Effect of antibiotic prophylaxis during hysteroresectoscopy on the recurrence of endometrial polyps

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Abstract

Background: Endometrial polyps (EP) are the most common type of benign intrauterine pathology and are characterized by a high risk of recurrence. One of the possible etiological factors for EPs is microbial infection. Administration of antibacterial drugs during hysteroresectoscopy (HRS) may reduce the frequency of EP recurrence.

Objective: To study the effect of antibiotic prophylaxis during hysteroresectoscopy for EPs on their recurrence rate.

Materials and methods: A prospective parallel-group study included 84 patients with EP confirmed by histological examination who were randomized into two groups based on the administration of antibiotic prophylaxis during HRS. Endometrial samples were obtained before the HRS. The composition of the endometrial microbiota was analyzed using culturomics with an extended set of selective and non-selective nutrient media. First-generation cephalosporins were administered intravenously in a single dose. The recurrence rate of EP was assessed 12–18 months after HRS.

Results: Chronic endometritis (CE) was associated with EP recurrence within 12–18 months after HRS. The overall recurrence rate was 25%, which was 2.8 times higher in the presence of CE (OR=2.8, 95% CI=0.9–8.4). Bacterial flora growth in the uterine cavity was observed in 40/84 (47.6%) patients with EP and in all 23 (100%) patients with CE. The predominant species were microorganisms of the Staphylococcus genus, which were detected 22 times more frequently in patients with CE (OR=22.3, 95% CI=7.3–68.4). Antibiotic prophylaxis during HRS did not reduce the overall recurrence rate of EP, but it did reduce the recurrence rate by five and seven times, respectively, in patients with CE and in those with microbial growth in the uterine cavity in addition to EP.

Conclusion: These findings confirm the role of microbial factors in the genesis of CE and associated EP, as well as the effectiveness of antibiotics in reducing the recurrence rate in patients with CE and bacterial microflora growth in the uterine cavity.

About the authors

Angelina I. Vanakova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Author for correspondence.
Email: angelinavanakova@gmail.com
ORCID iD: 0009-0007-8048-1682

obstetrician-gynecologist, oncologist at the Department of Innovative Oncology and Gynecology, PhD student at the Department of Obstetrics, Gynecology, Perinatology and Reproductology

 

Russian Federation, 117997, Moscow, Ac. Oparin str., 4; 119991, Moscow, Trubetskaya str., 8-2

Nataliya V. Dolgushina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: n_dolgushina@oparina4.ru
ORCID iD: 0000-0003-1116-138X

Dr. Med. Sci., Professor, Deputy Director, Professor at the Department of Obstetrics, Gynecology, Perinatology and Reproductology

Russian Federation, 117997, Moscow, Ac. Oparin str., 4; 119991, Moscow, Trubetskaya str., 8-2

Pavel A. Denisov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: priput1@gmail.com
ORCID iD: 0000-0003-1813-6718

Researcher at the Laboratory of Bioinformational Analysis, Institute of Microbiology, Antimicrobial Therapy and Epidemiology

Russian Federation, 117997, Moscow, Ac. Oparin str., 4

Olga D. Goncharuk

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: priput1@gmail.com
ORCID iD: 0000-0001-5876-8424

Head of the Laboratory of Medical Microbiology, Institute of Microbiology, Antimicrobial Therapy and Epidemiology

Russian Federation, 117997, Moscow, Ac. Oparin str., 4

Vera V. Muravieva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: priput1@gmail.com
ORCID iD: 0000-0003-0383-0731

PhD (Bio), Senior Researcher at the Laboratory of Molecular Microbiology, Institute of Microbiology, Antimicrobial Therapy and Epidemiology

Russian Federation, 117997, Moscow, Ac. Oparin str., 4

Tatiana V. Priputnevich

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: priput1@gmail.com
ORCID iD: 0000-0002-4126-9730

Corresponding Member of the RAS, Dr. Med. Sci., Associate Professor, Director of the Institute of Microbiology, Antimicrobial Therapy and Epidemiology

Russian Federation, 117997, Moscow, Ac. Oparin str., 4

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2. Рис. 1. Видовое разнообразие в микробиоте полости матки у пациенток с ПЭ

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3. Fig. 2. Frequency of PE recurrence depending on AB prophylaxis in HRS in patients with PE depending on the presence of CE and the composition of the uterine cavity microbiota

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