Abnormal vaginal colonization by gram-negative bacteria is significantly higher in pregnancy conceived through infertility treatment compared to natural pregnancy

Significant increased isolation of Escherichia coli in Iranian women with endometriosis: a case control - study

BACKGROUND

The role of bacterial contamination in the development and progression of endometriosis lesions is currently a hot topic for gynecologists. In this study, we decided to compare the endometrial cultures of women affected by endometriosis with those of non-endometriotic women, focusing on specific microbial pathogens.

MATERIAL AND METHOD

In this cross-sectional case-control study, 30 women with endometriosis in stages 4 of the disease whose endometriosis was confirmed based on clinical, ultrasound, and histopathological findings, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases with regular menstrual cycle, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared.

RESULTS

Results of the study indicate that there were no significant differences in terms of age, BMI, smoking, education level, place of residency, use of the intrauterine device, or vaginal douche, and age of menarche between the case and control groups. The only demographic difference observed was in parity, where the control group had a significantly higher parity than the case group (P = 0.001). Out of the 60 cultures, only 15 samples were positive in the endometriosis group, and E. coli was the most prevalent species, with 10 (33.3%) samples testing positive for it. Klebsiella spp. and Enterobacteria spp. were also detected in 3 (10.0%) and 2 (6.7%) samples, respectively. The comparison between the two groups showed that only E. coli had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. It was observed that parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001).

CONCLUSION

Based on The high occurrence of E. coli in women with endometriosis, along with its potential involvement in the progression and/or recurrence of this condition, the researchers propose that treating women with endometriosis and recurrent IVF failure, as well as those with endometriosis recurrence after surgical treatment, with suitable antibiotics and repeated culture until the culture becomes negative, could be beneficial.

Growing threat of extended-spectrum β-lactamase-producing Enterobacteriaceae colonisation in high-risk pregnancies: A cross-sectional study

OBJECTIVE

To investigate the epidemiological changes in extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) vaginal colonisation in pregnant women deemed at high risk, and to identify independent risk factors. Further, the differences in perinatal outcomes according to maternal ESBL-E vaginal colonisation were analysed.

DESIGN

Cross-sectional study.

SETTING

Republic of Korea.

POPULATION

A cohort of 1460 women admitted to our high-risk pregnancy unit between 14⁺⁰ and 36⁺⁶  weeks of gestation.

METHODS

The trend of changes in the association of ESBL-E vaginal colonisation from January 2010 to December 2020 was analysed. The main outcomes were analysed over the study period and ESBL-E vaginal colonisation.

MAIN OUTCOME MEASURES

Rate of ESBL-E vaginal colonisation, risk factors for ESBL-E vaginal colonisation and perinatal outcomes.

RESULTS

The ESBL-E vaginal colonisation rate has tended to increase over the past 11 years, which was attributed to a significantly higher proportion of ESBL-producing Escherichia coli. Cerclage (RR 3.7, 95% CI 2.19-6.40) and prior antibiotic treatment (RR 4.0, 95% CI 2.44-6.54) were found as independent risk factors for ESBL-E vaginal colonisation. Earlier gestational age at delivery and higher proven early-onset neonatal sepsis (EONS) rate were observed in the ESBL-E-positive group.

CONCLUSIONS

The ESBL-E vaginal colonisation rate in pregnant patients at high risk has increased over the past decade, and the independent risk factors for colonisation are cerclage and prior antibiotic treatment. Additionally, maternal ESBL-E vaginal colonisation is associated with higher rates of proven EONS.

