Search Results (446)

Background/Objectives: Sepsis is a life-threatening condition associated with high mortality. Optimal dosing strategies for β-lactam antibiotics in sepsis remain controversial, particularly in patients with renal impairment. Cefepime (CFPM) is widely used as empiric therapy; however, its appropriate initial dosing in critically ill patients is unclear. This study aimed to evaluate whether high-dose CFPM administration during the first 48 h improves survival in patients with sepsis, irrespective of renal function. Methods: This single-center, retrospective, observational study included adult intensive care unit (ICU) patients with sepsis who received CFPM as initial therapy between January 2017 and December 2024. Patients were categorized into High-dose (12 g within 48 h; 2 g every 8 h) and Low-dose (<12 g/48 h) groups. The primary outcome was ICU survival. To address confounding, inverse probability of treatment weighting (IPTW) based on serum creatinine was applied, with sensitivity analyses using 1% trimmed and stabilized IPTW. Results: Of 122 eligible patients, 84 were analyzed (High-dose: n = 27; Low-dose: n = 57). After IPTW adjustment, high-dose CFPM was significantly associated with improved ICU survival (odds ratio [OR] 5.43, 95% confidence interval [CI] 1.60–18.39, p = 0.0066). This association remained consistent in the 1% trimmed IPTW analysis (OR 4.07, 95% CI 1.19–13.97, p = 0.0256). Stabilized IPTW yielded a similar effect estimate, though without statistical significance (OR 5.43, 95% CI 0.72–41.16, p = 0.1017). Overall, results were consistent in direction and magnitude across models. Conclusions: High-dose CFPM administration during the initial 48 h was associated with improved ICU survival in patients with sepsis, independent of renal function. Full article

Urinary tract infections (UTIs) represent a major cause of morbidity among adult women, with a disproportionate burden among postmenopausal patients. Limited data exist from Eastern Europe regarding pathogen distribution, antimicrobial resistance, and treatment patterns in hospitalized women. We conducted a retrospective cohort study of 948 adult female patients hospitalized with symptomatic UTIs between January 2021 and December 2023 in a Romanian multidisciplinary hospital. Demographic, clinical, and microbiological parameters were analyzed. Pathogen identification was performed by MALDI-TOF MS, and antimicrobial susceptibility testing followed EUCAST 2024 standards. Empiric treatment strategies and subsequent therapy modifications were assessed. Postmenopausal women accounted for 78.4% of cases and exhibited higher rates of recurrent UTIs, frailty, diabetes, urinary catheterization, and prior antibiotic exposure. Escherichia coli remained the predominant pathogen (52.6%), followed by Klebsiella spp. (18.4%) and Enterococcus spp. (12.1%). ESBL-producing organisms were found in 21.4% of E. coli and 38.7% of Klebsiella isolates. Pathogen distribution differed by age: younger women had a higher proportion of E. coli, whereas postmenopausal women showed a relative increase in opportunistic/healthcare-associated pathogens, particularly Klebsiella spp. and Enterococcus spp., consistent with higher catheter exposure and comorbidity burden. Carbapenem resistance was rare but present in a small subset of Klebsiella isolates with phenotypes compatible with OXA-48-like carbapenemase production. Empiric therapy most frequently included ceftriaxone or fluoroquinolones, but 27.8% of regimens required adjustment after susceptibility results. Independent predictors of prolonged hospitalization included age > 65 years, recurrent UTI, MDR infection, urinary catheterization, and delayed targeted therapy. UTIs among hospitalized adult women—especially postmenopausal patients—are strongly influenced by comorbidity burden and antimicrobial resistance. Local resistance patterns highlight the need for evidence-based empiric treatment and rapid therapy optimization. Strengthening stewardship and preventive interventions in elderly women is essential. Full article

