Hormone therapy reduces UTI risk in postmenopausal women: Study
USA: Women taking menopausal hormone therapy are at a lower risk for recurrent urinary tract infections (UTI), according to a recent study. The results of the study were presented at the European Association of Urology 2020 virtual congress.
UTI leads to alterations in the genitourinary (GU) microbiome resulting in less bacterial diversity. This predisposes postmenopausal women to recurrent infections. The composition and function of the GU microbiome of PM women has not been systematically analyzed. Therefore, Nicole De Nisco, University of Texas at Dallas, Dept. of Biological Sciences, Richardson, USA, and colleagues aimed to define and compare the GU microbiomes of three cohorts of PM women (Never UTI, Remittent rUTI, and Relapsed rUTI) by utilizing wholegenome metagenomic sequencing (WGMS) in this cross-sectional study.
For the purpose, the researchers performed WGMS on clean-catch urine from PM women passing strict inclusion criteria for uncomplicated rUTI following IRB approval and patient consent. Women were sorted into cohorts by clinical history of rUTI. "Never UTI" (n=10): no clinical UTI history, "Remittent rUTI" (n=15): rUTI history, no current UTI, "Relapsed rUTI" (n=14): rUTI history, current UTI.
DNA was purified from urine and prepared libraries were sequenced on an Illumina NextSeq 500 generating paired-end reads that were analyzed with custom bioinformatic pipelines for taxonomic enrichment and functional profiling of the detected metagenomes.
Key findings of the study include:
- The diversity of the GU microbiome is diminished in the "Relapsed rUTI" with respect to the "Never UTI" and "Remittent rUTI" cohorts.
- There was a robust association between exogenous estrogen use and enrichment of the genus Lactobacillus in the GU microbiomes of women in "Never UTI" and "Remittent rUTI" cohorts.
- Women not taking estrogen consistently had low or undetectable levels of Lactobacillus.
- Preliminary analysis also revealed differential enrichment of putative protective (e.g. L. crispatus) and non-protective (e.g. L. inners) species in "Never UTI" versus "Remittent rUTI" cohorts.
"This cross-sectional study has revealed a strong association between exogenous estrogen use and enrichment of the genus Lactobacillus. Certain members of the genus Lactobacillus are protective within the cervicovaginal microbiome and may play a similar role in the GU microbiome," wrote the authors. "We thereby conclude that women taking menopausal hormone therapy may be more resistant to urine infections.
Abstract 84 -- "Metagenomic analysis of the genitourinary microbiome of postmenopausal women with recurrent UTI," was presented at theEuropean Association of Urology 2020 virtual congress.