Maternal Baseline Risk Factors for Abnormal Vaginal Colonisation among High-Risk Pregnant Women and the Association with Adverse Pregnancy Outcomes: A Retrospective Cohort Study

Abnormal vaginal colonisation can lead to adverse pregnancy outcomes such as preterm birth through intra-amniotic inflammation. Despite the concern, little is known about its risk factors and impact in pregnant women at high-risk for spontaneous preterm birth. Thus, we conducted this single-centre retrospective cohort study including 1381 consecutive women who were admitted to the high-risk pregnancy unit. The results of vaginal culture at admission were categorised according to the colonising organism: bacteria (Gram-negative or -positive) and genital mycoplasmas. Maternal baseline socioeconomic, and clinical characteristics, as well as pregnancy, delivery, and neonatal outcomes were compared according to the category. Maternal risk factors for Gram-negative colonisation included advanced maternal age, increased pre-pregnancy BMI, a greater number of past spontaneous abortions, earlier gestational age at admission, and IVF. Gram-positive colonisation was likewise associated with earlier gestational age at admission. Genital mycoplasmal colonisation was associated with a greater number of past induced abortions, a lower level of education completed, and a lower rate of multifetal pregnancy and IVF. The neonates from mothers with Gram-negative colonisation had a greater risk of NICU admission, proven early onset neonatal sepsis, and mortality. However, not Gram-positive bacteria or genital mycoplasma was directly associated with adverse pregnancy outcomes.

Incidence of symptomatic aerobic vaginitis among some Iraqi women in Baghdad city

Aerobic vaginitis (AV) is a newly adopted type of vaginal infection caused by aerobic bacteria; it was defined by Donders in 2002 and diagnosed according to Donder's criteria. AV is associated with increased vaginal pH, decreased vaginal microbiota and overgrowth of facultative anaerobic or aerobic bacteria, including Gram-positive cocci and Gram-negative bacilli. Because knowledge of the aerobic bacterial types causing AV is very important and only limited studies are available in Iraq about this type of vaginal infection, this study aimed to report the prevalence of AV in symptomatic women in Baghdad City, investigate the aerobic bacterial types associated and to evaluate the most critical symptoms and risk factors associated with AV. One hundred fifteen high vaginal swabs (HVSs) and 115 vaginal swabs (VSs) were collected from women of age 18-50 years attending some hospitals and private clinics in Baghdad City under the supervision of a competent gynecologist. Vaginal swabs were prepared for direct wet mount preparation to test under the microscope and Gram staining for AV identification according to Donders Criteria. High vaginal swabs were cultured on different culture media; the primary diagnosis of obtained colonies was based on phenotypic characteristics, conventional biochemical tests and Gram staining. The diagnosis was confirmed using Gram-positive (GP) and Gram-negative (GN) identification cards of the VITEK 2 System. Statistical analysis was carried out using (SPSS v 20) and p-value ≤ 0.05 at 95% CI was considered statistically significant. Out of the 115 swabs, only 89 (77.3%) swabs showed bacterial growth. Ninety-five bacterial isolates were obtained, including (65.2%) Gram-positive and (34.7%) Gram-negative bacteria. G+ve bacterial isolates included: (46.3%) Staphylococcus spp., (6.3%) Kocuria spp., (6.3%) Enterococcus spp., (5.2%) Micrococcus luteus and (1.0%) of Streptococcus agalactiae. G-ve bacterial isolates included (15.7%) Escherichia coli, (11.2%) Klebsiella pneumoniae, (3.2%) Pseudomonas aeruginosa (3.2%) Pseudomonas aeruginosa, (2.1%) Acinetobacter baumannii and (2.1%) Proteus mirabilis. More than half (58.4%) of patients showed severe AV. Mixed bacterial infections were reported in 6 (6.7%) cases only. Vaginal pH ranged between (5.5- 6.5). The most frequent(100%) testified symptoms were abnormal vaginal discharge and itching, or irritation, the less frequent symptoms (51.6%) was vaginal dyspareunia, and the most significant symptoms in associated with different bacterial types and age groups were foul smelling and burning (p= 0.001, 0.008, 0.0001). Among the risk factors, age was significantly associated with most bacterial types obtained with p values (0.05 and 0.02). Staphylococcus spp. and E.coli were the predominant bacterial types in AV patients in the current study, and the lower rate of bacteria was Streptococcus agalactiae (1.0%). A high prevalence of AV was reported; therefore, regular screening and proper diagnosis of AV using microscopic examinations, culturing of swabs and determining vaginal pH using specific vaginal pH test strips should be stimulated to develop AV management. Keywords: High vaginal swabs, Vaginal swabs, Aerobic vaginitis, aerobic G+ve and G-ve bacteria, Risk factors, Iraq.