Bacteriophage therapy, which employs bacterial viruses to selectively eliminate pathogenic bacteria, has re-emerged as a promising strategy in the face of increasing antimicrobial resistance. However, its widespread clinical implementation is constrained by concerns regarding safety, standardisation, and predictable efficacy. In this review, we examine the key role of genomics in transforming phage therapy from an empirical practice into a standardised and personalised modality of contemporary medicine. We describe how whole-genome sequencing (WGS) provides a basis for safety assessment by enabling systematic screening to exclude virulence factors, antibiotic resistance genes, and markers of lysogeny. WGS also facilitates the prediction of therapeutic efficacy and supports more rational phage selection by identifying receptor-binding proteins and characterising bacterial defence systems. In clinical settings, WGS data are increasingly used to monitor the evolution of bacterial populations and to adapt phage cocktails during treatment, thereby supporting personalised, adaptive phage therapy. Looking ahead, further progress is likely to come from integrating synthetic biology and artificial intelligence to engineer phage-based therapeutics with programmable specificity and predictable properties. Together, these developments are shaping a new paradigm of phage therapy as a scientifically grounded, standardised and controlled strategy to treat infections caused by antibiotic-resistant bacteria. Full article

Background: Early administration of antibiotics is commonly recommended for pneumonia in intensive care unit (ICU) patients. However, the clinical benefit of very early empirical treatment remains uncertain and may reflect differences in illness severity, baseline risk, or care pathways, particularly in non-septic or hemodynamically stable ICU populations. Methods: We performed a retrospective cohort study using the Medical Information Mart for Intensive Care IV (v2.2) database to evaluate the observational association between antibiotic timing and in-hospital mortality among adult ICU patients with pneumonia. Patients were categorized as receiving early (<3 h) or delayed (≥3 h) antibiotic therapy after ICU admission. A multivariable logistic regression model adjusted only for age and sex. Given the absence of detailed severity-of-illness measures, no causal inference was intended, and all analyses were considered hypothesis-generating. Additional analyses exploring antibiotic class, dosing frequency, and combination therapy were conducted in an exploratory manner, given substantial variation in sample sizes and a high risk of confounding by indication, misclassification, immortal-time, and survivorship bias. Results: Among 7569 ICU patients with pneumonia, 56.5% received antibiotics within three hours of ICU admission. Early antibiotic initiation was associated with higher in-hospital mortality than delayed therapy (26.1% vs. 21.5%; OR 1.30, 95% CI 1.16–1.44; p < 0.001). Because validated severity-of-illness measures were unavailable, residual confounding and confounding by indication are likely and may largely explain this association. A potential signal of increased mortality was observed in patients receiving ≥3 doses of levofloxacin (OR 4.39, 95% CI 1.13–17.02); however, this subgroup was small and the finding is highly susceptible to survivorship and indication bias. Mortality appeared lower in patients receiving two or three antibiotics compared with monotherapy, but marked group imbalances, lack of restriction or stratification, and clinical selection effects limit interpretability. Regimens involving ≥4 agents were rare and primarily associated with prolonged ICU length of stay rather than a clear mortality difference. Conclusions: In this large retrospective ICU cohort, very early antibiotic administration for pneumonia was observationally associated with higher in-hospital mortality. Causality cannot be inferred, and early treatment likely represents a marker of higher baseline risk or clinical urgency rather than a harmful exposure. These findings challenge the assumption that earlier antibiotic initiation is uniformly beneficial and underscore the importance of individualized, stewardship-aligned, and context-dependent decision-making regarding antimicrobial timing and intensity in critically ill patients. Full article

Purpose: Candida bloodstream infections remain a major global health challenge, with mortality rates approaching 40%. Beyond classical immunocompromised status, recent evidence highlights additional risk factors, including iatrogenic immunosuppression, advanced age, prolonged hospitalization, exposure to broad-spectrum antibiotics, and total parenteral nutrition. While Candida albicans (C. albicans) remains the most common species in Europe and the USA, non-albicans species, particularly Nakaseomyces glabratus (N. glabratus), Candida tropicalis (C. tropicalis), and Candida parapsilosis (C. parapsilosis), are emerging worldwide. Methods: This retrospective observational cohort study was conducted at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno, Italy, from January 2015 to December 2024. It included all patients with at least one positive blood culture for Candida species. Demographic data, hospital ward of admission, and antifungal susceptibility profiles were collected and analyzed using SPSS software (IBM SPSS Statistics for Mac, version 30 (IBM Corp., Armonk, NY, USA)). Results: The incidence rate is 48.7 new isolates per one thousand patient-days, with a trend of increasing episodes over time among a total of 364 patients. Most cases occurred in medical wards (59.5%), where patients were older (median age 76 (17). C. albicans accounted for 57.9% of isolates, and a significant association was found between species distribution and hospital unit (p < 0.05). Resistance to fluconazole, voriconazole, and amphotericin B increased among C. albicans, with similar trends in N. glabratus and C. parapsilosis. Conclusions: This large single-center cohort highlights both the persistent dominance of C. albicans and the worrisome rise in resistance among C. parapsilosis. Given the aging patient population and increasing antifungal resistance, local epidemiological data are crucial to guide empirical therapy. Our findings underscore the need for multidisciplinary antifungal stewardship programs to optimize personalized treatment strategies and contain the emergence of resistant strains. Full article

