[NP-Clinical] MRSA UTI

Tue Jan 16 07:33:04 PST 2007

In recent years, several large scale studies - including WHI - found an increase in both the incidence and severity of urinary incontinence among women using HT. I looked around for some of my references and included them below......

My first experience with this was personal.....about 10 years ago, after my hyst, and while experimenting with various estrogens, I noticed that I was suddenly becoming incontinent - both stress and urge! I was 45 and thought it was strange that it coincided with my estrogen use since we all were led to believe that it was estrogen deficiency that contributed to incontinence. I blamed it on having an almost 10 lb baby 15 years prior......but once I stopped estrogen - after about a year - my problems with incontinence magically disappeared! I have never had a problem since that time........I am very thin and have a generally low estrogen effect - deliberately. Although I will notice a slight problem after spending a weekend with a few bottles of wine :)).

The exact mechanism behind this is unclear .........but the data is certainly starting to support my experience and the experience of other women I have had the opportunity to work with since then. Incontinence is indeed a multifactoral problem - but this is one possibility that should be included in the equation.

References

Obstet Gynecol. 2006 Oct;108(4):855-62.  

Predictors of urinary incontinence in a prospective cohort of postmenopausal women.

Prescrire Int. 2006 Aug;15(84):137-8. 

Hormone replacement therapy aggravates postmenopausal urinary incontinence.

Effects of estrogen with and without progestin on urinary incontinence.

JAMA. 2005 Feb 23;293(8):935-48

Obstet Gynecol. 2004 Feb;103(2):254-60.  

Postmenopausal hormone therapy and risk of developing urinary incontinence.

J Urol. 2006 Oct;176(4 Pt 1):1493-9

Patient related risk factors for recurrent stress urinary incontinence surgery in women treated at a tertiary care center.

THIS ONE WAS INTERESTING - IT DID NOT MENTION ESTROGEN...BUT DID FIND THAT WOMEN WHO SMOKED WERE AT DECREASED RISK FOR INCONTINENCE ...SMOKING LOWERS ESTROGEN EFFECT!!

Pat Camillo PhD,RN,APN,C
Certified Nurse Practitioner in Women's Health,
Gerontology and Menopause
Carmenta Health
1 Kalisa Way Suite 103
Paramus, New Jersey 07652
(201) 265-9042

  ----- Original Message ----- 
  From: mary.beck 
  To: NP Clinical 
  Sent: Monday, January 15, 2007 11:58 AM
  Subject: Re: [NP-Clinical] MRSA UTI

  Hi Pat,
    Very interesting what you said about high estrogenic effect causing problems with urinary incontinence. I know urinary incontinence can be multifactorial, but could you speak specifically about estrogenic effect?

  Thanks,
  Mary Beck, NP
    ----- Original Message ----- 
    From: Pat Camillo 
    To: NP Clinical 
    Sent: Monday, January 15, 2007 8:21 AM
    Subject: Re: [NP-Clinical] MRSA UTI

    Hi Christine,

    Here are some thoughts about your mom.......

    First of all, I think it was inappropriate for her provider to treat her recent and assumed UTI without a culture - esp since she has so many..........in the dhort term, I would keep her on antibiotics through the surgery and immediate post op phase and make sure the culture is clear.

    In the long term, I would explore why she is having so many UTI's. Something that few people ever consider is a woman's estrogen effect. Contrary to older beliefs, it is a HIGH estrogen effect that can contribute to problems with incontinence. High endogenous estrogen also makes DJD worse and is perhaps even part of the pathology. I am thinking that if she had a bone scan, it is unlikely that she has osteopenia or osteoporosis......I am also thinking that she is likely overweight and this may be the cause of her increased estrogen. If she doesn't fit this profile there are other possibilities......let me know. 

    Good luck! 

    Pat

    Pat Camillo PhD,RN,APN,C
    Certified Nurse Practitioner in Women's Health,
    Gerontology and Menopause
    Carmenta Health
    1 Kalisa Way Suite 103
    Paramus, New Jersey 07652
    (201) 265-9042

      ----- Original Message ----- 
      From: Christine Smith 
      To: NP Clinical 
      Sent: Saturday, January 13, 2007 7:10 PM
      Subject: Re: [NP-Clinical] MRSA UTI

      I have no thoughts on this, and certainly you are our women's health resident expert so I hope someone has some ideas that you have not considered. However, I have another UTI problem. 

      My mother, 69 yo, has frequent UTIs ever since a bladder rupture, S/P motorcycle accident about 10 years ago (my parents were Harley lovers). Anyway, she had severe urge and stress incontinence - was urinating nearly every hour and was always unresponsive to Detrol, Ditropan etc.. She has seen multiple urologists and they felt a cath would be the best option until she did find a female urologist in Portland who did some sort of bladder/urethral repair last Spring.  The incontinence resolved but she has continued to have urgency and was ultimately learning to live with it. 

      NOW, she is scheduled for a knee replacement 1/31. Her orthopod is adamant no infections, including UTIs, or no surgery. She had her pre-op last week and was found to have another UTI and the Pre-op NP put her on Bactrim. No culture was done, and I don't think my mom was clear to the NP on just how bad and frequent her UTIs get. She is now down here in California with me for one week and has worsened. Peeing every hour - driving her nuts, and driving me nuts too. I took a urine sample to work and spun  it - only RBCs. No leukos, nitrites or bacteria. I had switched her to Cipro and after seeing the results of the UA opted to just have her finish the Cipro anyway. 

       No pain, just urgency and frequency. No CVAT. Feels otherwise well. Only on Lipitor and Fosamax and was just started on Atenolol 25mg for  very mildly elevated BP - 136/84. No other health issues except the bladder and DJD.

      With just RBCs it seems I should not need to do a urine culture, right? I can order one for her so she has the results by Tuesday or so - she does not return home until next Monday and so I want to do as much as possible. 

      Thoughts?

      Christine Smith, NP
      Antioch, CA
        ----- Original Message ----- 
        From: Pat Camillo 
        To: NP Clinical 
        Sent: Saturday, January 13, 2007 6:53 AM
        Subject: [NP-Clinical] MRSA UTI

        Recently saw a woman who had been having 2-3 UTI's a year, ran a culture - came back MRSA.......tx with cipro which was found to be sensitive.......she also complains of vulvar burning .....tx with terazole thinking it was yeast following multiple antibiotic therapies......some relief but not gone. I'm beginning to wonder if perhaps the vulvar complaint might be related to the MRSA.....

        Any thoughts would be appreciated :)

        Pat

        Pat Camillo PhD,RN,APN,C
        Certified Nurse Practitioner in Women's Health,
        Gerontology and Menopause
        Carmenta Health
        1 Kalisa Way Suite 103
        Paramus, New Jersey 07652
        (201) 265-9042

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    FnP Associates offers a complimentary continuing education program.
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    Receive 6.0 Contact Hours of Pharmacology
    NPCENTRAL.NET/CE/PAIN

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