Antibiotic Resistance Profiles from Isolated Bacteria in Outpatient Infertility Clinic in Greece

Aim: To investigate the prevalence of common aerobic gram positive and gram negative bacteria, Mycoplasma hominis, Ureaplasma urealyticum and Chlamydia trachomatis in symptomatic and asymptomatic Greek patients and to determine antibiotic resistance profiles. Methods: This retrospective study included a total of 316 adult men examined at the Assisted Reproduction Department of IASO- Obstetrics and Gynecology clinic in Athens, Greece. Sperm have been collected and proceed to culture and antibiotic sensitivity at the Central Laboratories following a standard protocol. Results: Twelve inappropriate out of 316 samples were excluded from the study. Out of the remaining 304 sperm samples 111 (37.5 %) were positive. Antibiotic sensitivity testing detected resistances to some commonly used antibiotics such as b-lactams and the quinolones. Ureaplasma urealyticum and Mycoplasma hominis were the most frequently isolated bacteria (45%), followed by Enterobacteriaceae (40%) and Enterococci 12.6%. The majority of 45 Enterobacteriaceae isolates, were Escherichia coli (31 strains/68%) corresponding to 27.9% of the total number of positive cultures. One infection to Chlamydia trachomatis was detected by an immunochromatic rapid test, one Candida sp, one Pseudomonas aeruginosa, two M. hominis and three Streptococcus group B. Escherichia coli were resistant to b lactams in about 38.7% due to b-lactamase, and 22.5%, 9.6%, 6.4%, were resistant to nitrofurantoin, sulfamethoxazole and ciprofloxacin respectively. Enterococci have shown resistance due to b-lactamase and PBP 5 alteration/hyperproduction. Ureaplasmas were resistant to the fluoroquinolones tested ciprofloxacin and ofloxacin, at 72.2% and 62.3% respectively. Conclusion: Carriage of bacteria in sperm is controversial for its contribution in sperm quality and fertility. In our IVF unit, we follow a protocol of isolation and antibiotic profiling of bacteria from sperm culture regardless of their concentration in sperm and giving the numbers/ml. This helps doctors to distinguish carriage or infection and to decide about potential therapy. Given the antibiotic resistances shown by this study, the importance of culture against empiric therapy in assisted reproduction patients is also clearly demonstrated.