Background: Globalization, increased mobility, changes in dietary habits, and a growing number of immunocompromised patients have heightened exposure to rare or opportunistic pathogens. Here, we present a case of cardiac implantable electronic device-related infective endocarditis (CIED-IE) caused by Bacillus cereus bacteremia originating in the gastrointestinal tract. Case presentation: A 66-year-old female, who had a cardiac resynchronization pacemaker (CRT-P) implanted in 2017 due to second-degree atrioventricular block and left bundle branch block, had undergone device replacement due to battery depletion 4 months earlier and was scheduled for transvenous lead extraction (TLE) due to generator pocket infection. During the TLE procedure, transoesophageal echocardiography revealed vegetations on the leads and in the right atrium. Standard empirical therapy covering methicillin-resistant Staphylococci and Gram-negative bacteria was administered, including oritavancin and gentamicin. Surprisingly, intraoperative samples cultured B. cereus, a Gram-positive, spore-forming rod that usually causes food poisoning through contamination of rice and other starchy foods. B. cereus is generally resistant to β-lactam antibiotics except for carbapenems but is susceptible to glycopeptides. The oritavancin treatment was extended to four fractionated doses (1200, 800, 800, and 800 mg) administered at 7-day intervals. To eradicate bacteria in the gastrointestinal tract, oral vancomycin (125 mg 4 times a day) was added. After 4 weeks of effective antibiotic therapy, a CRT-P with a left bundle branch area pacing lead was reimplanted on the right subclavian area, with no recurrence of infection during the 3-month follow-up. Clinical discussion: In the patient, a diet high in rice and improper storage of rice dishes, together with habitual constipation, were identified as risk factors for the development of invasive Bacillus cereus infection. However, the long half-life lipoglycopeptide antibiotic, oritavancin, administered weekly, proved effective in treating CIED-IE. Conclusions: Infection with rare or opportunistic microorganisms may require extended microbiological diagnostics and non-standard antibiotic therapy; therefore, the medical history should consider risk factors for such infections. Full article

Background and Objectives: Febrile neutropenia (FN) is a potentially life-threatening complication in children undergoing cancer treatment. Immediate initiation of empirical antibiotic treatment (EAT) has improved the prognosis and outcomes of FN. Although the ideal timing for initiating EAT is clear, the optimal timing for EAT discontinuation remains debatable. Early hospital discharge (EHD) with continuation of oral antibiotics has also been proposed as an alternative strategy. This narrative review aims to present a comprehensive overview of the evidence on early discontinuation of EAT or EHD in children with FN and cancer. Materials and Methods: A comprehensive literature search was performed to identify relevant studies assessing early EAT discontinuation or EHD in children with cancer and FN. Extracted data included the safety outcomes, the benefits for the patients and the cost for healthcare systems. Results: Thirty-one studies were included; twenty-one investigated the early discontinuation of EAT and ten studies evaluated EHD. Most studies reported early discontinuation of EAT or EHD as a safe FN treatment approach with potential benefits for the patients, especially when applied to selected low-risk FN cases. Reported benefits included shorter hospitalization duration and reduced antibiotic use, with additional economic advantages in several studies. Conclusions: Early discontinuation of EAT appears to be a safe and beneficial management approach for children with FN and cancer by reducing the length of hospital stay and the duration of antibiotic use. EHD with oral therapy continuation also appears to be safe but less beneficial than early discontinuation of EAT. High-quality evidence and standardized criteria are needed to support broader implementation of these strategies in routine clinical practice. Full article

