Cicinelli Ettore, Di Gennaro Francesco, Gesario Antonia, Iachetti Amati Daniela, Guido Giacomo, Frallonardo Luisa, Saracino Annalisa, Vimercati Antonella, Cicinelli Rossana, Nicolì Pierpaolo, Vitagliano Amerigo
Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
J Clin Med. 2025 Jul 9;14(14):4873. doi: 10.3390/jcm14144873.
In the context of the global rise in antimicrobial resistance (AMR), this study aimed to investigate temporal trends in AMR among pathogens isolated from endometrial cultures of patients diagnosed with chronic endometritis (CE). This cross-sectional study included 244 women consecutively diagnosed with CE at the Gynecology Unit of the University of Bari, Italy, between January 2020 and June 2024. Exclusion criteria were (i) previous CE diagnosis or treatment; (ii) antimicrobial use in the month prior to hysteroscopy and biopsy; (iii) use of oral or vaginal prebiotics/probiotics or contraceptives in the three months prior; (iv) known immunosuppression; and (v) hypersensitivity to quinolones or macrolides. CE was diagnosed using hysteroscopy combined with endometrial histology and microbial culture. Specifically, in cases with hysteroscopic signs suggestive of CE, endometrial biopsies were obtained using a Novak curette and processed for histological and immunohistochemical analyses, as well as for microbial identification and antimicrobial susceptibility testing in accordance with EUCAST guidelines. The primary outcomes were the prevalence of CE-associated pathogens and their AMR profiles. The median age at CE diagnosis was 33 years (range 26-44). The most frequently isolated pathogens were (26.2%), (19.3%), and (16.4%). High AMR rates were observed, with increasing trends over time. Ampicillin resistance reached 98.5% (63/64), penicillin resistance 30.8% (16/52), and extended-spectrum beta-lactamase (ESBL) positivity 34.7% (25/72), all with statistically significant trends ( < 0.001). Resistance to commonly used first-line antimicrobials, such as tetracyclines, quinolones, and nitroimidazoles, was also substantial. : This study highlights a significant increase in AMRs among microorganisms responsible for CE between 2020 and 2024. As a result, empirical first-line antimicrobial therapies commonly used to treat patients with CE may be increasingly ineffective in a growing number of cases. This underscores the need for improved and targeted diagnostic and therapeutic strategies to effectively manage CE and prevent treatment failures. Strengthening surveillance systems, implementing antimicrobial stewardship programs, and enhancing patient education may help counter the growing threat of AMR.
在全球抗菌药物耐药性（AMR）上升的背景下，本研究旨在调查从诊断为慢性子宫内膜炎（CE）的患者子宫内膜培养物中分离出的病原体的AMR时间趋势。这项横断面研究纳入了2020年1月至2024年6月期间在意大利巴里大学妇科连续诊断为CE的244名女性。排除标准为：（i）既往有CE诊断或治疗史；（ii）宫腔镜检查和活检前一个月使用过抗菌药物；（iii）在之前三个月内使用过口服或阴道益生元/益生菌或避孕药；（iv）已知免疫抑制；以及（v）对喹诺酮类或大环内酯类过敏。CE通过宫腔镜检查结合子宫内膜组织学和微生物培养进行诊断。具体而言，在有宫腔镜检查体征提示CE的病例中，使用Novak刮匙获取子宫内膜活检组织，并根据欧盟CAST指南进行组织学和免疫组织化学分析，以及微生物鉴定和抗菌药物敏感性测试。主要结果是CE相关病原体的患病率及其AMR谱。CE诊断时的中位年龄为33岁（范围26 - 44岁）。最常分离出的病原体是 （26.2%）、 （19.3%）和 （16.4%）。观察到较高的AMR率，且随时间呈上升趋势。氨苄西林耐药率达到98.5%（63/64），青霉素耐药率30.8%（16/52），超广谱β-内酰胺酶（ESBL）阳性率34.7%（25/72），均具有统计学显著趋势（<0.001）。对常用一线抗菌药物如四环素、喹诺酮类和硝基咪唑类的耐药性也很高。 ：本研究强调了2020年至2024年期间导致CE的微生物中AMR显著增加。因此，常用于治疗CE患者的经验性一线抗菌治疗在越来越多的病例中可能越来越无效。这突出了需要改进和有针对性的诊断和治疗策略，以有效管理CE并防止治疗失败。加强监测系统、实施抗菌药物管理计划以及加强患者教育可能有助于应对AMR日益增长的威胁。
