Abstract

Aerobic vaginitis (AV) is a vaginal infectious condition, characterized by a high inflammatory response and/or signs of epithelial atrophy, a decrease in the amount of Lactobacillus spp. and an increase in enteric origin bacteria. AV, often misdiagnosed, is difficult to treat due to the emerging spread of multi-drug resistant bacterial strains. The present study aimed to define the prevalence of AV, to detect causative bacteria and their antimicrobial resistance pattern. Women 10–95 years old, admitted to San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy (in the years 2015–2019) are included in the study. Bacterial identification and antibiotic susceptibility tests were carried out by VITEK® 2. Among 2069 patients, 1176 tested positive for microbial growth. A higher incidence of infection was found in the 55–64 age group. Among the pathogenic strains, 50.4% were Gram-negative, and 49.6% were Gram-positive. Escherichia coli (E. coli) (32.5%) was the most representative strain, followed by Enterococcus faecalis (E. faecalis) (29.4%), Klebsiella pneumoniae (K. pneumoniae) (7.8%) and Enterococcus faecium (E. faecium) (7.7%). E. coli showed high sensitivity to carbapenems and amikacin. K. pneumoniae carbapenems resistance was fluctuating over time. Alarming resistance to vancomycin was not recorded for Enterococci. Both strains were sensitive to teicoplanin, linezolid and tigecycline. Proper diagnosis and an effective therapeutic approach are needed to improve AV management.

Highlights

  • The vaginal microbiota is a complex ecosystem, which forms a mutually beneficial relationship with their host and has a significant impact on women’s health

  • Bacteriocins produced by Lactobacillus spp. are antimicrobial peptides that are toxic to pathogenic bacteria but pose no threat to the healthy vaginal microbiota [3]

  • A vaginal bacterial flora imbalance can result in infections such as vulvovaginal candidiasis (CVV), bacterial vaginosis (BV) or aerobic vaginitis (AV)

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Summary

Introduction

The vaginal microbiota is a complex ecosystem, which forms a mutually beneficial relationship with their host and has a significant impact on women’s health. Lactic acid represents one of the main products of the fermentation processes of glucose It confers an acid pH around 3.8–4.5 on the vaginal region, inhibiting the proliferation of pathogenic bacterial species. Microscopic analysis of vaginal smears shows Lactobacillus spp. deficiency, high load of Gram-positive and/or Gram-negative bacteria and parabasal epithelial cells and/or vaginal leukocytes. The high incidence of AV and drug-resistant bacterial strains highlights the need for better knowledge of AV-causing microorganisms and their antibiotic resistance profiles. The purpose of this retrospective study was to define the most prevalent AV causative aerobic bacteria and their antimicrobial susceptibility profiles isolated in women admitted at San Giovanni di Dio e Ruggi d’Aaragona Hospital, Italy, from 2015 to 2019

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