Background: Pelvic inflammatory disease (PID) is a common and potentially severe infection of the upper genital tract. Complications such as tubo-ovarian abscess (TOA), sepsis, and diffuse peritonitis contribute significantly to reproductive morbidity, particularly when diagnosis or treatment is delayed. Aim: The aim of this review is to present an updated, clinically relevant synthesis of the current evidence on the epidemiology, microbiology, diagnostic approach, imaging modalities, and management of PID, with a focus on severe forms including TOA, sepsis, and peritonitis. Content: PID is most frequently initiated by sexually transmitted pathogens—primarily Chlamydia trachomatis and Neisseria gonorrhoeae—which rapidly progresses to a polymicrobial infection involving anaerobic and enteric organisms. Diagnosis is predominantly clinical, supported by nucleic acid amplification tests, inflammatory markers, and imaging. Transvaginal ultrasonography remains the first-line diagnostic approach for suspected TOA, while CT or MRI is reserved for unclear cases or to assess rupture. Mild to moderate disease is managed with broad-spectrum combination antibiotics, whereas severe PID or TOA requires hospitalization, parenteral therapy, and timely source control through image-guided drainage or surgery. Ruptured abscesses and PID-associated sepsis demand urgent surgical intervention and multidisciplinary supportive care. Tailored approaches are necessary in pregnancy, adolescence, and immunosuppressed and postmenopausal patients. Conclusions: Prompt recognition, a low threshold for empiric antimicrobial therapy, the appropriate use of imaging, and decisive escalation to drainage or surgery are essential to limit morbidity and preserve reproductive health. Integrating guideline-based practice with structured clinical pathways may improve outcomes and reduce long-term sequelae of PID. Full article

Background: The inappropriate and empirical use of antibiotics in early childhood remains a major global public health concern, contributing significantly to the rise of antimicrobial resistance (AMR). In Kosovo, the COVID-19 pandemic further influenced prescribing behaviors in primary care, increasing the reliance on symptom-based treatment in the absence of laboratory confirmation and age-appropriate formulations. Aim: This study aimed to assess the prevalence and patterns of antibiotic prescribing among children aged 1–7 years in primary health care centers in Prishtina and Ferizaj from January 2022 to December 2025, and to compare regional differences in prescribing practices and guideline adherence. Methods: A retrospective observational study was conducted using data from the national electronic health record system and protocol books. All pediatric visits for children aged 1–7 years with infectious diagnoses were included. Descriptive statistics, Chi-square tests, and multivariable logistic regression were used to evaluate prescribing prevalence, demographic and seasonal variations, and independent predictors of antibiotic use, including assessment of appropriateness based on international pediatric guidelines. Results: Of 4320 pediatric visits, 1328 (30.7%) resulted in an antibiotic prescription. Prescribing prevalence was higher in Ferizaj (34.2%) than in Prishtina (28.5%, p < 0.01). Amoxicillin–clavulanic acid (42.9%) and amoxicillin (21.5%) were the most frequently prescribed agents, while macrolides (11.7% vs. 6.2%) and cephalosporins (7.9% vs. 3.4%) were more common in Ferizaj. Only 61.4% of prescriptions were fully guideline-concordant. Younger age (1–3 years), winter season, and residence in Ferizaj were independently associated with higher odds of receiving an antibiotic. Conclusions: Pediatric antibiotic prescribing in Kosovo remains high and predominantly empirical, reflecting real-world limitations in diagnostic capacity and formulation availability. Significant proportions of partially appropriate and inappropriate prescriptions highlight the need for standardized pediatric guidelines, improved diagnostic support, and strengthened stewardship initiatives within primary care. Full article

Patients with multiple traumas, particularly those with traumatic brain injury (TBI), are among the most challenging cases in intensive care medicine. Although early orotracheal intubation and invasive mechanical ventilation (IMV) are essential for airway protection and neurological treatment, they significantly increase the risk of lower respiratory tract infection (LRTI), including ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). These complications are particularly prevalent among neurocritical patients due to the distinctive interaction between the brain, lungs and immune system. This narrative review examines the current evidence on the mechanisms underlying the brain–lung–immune axis; the diagnostic challenges in identifying respiratory infections in mechanically ventilated TBI patients; and optimal approaches to empirical or quasi-targeted antimicrobial therapy based on diagnostic algorithms and rapid molecular techniques. Severe TBI induces neurogenic inflammation, autonomic dysregulation, and immunosuppression, thereby increasing susceptibility to pulmonary infections. The ‘triple hit hypothesis’ best explains this cascade: sympathetic hyperactivity (first hit), iatrogenic ventilatory injury (second hit), and intestinal dysbiosis with systemic immune dysregulation (third hit). VAP diagnosis remains challenging due to the lack of universal criteria, the overlap with systemic inflammatory response syndrome, and the low specificity of radiological and clinical signs. VAT may represent an intermediate stage within a continuum of ventilator-associated infection. Recent evidence supports the selective use of nebulized antibiotics for VAT, advocating an individualized, locally adapted empirical approach to VAP treatment. Syndromic molecular panels can accelerate the identification of pathogens, enabling the earlier and more appropriate selection of antimicrobials and improving outcomes while preserving stewardship. Understanding the brain–lung–immune axis and improving diagnostic accuracy are essential to enhancing the treatment of respiratory infections in neurocritical care. Integrating clinical assessment, biomarkers and rapid microbiological testing enables timely, targeted therapy and reduces the misuse of antimicrobials. Full article

