{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T07:49:56Z","timestamp":1782373796620,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Aerobic vaginitis (AV) is characterized by dysbiotic vaginal microflora with overgrowth of aerobic pathogens of enteric origin, presence of vaginal inflammation and immature epithelial cells. This study aimed to evaluate, over a period of 10 years, women of reproductive age (non-pregnant and pregnant) as well as menopausal women affected by AV. Methods: We included non-pregnant, pregnant and menopausal women diagnosed with AV over a period of 10 years. Diagnosis of AV was determined according to the criteria proposed by Donders in 2002. The isolated pathogens were identified with the rapid identification system I-dOne (Alifax S.r.l, Polverara, Italy) and the automated system VITEK2 (Biomerieux, Marcy l\u2019Etoile, France), which was used for antimicrobial susceptibility testing. Results: The overall aerobic vaginitis prevalence rate during the studied period was 9.5%. The most common isolated pathogens were Escherichia coli 27.3%, Enterococcus faecalis 25.0%, Streptococcus agalactiae 22.2%, Klebsiella pneumoniae 8.9%, Proteus spp 4.7%, and Staphylococcus aureus 3.5%. E. coli infection significantly increased the odds of mild AV by 1.65 times (p = 0.002) and Proteus species infection was over 6 times more likely to progress to severe disease (p &lt; 0.001). Furthermore, pregnant women were more likely to be infected with E. faecalis (p &lt; 0.001) while menopausal women were diagnosed significantly more with severe AV (p &lt; 0.001) compared to the other groups. Conclusions: The prevalence of aerobic vaginitis in the population studied was in concordance with global rates. Menopausal women displayed increased severe AV cases while, in contrast, mild cases were recorded during pregnancy. The most commonly isolated pathogens were of enteric origin.<\/jats:p>","DOI":"10.3390\/jcm15134926","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:16Z","timestamp":1782366496000},"page":"4926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Antimicrobial Resistance of Pathogens Associated with Aerobic Vaginitis: A 10-Year Study in Greece"],"prefix":"10.3390","volume":"15","author":[{"given":"Anthia","family":"Chasiakou","sequence":"first","affiliation":[{"name":"Department of Biopathology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stamatia","family":"Chasiakou","sequence":"additional","affiliation":[{"name":"Department of Biopathology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Kaparos","sequence":"additional","affiliation":[{"name":"Department of Biopathology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki-Georgia","family":"Prifti","sequence":"additional","affiliation":[{"name":"Department of Biopathology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stiliani","family":"Demeridou","sequence":"additional","affiliation":[{"name":"Department of Biopathology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-4715","authenticated-orcid":false,"given":"Athanasios","family":"Tsakris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavroula","family":"Baka","sequence":"additional","affiliation":[{"name":"Department of Biopathology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3793","DOI":"10.1007\/s00203-021-02414-3","article-title":"Vaginal microbiome: Normalcy vs dysbiosis","volume":"203","author":"Saraf","year":"2021","journal-title":"Arch. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.2217\/fmb-2022-0112","article-title":"Vaginal microbiome: Considerations for reproductive health","volume":"17","author":"Chopra","year":"2022","journal-title":"Future Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ncib, K., Bahia, W., Leban, N., Mahdi, A., Trifa, F., Mzoughi, R., Haddad, A., Jabeur, C., and Donders, G. (2022). Microbial diversity and pathogenic properties of microbiota associated with aerobic vaginitis in women with recurrent pregnancy loss. Diagnostics, 12.","DOI":"10.3390\/diagnostics12102444"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/j.1471-0528.2002.00432.x","article-title":"Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: Aerobic vaginitis","volume":"109","author":"Donders","year":"2002","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.resmic.2017.04.004","article-title":"Aerobic vaginitis: No longer a stranger","volume":"168","author":"Donders","year":"2017","journal-title":"Res. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1080\/00016340801936487","article-title":"Placental histological inflammation and reproductive tract infections in a low risk pregnant population in Latvia","volume":"87","author":"Rezeberga","year":"2008","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s00404-012-2571-4","article-title":"Aerobic vaginitis and mixed infections: Comparison of clinical and laboratory findings","volume":"287","author":"Fan","year":"2013","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.ejogrb.2012.12.003","article-title":"Sialidase activity in aerobic vaginitis is equal to levels during bacterial vaginosis","volume":"167","author":"Marconi","year":"2013","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9813","DOI":"10.1038\/s41598-024-58654-y","article-title":"Aerobic vaginitis, bacterial vaginosis, and vaginal candidiasis among women of reproductive age in Arba Minch, southern Ethiopia","volume":"14","author":"Aklilu","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"562","DOI":"10.4103\/ijpm.ijpm_459_24","article-title":"Evaluation of various diagnostic modalities for detection of bacterial vaginosis and aerobic vaginitis: An underdiagnosed entity among women of the reproductive age group","volume":"68","author":"Mishra","year":"2025","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1111\/j.1471-0528.2009.02237.x","article-title":"Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy","volume":"116","author":"Donders","year":"2009","journal-title":"Br. