Impact of Bacteria on Semen Parameters and Their Antibiotic Susceptibility Pattern in Infertile Men

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Male factors contribute to up to 60% of cases, with urogenital tract infections leading to bacteriospermia being a significant etiological agent [2]. These infections impair sperm function through mechanisms like acrosome dysfunction, DNA fragmentation, and inducing oxidative stress, contributing to idiopathic infertility [1, 14]. This study aimed to determine the prevalence of bacterial pathogens in semen, quantify their adverse effects on semen parameters, and analyze their antibiotic susceptibility patterns to optimize clinical treatment. Methods: This was an observational study conducted on 249 positive semen cultures evaluated following the WHO 5th Edition guidelines [12]. Bacterial pathogens were isolated and identified using standard culture methods. Antibiotic susceptibility testing (AST) was performed using the Kirby-Bauer disk diffusion method. Data were analyzed using ONE-way ANOVA and the Tukey test (p<0.05). Results: A total of 249 bacterial isolates were analyzed. The most frequent isolates were Klebsiella (35.7%) , followed by Enterococcus (26.5%) , and Staphylococcus (14.1%) . Bacteriospermia was significantly associated with abnormal semen profiles, including oligoasthenoteratozoospermia (OATS) , showing a statistically significant difference in sperm concentration, total motility, progressive motility, vitality, and normal forms compared to normozoospermia (p<0.05). Klebsiella isolates showed high resistance to Ampicillin (41.0%) and Cefuroxime (38.0%) . Conversely, high sensitivity was observed for Nitrofurantoin (36.7%) , Gentamicin (35.2%) , and Amikacin (34.5%) against Klebsiella isolates. Conclusion: Bacteriospermia presents a major challenge in male infertility management. The high prevalence of drug-resistant isolates, particularly Klebsiella , underscores the critical necessity of targeted, culture-guided therapy using sensitive agents like Gentamicin or Nitrofurantoin to improve fertility outcomes. Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Infertility (“Infertility is defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year” [1]) which affects >20% of couples, and is on the rise from the past thirty years. Studies by H. Oghbaei et al. show that up to 50% of cases of infertility are caused by male factors, 40% by female factors, and 10% by both [1]. Recent statistics show that the percentage of male infertility has increased from 40% to 60% since the 1980s. Even though there is massive progress in the understanding of human reproductive physiology, the causes of approximately 50% of infertility cases remain unknown, which is termed as idiopathic infertility [1]. Male infertility can be caused by a variety of conditions, including lifestyle choices, endocrine abnormalities, varicocele, ejaculatory disorders, hypogonadism, excessive alcohol use, genetic defects, sperm dysfunction, and urogenital tract infections. Diversity of microorganisms, in particular, viruses and bacteria have been identified as the urogenital tract pathogens which cause subfertility [1]. In addition to impairing spermatogenesis and male fertility, bacterial infections can have detrimental effects on other areas of the male genital tract [1]. Bacteria can cause sperm cell damage in a variety of ways, including acrosome dysfunction, DNA fragmentation, and cell membrane peroxidation [1]. Toxins and metabolites released by bacteria or the direct attachment of bacteria to sperm cells, which triggers signaling pathways linked to inflammation, oxidative stress, and apoptosis, can also have detrimental effects, impairing semen parameters [1]. Invasion of various microorganisms into the male reproductive tract could be detrimental to the semen quality as well as sperm function [1]. Furthermore, bacteria of semen can contaminate the female genital tract during ejaculation, potentially causing gynecological disorders such as ectopic pregnancy, cervicitis, endometritis, and embryonic or fetal death [1]. Urogenital tract infections and bacteriospermia are considered leading causes of male infertility [2]. Male genital tract infections can generate Anti-sperm Antibodies (ASAs) which