Background/Objectives: Ceftriaxone is widely used as empirical antimicrobial therapy (EAT) for urinary tract infections (UTIs). However, healthcare-associated urinary tract infections (HCA-UTIs) are often associated with inadequate EAT (IEAT). This study aims to evaluate the clinical impact of ceftriaxone as EAT in patients admitted to the hospital with community-onset HCA-UTIs in a setting with relatively high rates of antimicrobial resistance. Methods: A prospective observational study was conducted, comparing patients who received empirical treatment with ceftriaxone to those treated with other antibiotics. Results: A total of 235 cases were analyzed, 50.2% received ceftriaxone as EAT. The median age was 79 years, and 47.2% of patients were female. IEAT was significantly more frequent in the ceftriaxone group (36.4% vs. 17.1%, p = 0.001). Thirty-day mortality was 11.1%, with no significant difference between the ceftriaxone and non-ceftriaxone groups (11.9% vs. 10.3%, p = 0.752) but the use of antibiotics other than ceftriaxone was associated with a longer hospital stay (6 [4–8] vs. 5 [3–7] days, p = 0.037). The use of ceftriaxone as EAT was not associated with an increased risk of recurrence (16.1% vs. 15.4%, p = 0.709). Conclusions: In summary, empirical ceftriaxone use in patients with community-onset HCA-UTI was associated with a higher rate of inappropriate empirical therapy; however, it did not increase mortality or recurrence and was associated with a shorter hospital stay. These findings support the use of ceftriaxone as a potential option in selected patients without septic shock, while highlighting the importance of considering local resistance patterns and individual patient risk factors. Full article

Background and Objectives: Odontogenic sinusitis (ODS) is a particular type of sinus infection induced by dental infections or iatrogenic causes. Although not rare, it is often underrated and sometimes confused with other forms of chronic rhinosinusitis. The aim of this review was to summarize the main diagnostic aspects, microbiological profile, and current options in the therapeutic management of ODS. Materials and Methods: Recent studies and consensus statements from both dental and ENT fields were reviewed. The focus was on the ODS diagnostic criteria, the types and the timing of dental and endoscopic treatment approaches, and treatment combinations inducing the best outcomes in ODS. Results: ODS usually involves anaerobic bacteria such as Fusobacterium and Peptostreptococcus. Empirical antibiotics like amoxicillin or amoxicillin–clavulanate are most often used, but antibiotic therapy alone rarely cures the disease. Dental treatment is essential in ODS cases with oroantral fistulas, infected maxillary sinus bone grafts, or implants. However, in these clinical situations, concurrent one-stage dental and endoscopic sinus surgery (ESS) treatment seems to offer the highest success rate, close to 97%. Combined surgery significantly improved ODS treatment outcomes in terms of reduced reintervention rates and recurrence. There is still debate on how wide ESS should be in uncomplicated ODS, but many reports show that maxillary antrostomy alone can be sufficient. In apical periodontitis-related ODS, recurrence after primary ESS is uncommon in the short term. Conclusions: ODS management needs cooperation between ENT and dental specialists. Treating the dental underlying infection remains critical to prevent oral or systemic complications. Future research should better define diagnostic criteria, antibiotic use guidelines, and the best timing for combined surgery. New studies on microbiology, immunity, and artificial intelligence could help improve diagnosis and medical care of ODS patients. Full article

