Prevalence and Antimicrobial Susceptibility Profiles of Microorganisms Associated with Lower Reproductive Tract Infections in Women from Southern Poland-Retrospective Laboratory-Based Study.

Jadwiga Wójkowska-Mach,Małgorzata Romanik,Dorota Romaniszyn,Monika Pomorska-Wesołowska

doi:10.3390/ijerph18010335

Abstract

Objective: Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections. The aim of the study was to analyze the etiological factors of the vaginal dysbacteriosis, and the antimicrobial susceptibility of the dominant bacterial and fungal infections in different age groups of outpatient women from the Silesian Region. Materials and methods: A retrospective laboratory-based multi-center study encompassed 4994 women of different ages in Silesian Voivodeship, in the south of Poland; patients who had vaginal swabs collected as per physicians’ orders during the period from 1 January 2017 until 30 June 2018 were included in the study. The inclusion criteria were: non-hospitalized female, aged ≤80, with suspected vulvovaginal candidiasis or bacterial vaginosis and clinical sings of infections. Results: Gram-positive cocci were the ones most often isolated: Enterococcus faecalis (29.2%) and Streptoccoccus agalactiae (13.1%), followed by bacilli from the Enterobacteriaceae group, including Escherichia coli (26.3%). The presence of Streptococcus agalactiae was confirmed in 13.1%, slightly more often in the 45–80 age group, and Gardnerella vaginalis in 6.4%, most often in women aged 15–24. The prevalence of yeast-like infections was 24.3%, Candida albicans accounted for 78.3%, whereas among C. non-albicans spp.—C. glabrata dominated (14.9%) followed by C. parapsilosis (3.8%). The highest resistance was observed only in Streptococcus agalactiae as the MLSB mechanism (Macrolide-lincosamide-streptogramin B) was identified in 38.6% of strains. The prevalence of vulvovaginal candidiasis was 24.3%, the highest in women aged 15–44. Conclusions: Drug resistance in studied vulvovaginitis was associated only with Streptococcus agalactiae. A high proportion of yeast-like aetiology was found, probably associated with recurrent infections. In the analyzed cases only the Amsel criteria and culture methods were used for diagnosis without preparations and microbiological Nugent criteria.

Highlights

The presence of Streptococcus agalactiae was confirmed in 13.1%, slightly more often in the 45–80 age group
It is puzzling that despite the fact that the vaginal flora and vaginal infections have been the topics of interest to physicians and scientists alike, for many years there is still much to be learned and newer scientific reports are continuing to improve our understanding of the vaginal flora and microbiology of infections
This is the case in Poland, where such microbiology and antimicrobial resistance of infections are not described in detail, except for the phenomenon of Streptococcus agalactiae colonization among pregnant women [9,10]

Summary

Introduction

The bacterial flora in the vagina of a healthy woman of reproductive age is dominated by lactobacilli. Besides of Lactobacillus species, the following bacterial genera may be isolated from the female genital tract: Streptococcus, Staphylococcus, Enterococcus, Escherichia and Klebsiella, as well as Candida yeasts. Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections [1,2].

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Conclusion