result in an autoimmunity response [3]. The advent of antibiotic resistance in bacteria has made choosing prescribed therapy more strenuous and expensive [4]. Regular screening of organisms that cause various infections and identifying their antibiotic susceptibility pattern is crucial for guiding clinicians to select a relevant antibiotic for empirical treatment of infections [4]. Male genitourinary tract infections are responsible for around 15% of cases of male infertility [5]. The impact of male urogenital bacteria on spermatogenesis, sperm functions, and bacterial sensitivity/resistance patterns toward antibiotics is the focus of the current study [1]. 2. Methods 2.1 Definition and Etiology Bacteriospermia (infection with bacteria in the semen) [6] is a major cause of male infertility, directly leading to abnormal semen parameters and impaired sperm functions. The mechanisms of injury are multifactorial, including: decreased sperm motility, deterioration of spermatogenesis, changed acrosome response, generation of excessive Reactive Oxygen Species (ROS) leading to higher DNA fragmentation index , generation of Anti-sperm Antibodies (ASAs) due to breach of the blood-testis barrier, and obstruction in the genital tract secondary to chronic inflammation and fibrosis [7]. Infections caused by gram-positive and gram-negative bacteria are collectively responsible for an estimated 15% of primary male infertilities [1]. These bacterial species often cause inflammation in the male accessory glands (such as prostatitis or epididymitis) which ultimately results in gland dysfunction, potential blockage, and impaired semen production and parameters [1, 15]. The severity of inflammation is often indicated by leukocytospermia (a condition diagnosed by observing 10 or more pus cells per ×40 microscopic objective lens (HPF) in the seminal fluid) [5]. Leukocytospermia is problematic because these immune cells, while combating infection, generate excessive ROS, which causes damaging oxidative stress to the spermatozoa's membrane and DNA [5]. Furthermore, specific bacterial components, such as endotoxins, are recognized by innate immune receptors on the sperm itself (e.g., Toll-like receptors 2 and 4), triggering cellular damage and apoptosis [16]. 2.2 Study Design and Patient Selection This was an observational study conducted on a cohort of patients presenting for infertility evaluation. A total of 249 subjects were included in the study. The final classification of the 249 men was: Normozoospermia (n=146, 58.6%) , Asthenozoospermia (n=34, 13.7%) , Oligoasthenoteratozoospermia (OAT) (n=25, 10%) , Oligoasthenozoospermia (n=21, 8.4%) , Teratozoospermia (n=4, 1.6%) , Asthenoteratozoospermia (n=8, 3.2%) , Oligozoospermia (n=7, 2.8%) , Azoospermia (n=2, 0.8%) , and Polyzoospermia (n=2, 0.8%) . 2.3 Semen Analysis Semen samples were analyzed according to the established World Health Organization (WHO) guidelines [12]. Initial Macroscopic Examination: Included assessment of Liquefaction , Semen viscosity , Appearance of the ejaculate , Semen volume , and Semen pH [12]. Initial Microscopic Investigation: Focused on Sperm Motility (Progressive Motility (PR), Non-Progressive Motility (NP), Immotility (IM)), Sperm Vitality , Sperm Numbers , and Sperm Morphology (head, midpiece, and tail) [12]. 2.4 Microbial Isolation and Identification Semen samples were cultured for bacterial isolation. The most frequently isolated organisms, documented by their colony-forming units (CFUs), included: Klebsiella ( n=89, 35.7% ), Enterococcus ( n=66, 26.5% ), Staphylococcus ( n=35, 14.1% ), and E. Coli ( n=31, 12.4% ), among others. 2.5 Antibiotic Susceptibility Testing (AST) The antimicrobial resistance was identified primarily using the Disk Diffusion Method (Kirby-Bauer method). The measured zone of inhibition determined the isolate classification as Susceptible (S) , Intermediately susceptible (I) , or Resistant (R) . The panel of antibiotics tested included Cephalosporins (CN, CFM, CTX, CXM, CAZ, CPD), Penicillins (AMX, AMP, PIT), Carbapenems (MRP, IPM), Aminoglycosides (G, AK), Quinolones/Fluoroquinolones (CIP, NX, LE), and others (E, NIT). 