H2O2-PRODUCING LACTOBACILLI AND POSTMENOPAUSAL UTI

描述（改编自应用程序） 尿路感染每年影响超过700万妇女， UTI的发病率随着年龄的增长而增加。虽然取得了显著的进步， 在我们对年轻成年女性UTI发病机制的理解中， 绝经后妇女中UTI发病机制和流行病学仍然 对这一问题的了解甚少，特别是在非机构化群体中， 人口阴道定植E.大肠杆菌已经被证明是一种重要的 UTI之前的事件，并且在绝经后女性中非常普遍。在 体外研究表明，正常阴道分泌物的主要成分 产H_（20）_2的乳酸杆菌植物群对E.杆菌我们最近的数据 事实证明，存在着一种相反的关系， 产H2 O2乳酸杆菌和E.大肠杆菌阴道定植 复发性UTI的绝经前女性。然而， 产H2 O2乳酸杆菌与阴道E.杆菌 在绝经后妇女中， 被定性。一项对发生率和风险的前瞻性评价 1000名社区居住的绝经后妇女中UTI的因素（DK 43134， 斯蒂芬·D Fin，MD，MPH）已在 普吉湾，一个位于华盛顿西部的以人口为基础的健康维护组织。基于我们 在绝经前妇女中的发现，我们建议进行更多的研究， 使我们能够（1）确定阴道乳酸杆菌的流行率， 绝经后妇女的H202状态和物种特征;（2） 研究产H202乳酸杆菌与E.杆菌 阴道定植;（3）将此信息与UTI的发病率联系起来， 绝经后妇女无症状菌尿的暴露 如雌激素使用、糖尿病和抗菌药物使用;（4）评估 尿毒力基因在E.大肠杆菌菌株引起膀胱炎， 绝经后妇女;（5）评估使用避孕套的可行性 益生菌预防绝经后妇女的UTI。这些额外的研究将 需要流行病学、生物统计学和实验室方法相结合 结合结构化教学和课堂教学， 为候选人的发展提供良好的培训体验 成为一个成功的独立的临床研究者

DESCRIPTION (adapted from the application) Urinary tract infections affect over 7 million women per year, and the incidence of UTI increases with advancing age. Although marked strides have been made in our understanding of the pathogenesis of UTI in young adult women, the pathogenesis and epidemiology of UTI among postmenopausal women remain poorly understood, especially among the non-institutionalized segment of the population. Vaginal colonization with E. coli has been shown to be an important event preceding UTI, and it is highly prevalent in postmenopausal women. In vitro studies suggest that the predominant constituents of normal vaginal flora, H202-producing lactobacilli, are inhibitory to E. coli. Our recent data demonstrate that there is, indeed, an inverse relationship between the presence of H202-producing lactobacilli and E. coli vaginal colonization in premenopausal women with recurrent UTI. However, the prevalence of H202-producing lactobacilli, and their relationship to vaginal E. coli colonization and to the incidence of UTI among postmenopausal women has not been characterized. A prospective evaluation of the incidence of and risk factors for UTI in 1000 community-dwelling postmenopausal women (DK43134, Stephan D. Fin, MD, MPH) has been initiated at the Group Health Cooperative of Puget Sound, a population-based HMO in western Washington. Based on our findings in premenopausal women, we are proposing additional studies which will enable us to (1) establish the prevalence of vaginal lactobacilli, characterized by H202 status and by species, in postmenopausal women; (2) examine the relationship between H202-producing lactobacilli and E. coli vaginal colonization; (3) relate this information to the incidence of UTI and asymptomatic bacteriuria in postmenopausal women while accounting for exposures such as estrogen use, diabetes, and antimicrobial use; (4) assess the prevalence of urovirulence genes in E. coli strains causing cystitis in postmenopausal women; and (5) assess the feasibility of using a lactobacillus probiotic to prevent UTI in postmenopausal women. These additional studies will entail a combination of epidemiological, biostatistical, and laboratory methods which, in combination with structured didactic and classroom instruction, will provide an excellent training experience for the development of the Candidate into a successful, independent, clinical investigator.