Differential impact of abnormal vaginal colonization on perinatal outcome and association with early-onset neonatal sepsis: preterm labor vs. preterm premature rupture of membrane

OBJECTIVE

The purpose of this study was to check whether the impact of abnormal vaginal colonization on perinatal outcomes would be different in patients with preterm labor (PTL) and premature membrane rupture (PPROM). We also sought to determine the concordance rate of microorganisms isolated from the maternal vagina and neonatal blood in cases of early-onset neonatal sepsis (EONS) in PTL and PPROM.

METHODS

This retrospective study included 996 singleton pregnancies who were admitted to the high risk care unit of our institution due to PTL (n = 519) or PPROM (n = 477) and underwent vaginal culture examination at admission between January 2005 and April 2019. Abnormal vaginal colonization was defined upon isolation of aerobic microorganisms. The maternal baseline characteristics, delivery, and neonatal outcomes were compared according to the presence or absence of abnormal vaginal flora, both in PTL and PPROM.

RESULTS

The rate of abnormal vaginal colonization in PTL and PPROM was 17.0 and 21.4%, respectively. Both in PTL and PPROM, the gestational age at admission was lower in the abnormal vaginal colonization group (PTL, 27.2 ± 3.5 vs. 28.2 ± 3.5 weeks, p = .024; PPROM, 26.1 ± 5.3 vs. 27.5 ± 4.5 weeks, p = .007). Multivariable analysis demonstrated that the group with abnormal bacteria in PPROM but not in PTL had a significantly higher rate of EONS than the group without abnormal bacteria after adjustment for confounders including gestational age at admission (PPROM, odds ratio, OR [95% confidence interval, CI]: 4.172 [1.426-12.206]; PTL, OR [95% CI]: 0.661 [0.079-5.505]). Concordance analysis showed that the maternal vaginal bacteria colonization by Escherichia coli (5.9 vs. 0.5%, p = .033) and Staphylococcus aureus (14.3 vs. 0.2%, p = .032) in PPROM was significantly correlated with the microorganisms from the neonatal blood culture EONS cases. In PTL, no specific microorganisms showed concordance between maternal vaginal bacteria and microorganisms causing EONS.

CONCLUSION

Our data showed that maternal vaginal colonization in PPROM, but not in PTL, is an independent risk factor for EONS.

Vaginal colonisation of women in labour with potentially pathogenic bacteria: a cross sectional study at three primary health care facilities in Central Uganda

BACKGROUND

Potentially pathogenic bacteria that colonise the lower genital tract of women in labour can be passed to the baby during birth. While many babies become colonised with these bacteria after delivery, a few develop neonatal infections. The lower genital tract is a reservoir for potential pathogens and a source of infection for neonates. We determined the prevalence of vaginal colonisation of potentially pathogenic bacteria among women in labour in Central Uganda and identified potential risk factors associated with this colonisation.

METHODS

We conducted a cross sectional study at three primary health care facilities and collected vaginal swabs from HIV-1 negative women in labour. Specimens were cultured on different selective microbiological media, and biochemical tests were used to classify bacterial isolates on the species level. Multivariable logistic regression analyses were used to estimate the association between relevant exposures and colonisation with potentially pathogenic bacteria.

RESULTS

We recruited 1472 women in labour whose mean age was 24.6 years (standard deviation [SD] 4.9). Of these, 955 (64.9%; 95% Confidence Interval [CI] 62.4, 67%) were vaginally colonised with at least one potentially pathogenic bacterial species. The most commonly isolated species were Escherichia coli (n = 508; 34.5%), Klebsiella pneumoniae (n = 144; 9.8%) and Staphylococcus aureus (n = 121; 8.2%). Results from exploratory multivariable regression analyses indicated that having had ≥5 previous pregnancies (adjusted odds ratio [aOR] 0.59; 95% CI 0.35, 0.97) or being ≥30 years old (aOR 1.52; 95% CI 1.03, 2.23) could be associated with vaginal colonisation with any potentially pathogenic bacteria, as well as with vaginal colonisation with S. aureus (aOR 0.33; 95% CI 0.12, 0.88, and aOR 2.17; 95% CI 1.17, 4.00, respectively). Possession of domestic animals in a household (aOR 0.57; 95% CI 0.35, 0.92) could be associated with vaginal colonisation with E. coli.