2.6 Statistical Analysis Data processing was performed using IBM SPSS Statistics version 11 . The Kolmogorov–Smirnov test determined data distribution. ONE way ANOVA and the Tukey test were used for multiple comparisons. The Chi-square test was used for categorical variables. A P-value of <0.05 was considered to be statistically significant. 2.7 Ethical Approval and Consent to Participate The study protocol was reviewed and approved by the Institutional Ethics Committee. Written informed consent was obtained from all participants. 3. Results A total of 249 subjects were included in the study, and their positive culture profiles were correlated with their concluded semen analysis impressions. Statistical analysis, including ONE way ANOVA and the Tukey test for multiple comparisons, was performed. 3.1 Distribution of Clinical Impressions Among the 249 men with positive semen cultures, the distribution of clinical impressions was highest for Normozoospermia (n=146, 58.6%) , followed by Asthenozoospermia (n=34, 13.7%) , and Oligoasthenoteratozoospermia (n=25, 10%) . 3.2 Microbial Isolation Profile The highest incidence of bacterial isolates from positive semen cultures was found to be Klebsiella (n=89, 35.7%) , followed by Enterococcus (n=66, 26.5%) , and Staphylococcus (n=35, 14.1%) . Table 1: Bacterial Isolates from Positive Semen Culture Profile (n=249) Organism n Percentage (%) Klebsiella 89 35.7 Enterococcus 66 26.5 Staphylococcus 35 14.1 E. Coli 31 12.4 Streptococcus 6 2.4 Pseudomonas 5 2.0 Mixed Colony Staphylococcus & Pseudomonas 3 1.2 Klebsiella & Staphylococcus 3 1.2 E. Coli & Klebsiella 2 0.8 E. Coli & Enterococcus 1 0.4 Enterococcus & Proteus 1 0.4 Staphylococcus & Enterococcus 1 0.4 Enterobacter 1 0.4 Proteus 1 0.4 Staphylococcus aureus 1 0.4 Total 249 100.0 3.3 Comparison of Semen Parameters by Clinical Impression The semen parameters (Concentration (Conc.), Total Motility (TM), Progressive Motility (PM), Non-Progressive Motility (NPM), Immotility (IM), Vitality, Normal forms, and Volume) varied significantly across the different clinical impressions. Table 2: Comparison of Semen Parameters by Clinical Impression Impression n Statistic Conc. TM PM NPM IM Vitality Normal forms Volume Asthenoteratozoospermia 8 Mean 51.70 22.25 12.00 8.75 61.75 29.38 2.63 1.71 S.D 27.90 7.89 6.50 4.20 34.99 12.55 0.52 0.81 Asthenozoospermia 34 Mean 58.08 26.44 16.32 8.29 52.59 31.88 4.76 2.51 S.D 52.30 9.50 9.66 5.22 31.53 13.95 3.16 2.89 Azoospermia 2 Mean 30.05 15.00 12.00 3.00 35.00 27.00 2.00 1.35 S.D 42.50 21.21 16.97 4.24 49.50 38.18 2.83 1.20 Normozoospermia 146 Mean 74.45 58.74 48.50 9.95 37.96 63.44 11.46 2.03 S.D 49.08 12.00 14.50 7.15 14.39 14.82 4.50 1.06 OAT (Oligoasthenoteratozoospermia) 25 Mean 9.49 23.08 6.80 13.76 40.36 28.80 2.00 2.00 S.D 3.20 8.25 5.38 6.78 34.81 12.05 0.96 1.24 Oligoasthenozoospermia 21 Mean 5.45 20.71 5.67 14.57 72.33 9.48 0.71 1.84 S.D 3.36 10.43 10.18 9.56 24.59 15.82 1.82 1.00 Oligozoospermia 7 Mean 11.81 59.43 31.71 26.43 29.00 54.71 6.71 3.21 S.D 2.39 8.96 14.45 12.31 18.74 25.54 2.36 1.56 Polyzoospermia 2 Mean 305.95 60.50 54.50 6.00 33.50 60.50 9.50 1.70 S.D 128.00 10.00 6.00 4.24 29.00 27.50 2.12 0.42 Teratozoospermia 4 Mean 42.13 48.50 20.25 27.50 51.50 30.25 2.00 1.50 S.D 29.98 29.28 10.89 20.62 26.24 19.38 0.82 0.29 3.4 Antibiotic Susceptibility Testing (AST) The AST results show the resistance and susceptibility patterns of the isolated organisms to the panel of 18 antibiotics. Table 3: Percentage Resistance of Bacterial Isolates to Tested Antibiotics (%R) Organism CN CFM CTX CXM CAZ E AMX AMP NIT G AK CIP NX MRP PIT LE IPM CPD E. Coli 14.6 11.5 14.8 10.1 11.9 10.9 12.7 12.2 3.4 7.4 6.2 12.6 3.6 9.5 11.8 11.5 20.0 11.8 Enterococcus 26.0 27.5 18.2 22.8 30.2 28.6 14.8 14.7 14.9 42.6 38.5 31.5 39.3 23.8 11.8 34.4 13.3 27.2 Klebsiella 32.3 34.1 31.8 38.0 37.3 36.0 37.3 41.0 34.5 37.0 40.0 34.6 36.4 42.9 23.5 34.4 40.0 35.5 Staphylococcus 14.6 14.8 20.5 15.8 11.1 13.1 19.7 17.3 26.4 9.3 7.7 11.8 12.9 9.5 29.4 14.8 20.0 14.9 Table 4: Percentage Susceptibility of Bacterial Isolates to Tested Antibiotics (%S) Organism CN CFM CTX CXM CAZ E AMX AMP NIT G AK CIP NX MRP PIT LE IPM CPD E. Coli 5.6 15.4 11.7 16.7 12.6 15.7 12.4 13.2 17.1 14.0 15.3 12.1 23.8 12.7 12.2 12.6 12.0 19.0 Enterococcus 25.9 24.6 30.5 32.2 22.7 21.4 41.9 46.2 32.3 21.8 22.0 21.6 10.5 26.8 27.5 23.5 27.0 19.0 Klebsiella 48.1 41.5 37.7 32.2 35.3 37.1 33.3 27.5 36.7 35.2 34.5 36.2 36.2 35.1 36.7 36.6 35.6 38.1 Staphylococcus 13.0 10.8 11.0 11.1 16.0 14.3 6.7 7.7 7.6 15.5 15.8 17.2 14.3 14.5 13.1 14.2 13.7 4.8 (Note: Data for mixed colonies and rare isolates have been omitted from Tables 3 and 4 for clarity and focus on major isolates). 