

Infekcije mokraćnog sustava (IMS) spadaju među najčešće infekcije žena svih dobi. Kod žena u postmenopauzi, proces starenja doprinosi lokalnim promjenama tkiva donjeg dijela urinarnog sustava, uključujući pojavu IMS. Tijekom 2009. provedena je prospektivna studija u ginekološkim ordinacijama Domova zdravlja na području Zagreba, na skupini žena u postmenopauzi s urinarnim simptomima. Ispitanice su podijeljene u dvije skupine: žene koje uzimaju hormonsko liječenje (HL) i kontrolnu skupinu. Ciljevi ovog rada bili su ustanoviti postotak mikrobiološki dokazanih infekcija donjeg dijela mokraćnog sustava (DIMS) u postmenopauzalnih žena s urinarnim simptomima i utjecaj HL na mikrobiološki potvrđene DIMS kod žena koje redovito/neredovito uzimaju HL. Od ukupno 2338 žena, statistički značajno više žena s urinarnim simptomima bilo je u skupini na HL (64,4%, 143/ 221) nego u kontrolnoj skupini (4,8%, 102/2116, p<0,001). Međutim, od 245 ispitanica s urinarnim simptomima, DIMS je mikrobiološki potvrđena samo u 58,8% (144/245) od njih. U skupini žena na HL bilo je statistički značajno manje pacijentica sa mikrobiološki dokazanom DIMS (46,9%, 67/143) u usporedbi s kontrolama (75,5%, 77/102, p<0,001). Utvrđena je učinkovitost lokalnog ali i sistemskog HL u sprječavanju DIMS u usporedbi s kontrolnom skupinom (p<0,001, p=0,049). Međutim, u skupini na HL, između ispitanica na lokalnom (30,3%, 20/66) i sistemskom liječenju (61,1%, 47/77) ustanovljena je statistički značajna razlika u učestalosti DIMS (p<0,01). U skupini ispitanica koje redovno uzimaju HL, lokalno ili sistemski, također je ustanovljeno statistički značajno manje DIMS nego u kontrolnoj skupini (p<0,0, p=0,06). U skupini koja neredovno uzima HNL nije nađena razlika u učestalosti DIMS između žena na lokalnom (63,%, 7/11) ili sistemskom (76,9%, 20/ 26) HL te kontrolne skupine (75,5%, 77/102, p=0,917, p=0,625). Obzirom da kod velikog broja ispitanica (41,2%, 101/ 245), DIMS nije potvrđena mikrobiološkom pretragom, zaključujemo da je primjena mikrobiološke dijagnostike neophodna za postavljanje točne dijagnoze DIMS. Na smanjenu učestalost DIMS utjecala je primjena lokalnog ali i sistemskog HL.

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