Frontiers in cellular and infection microbiology · 2026
Vaginal and endometrial microbiota dysbiosis in patients with chronic endometritis: a systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Wang Ruiying, Cao Qi, Qiao Xinyu, Zhong Yuchan, Bo Wenjie, Huang Xin, Li Yujing, Huang Wei
Аннотация
BACKGROUND: Chronic endometritis (CE), a persistent inflammatory condition of the endometrial lining, is clinically linked with adverse reproductive outcomes. It is currently hypothesized to be associated with infection, and is often treated with broad-spectrum antibiotics. However, the specific microbial alterations remain poorly defined due to heterogeneous findings.
METHODS: PubMed, Web of Science, Medline, Embase, Cochrane Library, and Scopus were searched for studies published up to July 2025. Studies were included if they compared CE patients to non-CE controls and analyzed vaginal or endometrial microbiota. Standardized mean difference (SMD) for alpha-diversity, odds ratio (OR) for microbial detection rates, with 95% confidence intervals (CIs) were calculated. Qualitative syntheses of beta-diversity and microbial abundance profiles were also performed.
RESULT: Twenty-two studies (n = 1274 CE patients, n = 1109 controls) were included. Alpha-diversity indices showed no significant differences for both vaginal and endometrial microbiota. However, a subgroup analysis revealed a significant upregulation in endometrial Chao1 indices in 16S V4 sequencing studies (SMD = 0.38, 95% CI: 0.06 to 0.70, I 2 = 0). Beta-diversity findings were inconsistent, though three endometrial studies reported significant intergroup differences. Qualitative synthesis revealed a decrease in Lactobacillus and an increase in opportunistic pathogens, including Gardnerella and Sphingomonas. Pooled analysis of microbial detection rates showed significantly higher prevalence for Enterococcus (OR = 4.93, 95% CI: 2.13 to 11.39, I 2 = 48%) and Ureaplasma (OR = 6.30, 95% CI: 2.53 to 15.68, I 2 = 0%) in CE patients.
CONCLUSION: CE is associated with dysbiosis of the vaginal and endometrial microbiota, characterized by a shift from beneficial commensals to pathogenic microbes. This dysbiosis may contribute to an altered the intrauterine immune microenvironment.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420251115587, identifier CRD420251115587.
METHODS: PubMed, Web of Science, Medline, Embase, Cochrane Library, and Scopus were searched for studies published up to July 2025. Studies were included if they compared CE patients to non-CE controls and analyzed vaginal or endometrial microbiota. Standardized mean difference (SMD) for alpha-diversity, odds ratio (OR) for microbial detection rates, with 95% confidence intervals (CIs) were calculated. Qualitative syntheses of beta-diversity and microbial abundance profiles were also performed.
RESULT: Twenty-two studies (n = 1274 CE patients, n = 1109 controls) were included. Alpha-diversity indices showed no significant differences for both vaginal and endometrial microbiota. However, a subgroup analysis revealed a significant upregulation in endometrial Chao1 indices in 16S V4 sequencing studies (SMD = 0.38, 95% CI: 0.06 to 0.70, I 2 = 0). Beta-diversity findings were inconsistent, though three endometrial studies reported significant intergroup differences. Qualitative synthesis revealed a decrease in Lactobacillus and an increase in opportunistic pathogens, including Gardnerella and Sphingomonas. Pooled analysis of microbial detection rates showed significantly higher prevalence for Enterococcus (OR = 4.93, 95% CI: 2.13 to 11.39, I 2 = 48%) and Ureaplasma (OR = 6.30, 95% CI: 2.53 to 15.68, I 2 = 0%) in CE patients.
CONCLUSION: CE is associated with dysbiosis of the vaginal and endometrial microbiota, characterized by a shift from beneficial commensals to pathogenic microbes. This dysbiosis may contribute to an altered the intrauterine immune microenvironment.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420251115587, identifier CRD420251115587.