4. Discussion The primary objective of this study was to assess the prevalence of bacteriospermia in an infertile male cohort and to correlate bacterial presence with adverse changes in semen parameters. The findings confirmed that bacteriospermia is a significant factor in male subfertility, aligning with global statistics indicating infections are responsible for approximately 15% of male infertility cases [5]. Prevalence of Isolates and Comparison to Literature Our analysis of 249 positive cultures (Table 1) revealed that Klebsiella spp. was the dominant isolate (35.7%), followed by Enterococcus spp. (26.5%), and Staphylococcus spp. (14.1%). This finding contrasts with many reports from other regions which often cite E. coli or Enterococcus as the most common gram-negative and gram-positive urogenital pathogens, respectively [32, 33]. For instance, some studies emphasize E. coli as the main gram-negative causative agent [37]. The high prevalence of Klebsiella in our specific cohort may reflect regional differences in hygiene, common infectious reservoirs, or local prescribing practices that favor resistance in this organism. The presence of mixed colonies (e.g., Staphylococcus & Pseudomonas ) also indicates polymicrobial infection, which can complicate both diagnosis and treatment [1]. Impact on Semen Parameters Our results support the hypothesis that bacterial infection, regardless of the severity of growth (scanty, moderate, or heavy), impairs sperm function. Statistical comparison across clinical impressions (Table 2) showed a pronounced negative impact on key parameters. Organisms such as E. Coli, Klebsiella, and their mixed colonies were associated with a decline in sperm concentration, progressive motility (PM), total motility (TM), and normal morphology. These impairments are likely mediated by the mechanisms of damage discussed in the introduction: bacteria release toxins and metabolites, which in turn induce inflammation and increase the production of Reactive Oxygen Species (ROS) by leukocytes [14, 15]. The resulting oxidative stress causes lipid peroxidation of the sperm membrane, leading to a loss of motility and increased DNA fragmentation, ultimately contributing to asthenozoospermia and teratozoospermia [17, 34]. The fact that a majority of normozoospermic men showed heavy bacterial growth without significant impairment suggests a potential subclinical carrier state or effective local immune suppression, highlighting the need for functional assays (like DNA fragmentation) beyond conventional semen analysis to fully assess bacterial damage [36]. 5. Conclusion The current study demonstrates a high prevalence of bacteriospermia in infertile men, with Klebsiella spp. being the most frequent isolate, and confirms the negative impact of specific bacteria on critical semen parameters. Resistance patterns are a critical finding: Resistance towards Meropenem (42.90%), Ampicillin (41.00%), Amikacin (40.00%), and Gentamicin (42.60%) suggests a significant and growing problem of antimicrobial resistance (AMR) within our patient population. This high level of resistance against commonly used antibiotics likely reflects frequent and indiscriminate use, leading to the emergence of drug-resistant bacteria [4]. Based on the observed sensitivity patterns, Cefalexin, Cefixime, Cefotaxime, Erythromycin, Nitrofurantoin, and Ampicillin appear to be potential drugs of choice for empirical treatment [37]. Therefore, regular screening of bacterial pathogens along with an updated antibiotic susceptibility profile is essential in the management of infertile men. This approach will provide clear insight into bacterial epidemiology and guide clinicians toward effective, targeted antibiotic therapy. Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the Institutional Ethics Committee. Written informed consent was obtained from all participants prior to their enrollment in the study and sample collection. All patient data were anonymized and handled in strict compliance with the principles of the Declaration of Helsinki and institutional guidelines. