Endometritis after hysteroscopic procedures in Ukraine: results a multicenter study

Aim: To determine the current prevalence of endometritis after hysteroscopic procedures and antimicrobial resistance of responsible pathogens in Ukraine.

Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of endometritis were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST.

Results: Among 13,872 patients with hysteroscopic procedures, 1027 (7.4%) endometritis were observed. Of these cases, 0.4% were detected after diagnostic hysteroscopy, and 7.0% were detected after operative hysteroscopy. Of all endometritis cases, 64.2% were detected after hospital discharge. The most commonly reported bacterial species were Escherichia coli (24.3%), followed by Enterobacter spp. (12.7%), Enterococcus spp. (8.3%), Pseudomonas aeruginosa (8.1%), Serratia marcescens (6.8%), Staphylococcus aureus (5.9%), Proteus mirabilis (5.8%), Klebsiella oxytoca (5.1%), Stenotrophomonas maltophilia (4.5%), Klebsiella pneumoniae (4.1%). A significant proportion of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine.

Conclusions: Our data suggest a high prevalence of endometritis after hysteroscopic procedures. Risk for endometritis was higher after operative hysteroscopy compared with diagnostic hysteroscopy. Many most of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials. These data underscore the importance of tracking antimicrobial resistance of responsible pathogens of HAIs in hospitals.