Endometritis : International publication of Locus Medicus in the journal Heliyon

International publication of the scientific team of Locus Medicus

Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis

Authors:

Vassilis Kapetanios, Maria Lampraki, Georgios Georgoulias, Stavros Kasdaglis, Stylianos Kliafas, Nikolaos Gkavra, Maria Xountasi, Vassilis Tsilivakos, Michail Leventopoulos

One of the main issues of particular interest to the scientific staff of Locus Medicus in recent years concerns endometritis, i.e. inflammation of the endometrium, which is one of the main reasons for infertility and miscarriages. Combining results of laboratory microbiological and molecular tests simultaneously with clinical in-depth observation of hysteroscopies results which were published in the journal Heliyon,  Elsevier, impact factor 4, DOI : https://doi.org/10.1016/j.heliyon.2024.e30259, Published : April 26, 2024

A key result of primary clinical significance was the statistically significant association of E-coli presence with focal endometrial hyperplasia. This result emphasizes the basic need for microbiological study of endometrial lavage. It is the first time that the existence of a specific hysteroscopic image has been associated with a specific bacterial agent.

Highlights

• Escherichia coli is associated with focal endometrial hyperplasia.
• A potential pathogenic role for this bacterium in CE complications.
• Hysteroscopy and microbial cultures can be used efficiently to identify CE.
• Targeted antibiotic treatment seems to improve reproductive outcome.

Abstract

Objective and rationale

Chronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species.

Methods

The study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ² and Fisher’s exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions.

Results

A significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non–CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures.

Conclusions

The presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.

Keywords

Bacterial culture, Endometritis, Escherichia coli , Hyperplasia, Office hysteroscopy