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. 2021 Sep 20;10(9):1133.
doi: 10.3390/antibiotics10091133.

Prevalence and Antibiotic Resistance Profile of Bacterial Pathogens in Aerobic Vaginitis: A Retrospective Study in Italy

Enrica Serretiello  1 , Biagio Santella  1 , Veronica Folliero  2 , Domenico Iervolino  3 , Emanuela Santoro  4 , Roberta Manente  1 , Federica Dell'Annunziata  2 , Rossella Sperlongano  2 , Valeria Crudele  1 , Anna De Filippis  2 , Massimiliano Galdiero  2 , Gianluigi Franci  4   5 , Giovanni Boccia  4   5
Affiliations

Prevalence and Antibiotic Resistance Profile of Bacterial Pathogens in Aerobic Vaginitis: A Retrospective Study in Italy

Enrica Serretiello et al. Antibiotics (Basel). .

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.

Keywords: aerobic vaginitis; antibiotic treatment; antimicrobial resistance; multi-drug resistance.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percentage of (a) Gram-negative and (b) Gram-positive bacteria found in positive vaginal swabs. In (a) “least representative” signifies strains isolated only one time during the five years, so these strains were merged together into one category. In (b) CoNs represents coagulase-negative staphylococci.
Figure 2
Figure 2
Incidence trend of the main representative bacteria isolated during the 5 years investigated.
Figure 3
Figure 3
(a) E. coli and (b) K. pneumoniae antimicrobial susceptibility trend percentage is reported for each year investigated in the study. The table under the image reports the relative resistance percentage analyzed in the chart, divided by classes of antibiotics tested. % = % of resistance for each year; n. = number of total assays conducted for each year. Abbreviations: Amox./clav. = amoxicillin/clavulanic acid; Pip./Taz. = Piperacillin/tazobactam; Cefo. = Cefotaxime; Cefta. = Ceftazidime; Erta. = Ertapenem; Merop. = Meropenem; Amika. = amikacina; Genta. = Gentamicin; Cipro.= ciprofloxacin.
Figure 3
Figure 3
(a) E. coli and (b) K. pneumoniae antimicrobial susceptibility trend percentage is reported for each year investigated in the study. The table under the image reports the relative resistance percentage analyzed in the chart, divided by classes of antibiotics tested. % = % of resistance for each year; n. = number of total assays conducted for each year. Abbreviations: Amox./clav. = amoxicillin/clavulanic acid; Pip./Taz. = Piperacillin/tazobactam; Cefo. = Cefotaxime; Cefta. = Ceftazidime; Erta. = Ertapenem; Merop. = Meropenem; Amika. = amikacina; Genta. = Gentamicin; Cipro.= ciprofloxacin.
Figure 4
Figure 4
(a) E. faecium and (b) E. faecalis antimicrobial susceptibility trend percentage is reported for each year investigated in the study. The table under the image reports the relative resistance percentage analyzed in the chart, divided by classes of antibiotics tested. % = % of resistance for each year; n. = number of total assays conducted for each year. Abbreviations: Amp = ampicillin; Genta = Gentamicin; Strepto = streptomycin; Vanco = Vancomycin; Teico = teicoplanin; Linez = Linezoli; Tige = Tigecycline; Imi = Imipenem.
Figure 4
Figure 4
(a) E. faecium and (b) E. faecalis antimicrobial susceptibility trend percentage is reported for each year investigated in the study. The table under the image reports the relative resistance percentage analyzed in the chart, divided by classes of antibiotics tested. % = % of resistance for each year; n. = number of total assays conducted for each year. Abbreviations: Amp = ampicillin; Genta = Gentamicin; Strepto = streptomycin; Vanco = Vancomycin; Teico = teicoplanin; Linez = Linezoli; Tige = Tigecycline; Imi = Imipenem.
Figure 5
Figure 5
Incidence trend of E. coli producing ESBL and K. pneumoniae producing ESBL. %= % of resistance for each year; n. = number of total assays conducted for each year.
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