Urinary tract infection (UTI) affects approximately 3% of all women aged 45 to 65 years each year. Although single infections are generally self- limiting and easy to treat, some women suffer from chronic recurring infections. The impact of recurring infections on quality of life can be substantial, resulting in repeated physician visits and disability days. Despite the increasing prevalence of bacteriuria and symptomatic UTI with age, no studies have examined the role of health behaviors or bacterial virulence factors on risk of UTI among older women. Hormonal changes with aging and associated impact on the vaginal flora and peri-urethral environment may explain at least part of the increased risk of UTI with age. There has been some suggestion that supplemental estrogen may increase risk of UTI through conversion of vaginal flora to premenopausal ecology, although others suggest that supplemental estrogen may decrease risk by increasing resistance of urogenital epithelia. It is the overall goal of this study to examine how menopause and associated use of supplemental estrogen modifies the relationships between health behavior, bacterial virulence factors and risk of UTI among White and Non-White women aged 40 to 65.
Aim 1. Describe the associations between health behavior, medical history, menopausal status (pre-, per- or postmenopausal), estrogen use and urinary tract infection among White and Non-White women by comparing the frequency of these characteristics among 1600 women aged 40 to 65 with (n=400) and without (n=1200) physician-diagnosed, culture confirmed symptomatic UTI.
Aim 2. Describe the associations of health behavior, medical history, menopausal state and estrogen replacement therapy with UTI by racial/ethnic group.
Aim 3. Compare the bacterial virulence characteristics of uropathogens causing symptomatic UTI with those of uropathogens causing asymptomatic bacteriuria among controls. UTI has a significant impact upon many women's lives. The role of health behavior, menopause, estrogen replacement therapy, and bacterial virulence factors on UTI risk among 40 to 65 year olds is only beginning to be explored. If the proposed study identifies risk factors which, if modified, could prevent even a small proportion of the 823,000 UTI that occur annually in this age group, this study will have made a significant contribution to women's health.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK047519-01
Application #
3248734
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Project Start
1993-09-30
Project End
1997-08-31
Budget Start
1993-09-30
Budget End
1994-08-31
Support Year
1
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Type
Schools of Public Health
DUNS #
791277940
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Marrs, Carl F; Zhang, Lixin; Foxman, Betsy (2005) Escherichia coli mediated urinary tract infections: are there distinct uropathogenic E. coli (UPEC) pathotypes? FEMS Microbiol Lett 252:183-90
Zhang, Lixin; Foxman, Betsy (2003) Molecular epidemiology of Escherichia coli mediated urinary tract infections. Front Biosci 8:e235-44
Marrs, Carl F; Zhang, Lixin; Tallman, Patricia et al. (2002) Variations in 10 putative uropathogen virulence genes among urinary, faecal and peri-urethral Escherichia coli. J Med Microbiol 51:138-42
Foxman, B; Somsel, P; Tallman, P et al. (2001) Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors. J Clin Epidemiol 54:710-8
Zhang, L; Foxman, B; Tallman, P et al. (1997) Distribution of drb genes coding for Dr binding adhesins among uropathogenic and fecal Escherichia coli isolates and identification of new subtypes. Infect Immun 65:2011-8
Johnson, J R; Russo, T A; Scheutz, F et al. (1997) Discovery of disseminated J96-like strains of uropathogenic Escherichia coli O4:H5 containing genes for both PapG(J96) (class I) and PrsG(J96) (class III) Gal(alpha1-4)Gal-binding adhesins. J Infect Dis 175:983-8
Foxman, B; Zhang, L; Tallman, P et al. (1997) Transmission of uropathogens between sex partners. J Infect Dis 175:989-92