Epidemiology of healthcare-associated endometritis after surgical abortion in Ukraine: results a multicenter study

Aim: To determine the current prevalence of healthcare-associated endometritis after surgical abortion and antimicrobial resistance of responsible pathogens in Ukraine.

Materials and Methods: We performed a prospective, multicentre cohort study was based on surveillance data of healthcare-associated endometritis after legal induced surgical abortion. Women who underwent induced surgical abortion at gynecological departments of 16 regional hospitals between 2020 and 2022 are included in the study. Definitions of endometritis were adapted from the CDC/NHSN. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST.

Results: Among 18,328 women who underwent surgical abortion, 5,023 (27.4%) endometritis were observed. Of all post-abortion endometritis cases, 95.3% were detected after hospital discharge. The prevalence of endometritis in different types surgical abortion was: after vacuum aspiration at < 14 weeks, 23.8%, and after dilatation and evacuation at ≥ 14 weeks, 32%. The most responsible pathogens of post-abortion endometritis are Escherichia coli (24.1%), Enterococcus spp. (14.3%), Enterobacter spp. (12,8%), Pseudomonas aeruginosa (8.3%), Proteus mirabilis (6.6%), Serratia marcescens (6.2%), Staphylococcus aureus (5.9%), and Stenotrophomonas maltophilia (5.7%). A significant proportion these pathogens developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group.

Conclusions: Results this study suggest a high prevalence of endometritis after surgical abortion in Ukraine. A significant proportion of women were affected by endometritis caused by bacteria developed resistance to several antimicrobials. Optimizing the antibiotic prophylaxis may reduce the burden of endometritis after surgical abortion, but prevention is the key element.