Background and Objectives: Helicobacter pylori (H. pylori) infection remains one of the most common chronic bacterial infections worldwide and is associated with a wide range of gastrointestinal disorders, including gastritis, peptic ulcer disease, and gastric cancer. Increasing rates of antibiotic resistance, particularly to clarithromycin and fluoroquinolones, represent a major therapeutic challenge. The objective of this study was to determine the prevalence of resistance-associated mutations in H. pylori-positive gastric biopsy samples from western Romania. Materials and Methods: We conducted a prospective study from January to December 2024, enrolling 138 patients undergoing gastroscopy. Biopsies were collected from the gastric antrum, and H. pylori infection was confirmed using the rapid urease test (RUT). Positive samples were further analyzed with the GenoType HelicoDR assay to detect mutations in the 23S rRNA gene (clarithromycin resistance) and gyrA gene (fluoroquinolone resistance). Clinical, demographic, and endoscopic data were also collected. Results:H. pylori infection was confirmed in 41.3% of the patients (57), of whom 63.2% (36) were treatment-naïve and 36.8% (21) had prior eradication therapy. Among treatment-naïve patients, clarithromycin resistance was identified in 19.4%, whereas previously treated patients showed a markedly higher resistance rate of 47.6% (p = 0.018). All clarithromycin-resistant cases carried the A2147G (23S MUT3) mutation. Fluoroquinolone resistance was present in 13.9% of naïve patients and increased to 23.8% in those with prior eradication therapy, with resistance linked to gyrA mutations at codons 87 (N87K) and 91 (D91 variants). Combined resistance to both antibiotics was observed only in a subset of previously treated patients. Conclusions: Primary resistance to clarithromycin in western Romania exceeds the 15% threshold defined by international guidelines, making clarithromycin-based triple therapy unsuitable as an empirical first-line option. The findings support the use of bismuth quadruple therapy as the preferred empirical regimen in this region. Also, molecular testing proved effective for rapid identification of resistance-associated mutations. Full article

Small intestinal bacterial overgrowth (SIBO) is a major yet underrecognized driver of gastrointestinal morbidity in systemic sclerosis (SSc). Disordered motility, fibrosis, and dysbiosis promote microbial stasis, malabsorption, and malnutrition, contributing substantially to impaired quality of life and survival. Diagnostic accuracy remains limited: jejunal aspirate culture is invasive, whereas breath testing offers only moderate sensitivity and specificity. Empirical antibiotic therapy yields transient symptom relief, but recurrence is common, and evidence guiding optimal eradication strategies is sparse. Adjunctive measures, including probiotics, prokinetics, and dietary interventions, remain variably applied, with heterogeneous outcomes across studies. Novel microbiome-targeted, neuromodulatory, and antifibrotic therapies are emerging as promising mechanism-based options. Bearing this in mind, this narrative review aims to consolidate current knowledge on SIBO eradication in SSc. We first outline the pathophysiological rationale and clinical relevance of bacterial overgrowth. We then synthesize available evidence for treatment strategies, appraise barriers to durable remission, and discuss implications for multidisciplinary management. Finally, we highlight emerging approaches, including microbiome-directed therapies, novel prokinetics, and antifibrotic interventions, and define priorities for future clinical research. Full article

Objective: This study aimed to evaluate the efficacy of empirical antibiotic therapy in treating chronic endometritis (CE) associated with abnormal uterine bleeding (AUB), infertility, or intrauterine lesions. Methods: The prospective cohort study involved 102 women undergoing outpatient hysteroscopy (OH), with immunohistochemical diagnosis of CE based on plasma cell density (PCD). Seventy-six of these women received empirical antibiotic therapy (ofloxacin and metronidazole), while 26 did not. A follow-up OH was conducted in the third cycle following the initial procedure. Results: Hysteroscopic polypectomy significantly reduced PCD regardless of antibiotic use (p = 0.009). In cases without focal lesions but exhibiting CE features, antibiotic therapy notably decreased PCD (p = 0.018). The incidence of certain histopathological features of CE, such as stromal edema and stromal cell compaction, was significantly lower in women treated with antibiotics (p = 0.014). Among intrauterine pathologies, endometrial polyps (p = 0.009) and cesarean scar defects (p = 0.011) significantly increased the risk of CE. Only spindled transformation of stromal cells with edema correlated significantly with elevated PCD (p = 0.022). Antibiotic therapy did not improve obstetric outcomes. Conclusions: Polypectomy alone reduced PCD without antibiotics, while antibiotic treatment significantly decreased PCD and resolved CE features in cases without focal lesions. Therefore, antibiotics may be prioritized for cases without focal lesions, whereas surgical intervention may be sufficient for CE associated with eligible pathologies. Full article