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1600-0412.2010.01011.x","article-title":"Factors related to elevated vaginal pH in the first trimester of pregnancy","volume":"90","author":"Zodzika","year":"2011","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s10096-016-2787-5","article-title":"Abnormal vaginal flora in symptomatic non-pregnant and pregnant women in a Greek hospital: A prospective study","volume":"36","author":"Tansarli","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s10096-018-3416-2","article-title":"Aerobic vaginitis in late pregnancy and outcomes of pregnancy","volume":"38","author":"Han","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1177\/0956462418785451","article-title":"2018 European (IUSTI\/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge","volume":"29","author":"Sherrard","year":"2018","journal-title":"Int. J. STD AIDS"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/09564624231179277","article-title":"2023 update to 2018 European (IUSTI\/WHO) guideline on the management of vaginal discharge","volume":"34","author":"Sherrard","year":"2023","journal-title":"Int. J. STD AIDS"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1128\/jcm.29.2.297-301.1991","article-title":"Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation","volume":"29","author":"Nugent","year":"1991","journal-title":"J. Clin. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s10096-013-1846-4","article-title":"Prevalence and treatment of aerobic vaginitis among non-pregnant women: Evaluation of the evidence for an underestimated clinical entity","volume":"32","author":"Tansarli","year":"2013","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_19","first-page":"CR228","article-title":"A retrospective analysis of isolates from patients with vaginitis in a private Greek obstetric\/gynecological hospital (2003\u20132006)","volume":"14","author":"Iavazzo","year":"2008","journal-title":"Med. Sci. Monit."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1080\/01443615.2017.1308322","article-title":"Prevalence of vaginitis in different groups among females in Greece","volume":"37","author":"Sianou","year":"2017","journal-title":"J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Serretiello, E., Santella, B., Folliero, V., Iervolino, D., Santoro, E., Manente, R., Dell\u2019Annunziata, F., Sperlongano, R., Crudele, V., and De Filippis, A. (2021). Prevalence and antibiotic resistance profile of bacterial pathogens in aerobic vaginitis: A retrospective study in Italy. Antibiotics, 10.","DOI":"10.3390\/antibiotics10091133"},{"key":"ref_22","first-page":"4","article-title":"Epidemiological, clinical and microbiological findings in women with aerobic vaginitis","volume":"54","author":"Dermendjiev","year":"2015","journal-title":"Akush. Ginekol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s10096-016-2584-1","article-title":"Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities","volume":"35","author":"Pinto","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s00404-015-4007-4","article-title":"Diagnosis of aerobic vaginitis by quantitative real-time PCR","volume":"294","author":"Rumyantseva","year":"2016","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hasona, I.F., Awad, A., Younis, G., and Mohamed, W.F. (2026). A One Health perspective on Proteus mirabilis: The interaction of virulence and antimicrobial resistance across human and animal reservoirs. Microorganisms, 14.","DOI":"10.3390\/microorganisms14020444"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s00404-014-3525-9","article-title":"Diagnostic and therapeutic advancements for aerobic vaginitis","volume":"291","author":"Han","year":"2015","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1111\/j.1471-0528.2011.03020.x","article-title":"Aerobic vaginitis in pregnancy","volume":"118","author":"Donders","year":"2011","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_28","first-page":"164","article-title":"Aerobic vaginitis: Antibiotic resistance trend and future actions of antimicrobial diagnostic stewardship","volume":"47","author":"Foglia","year":"2024","journal-title":"New Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"106103","DOI":"10.1016\/j.ejps.2021.106103","article-title":"Antimicrobial resistance: Prevalence, economic burden, mechanisms of resistance and strategies to overcome","volume":"170","author":"Pullingam","year":"2022","journal-title":"Eur. J. Pharm. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"The American College of Obstetricians and Gynecologists (2020). Prevention of group B streptococcal Early-Onset disease in newborns: ACOG committee opinion, number 797. Obstet. Gynecol., 135, e51\u2013e72.","DOI":"10.1097\/AOG.0000000000003668"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1038\/s41390-022-02375-3","article-title":"Evolving antibiotic resistance in group B streptococci causing invasive infant disease: 1970\u20132021","volume":"93","author":"Sabroske","year":"2023","journal-title":"Pediatr. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Hsu, C.Y., Moradkasani, S., Suliman, M., Uthirapathy, S., Zwamel, A.H., Hjazi, A., Vashishth, R., and Beig, M. (2025). Global patterns of antibiotic resistance in group B Streptococcus: A systemic review and meta-analysis. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1541524"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/1040841X.2020.1758626","article-title":"A review of antibiotic resistance in Group B Streptococcus: The story so far","volume":"46","author":"Hayes","year":"2020","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3877","DOI":"10.1038\/s41598-024-54521-y","article-title":"Macrolide and lincosamide resistance of Streptococcus agalactiae in pregnant women in Poland","volume":"14","author":"Kaminska","year":"2024","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4926\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T07:35:04Z","timestamp":1782372904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4926"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":34,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15134926"],"URL":"https:\/\/doi.org\/10.3390\/jcm15134926","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}