CONCLUSIONS

Two-thirds of HIV-1 negative women in labour were vaginally colonised by potentially pathogenic bacteria, mainly E. coli, K. pneumoniae, and S. aureus.

Prospective study of bidet toilet use: Association of abnormal vaginal colonization and preterm birth in high-risk pregnant women

AIM

This study aimed to evaluate the association of bidet toilet use with abnormal vaginal microbial colonization and preterm birth (PTB) in high-risk pregnancies.

METHODS

This is a prospective cohort study of 208 women, who were admitted to a high-risk pregnancy unit, due to preterm labor, preterm premature rupture of the membrane, or short cervical length, in two tertiary hospitals from April 2015 to July 2017. Responses to a questionnaire about using bidet toilet and vaginal culture were obtained upon admission. Maternal baseline characteristics, vaginal culture results, and pregnancy and neonatal outcomes were compared between bidet toilet users and nonusers.

RESULTS

Among the 204 subjects, 67 (32.8%) women were identified as bidet toilet users. Overall, bidet toilet use was associated with a higher rate of abnormal vaginal microbial colonization, compared to the nonusers (60.7% vs 44.2%, P = 0.036). Notably, Escherichia coli colonization rate was significantly higher in bidet toilet users than nonusers (13.1% vs 3.3%, P = 0.023). Bidet toilet users had a significantly higher rate of PTB before 37 weeks of gestation, compared to the nonusers (87.3% vs 73.0%, P = 0.040).

CONCLUSION

Our study suggests that chronic use of a bidet toilet is associated with a higher rate of abnormal vaginal colonization by Gram-negative bacteria and PTB in high-risk pregnancies.

Prevalence of vaginal microorganisms among pregnant women according to trimester and association with preterm birth

Objective

The aim of this study was to investigate the prevalence of abnormal vaginal microorganisms in pregnant women according to trimester, and to determine whether the presence of abnormal vaginal colonization is associated with higher risk of miscarriage or preterm delivery. Furthermore, we analyzed delivery outcomes according to individual microorganism species.

Methods

We included pregnant women who underwent vaginal culture during routine prenatal check-up between January 2011 and June 2016. We compared delivery outcomes according to the presence or absence of abnormal vaginal flora grouped by trimester.

Results

This study included 593 singleton pregnancies. We classified participants into 3 groups, according to the trimester in which vaginal culture was performed; 1st trimester (n=221), 2nd trimester (n=138), and 3rd trimester (n=234). Abnormal vaginal colonization rate significantly decreased with advancing trimester of pregnancy (21.7% for 1st, 21.0% for 2nd, 14.5% for 3rd; P=0.048). Abnormal vaginal colonization detected in the 2nd trimester but not in 1st trimester was associated with a significant increase in preterm delivery before 28 weeks of gestation (6.9% vs. 0%; P=0.006). Among abnormal vaginal flora isolated in the 2nd trimester, the presence of Klebsiella pneumonia was identified as significant microorganism associated with preterm delivery before 28 weeks of gestation (50% vs. 0.7% for K. pneumonia; P=0.029).

Conclusion

There is an association between abnormal vaginal colonization detected in the 2nd trimester and preterm delivery before 28 weeks. K. pneumonia has been identified as the likely causative microorganisms.

Eve's garden: myths, legends and secrets unmasked

This special issue of Research in Microbiology aims to provide some insights in one of women's most fascinating interacting microbial communities: the vaginal microbiome. Even in the 21st century, with many advanced methods at hand, the definition of the healthy vaginal microbiome remains under debate. The interest in studying the dysbiosis of the vaginal microbiome is increasing and goes well beyond the study of bacterial vaginosis. The selection of contributions in this issue summarizes what is currently known in terms of inter- and intra-microorganisms interaction as well as the virulence factors that some of them may deploy.