Objective:

To analyze the association between vaginal estrogen prescribing and rates of sepsis, hospital admission, and all-cause mortality in female patients with recurrent urinary tract infections.

Approach:

• Study Design: An observational, unadjusted database analysis using the Epic Cosmos database, which includes over 1.9 million female patients diagnosed with recurrent urinary tract infections.
• Patient Classification: Patients were classified as vaginal estrogen recipients if they had a prescription within 2 months of their second urinary tract infection.
• Outcome Measures: Outcomes included rates of sepsis, hospital admission, and all-cause mortality within 8 years.

Key Findings:

• 5.1% of patients received vaginal estrogen prescriptions within 2 months of diagnosis.
• Unadjusted rates of sepsis were lower in recipients (4.2% to 10.4%) compared to nonrecipients (8.5% to 24.1%).
• Hospital admission rates were lower in recipients (7.5% to 12.0%) compared to nonrecipients (15.7% to 27.5%).
• All-cause mortality rates were lower in recipients (0.3% to 3.9%) compared to nonrecipients (0.8% to 9.6%).

Interpretation:

The study emphasizes that the observational nature and lack of multivariable adjustment limit causal inferences regarding the association between vaginal estrogen prescribing and adverse outcomes.

Limitations:

• All reported odds ratios were unadjusted due to the observational nature of the study.
• The study could not confirm whether prescriptions were filled or used consistently.
• Mortality data may be underestimated due to reliance on discharge disposition codes.
• The findings may not generalize to under-resourced settings.

Conclusion:

The analysis indicates an association between vaginal estrogen use and improved outcomes in recurrent urinary tract infections, highlighting the need for further research to understand the underutilization of this therapy.