Prevalence and Antimicrobial Resistance of Pathogens Associated with Aerobic Vaginitis: A 10-Year Study in Greece

Background: Aerobic vaginitis (AV) is characterized by dysbiotic vaginal microflora with overgrowth of aerobic pathogens of enteric origin, presence of vaginal inflammation and immature epithelial cells. This study aimed to evaluate, over a period of 10 years, women of reproductive age (non-pregnant and pregnant) as well as menopausal women affected by AV. Methods: We included non-pregnant, pregnant and menopausal women diagnosed with AV over a period of 10 years. Diagnosis of AV was determined according to the criteria proposed by Donders in 2002. The isolated pathogens were identified with the rapid identification system I-dOne (Alifax S.r.l, Polverara, Italy) and the automated system VITEK2 (Biomerieux, Marcy l’Etoile, France), which was used for antimicrobial susceptibility testing. Results: The overall aerobic vaginitis prevalence rate during the studied period was 9.5%. The most common isolated pathogens were Escherichia coli 27.3%, Enterococcus faecalis 25.0%, Streptococcus agalactiae 22.2%, Klebsiella pneumoniae 8.9%, Proteus spp 4.7%, Staphylococcus aureus 3.5%. E. coli infection significantly increased the odds of mild AV by 1.65 times (p=0.002) and Proteus species infection was over 6 times more likely to progress to severe disease (p=0.000). Furthermore, pregnant women were more likely to be infected with E. faecalis (p=0.000) while menopausal women were diagnosed significantly more with severe AV (p=0.000) compared to the other groups. Conclusions: The prevalence of aerobic vaginitis in the population studied was in concordance to global rates. Menopausal women displayed significantly more severe AV cases while, in contrast, mild cases were recorded during pregnancy. The most commonly isolated pathogens were of enteric origin.