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding [No funding was received for this study.] Authors' contributions MURALIDHAR BABU C V: Conceptualization, methodology, data acquisition, and original draft preparation. Dr. Mir Jaffar: Data validation, supervision, and manuscript review. All authors read and approved the final manuscript. References Oghbaei H, Ghoroghchian M, Mirjalili E, Alihassani M, Kargar M. Effects of bacteria on male fertility: Spermatogenesis and sperm function. Life Sci . 2020;256:117891. Waqqar S. 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FERTILITY","correspondingAuthor":false,"prefix":"Dr.","firstName":"Mir","middleName":"","lastName":"Jaffar","suffix":""}],"badges":[],"createdAt":"2025-10-07 11:23:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7799013/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7799013/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95668653,"identity":"b3537424-1615-4333-8a72-90e2da7aea33","added_by":"auto","created_at":"2025-11-11 17:07:07","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30109,"visible":true,"origin":"","legend":"","description":"","filename":"IMPACTOFBACTERIAONSEMENPARAMETERSANDANTIBIOTICSUSEPTIBILITYPATTERNMAINDOC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/138a6b92cc3c04bef6acc6a0.docx"},{"id":95668651,"identity":"0e1d15ef-5397-4b6d-b4ca-729091da6a36","added_by":"auto","created_at":"2025-11-11 17:07:07","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4919,"visible":true,"origin":"","legend":"","description":"","filename":"f465a779579f4f5c847edb98d41b6523.json","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/3be11710dc9e7ccaabc55f46.json"},{"id":95668657,"identity":"06b8687a-6480-4062-92fb-9c7971ccf612","added_by":"auto","created_at":"2025-11-11 17:07:07","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":740605,"visible":true,"origin":"","legend":"","description":"","filename":"FiguresandTables.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/6ea4d4275ec71de57f4451fd.pdf"},{"id":95798813,"identity":"1d950bdd-fd1c-481f-81b1-5fb5dd9163ca","added_by":"auto","created_at":"2025-11-13 08:17:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":108959,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/79325ba9de897f0ae754f21d.jpg"},{"id":95668654,"identity":"e9c2c6f0-e8aa-4abc-9c3e-4f5c211a2e60","added_by":"auto","created_at":"2025-11-11 17:07:07","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":319621,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/78917edd124a83bedecbd783.jpg"},{"id":95668656,"identity":"63389503-dfe3-4b89-8dcb-f4ab3d1429a7","added_by":"auto","created_at":"2025-11-11 17:07:07","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":280765,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/a54a828f9a1a256cf1765691.jpg"},{"id":95668655,"identity":"3b2212f9-6759-45c3-a569-e795a63a0d06","added_by":"auto","created_at":"2025-11-11 17:07:07","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":600015,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/4a40a3a61a9350a95fa7bb52.jpg"},{"id":95804567,"identity":"169c5ff6-d5f1-4196-9eab-4ccbd7b6dbb0","added_by":"auto","created_at":"2025-11-13 08:38:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3275581,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7799013/v1/8c8982c1-1172-4d62-b579-7406626923f6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Bacteria on Semen Parameters and Their Antibiotic Susceptibility Pattern in Infertile Men\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eInfertility (“Infertility is defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year” [1]) which affects \u0026gt;20% of couples, and is on the rise from the past thirty years. Studies by H. Oghbaei et al. show that up to 50% of cases of infertility are caused by male factors, 40% by female factors, and 10% by both [1]. Recent statistics show that the percentage of male infertility has increased from 40% to 60% since the 1980s. Even though there is massive progress in the understanding of human reproductive physiology, the causes of approximately 50% of infertility cases remain unknown, which is termed as \u003cstrong\u003eidiopathic infertility\u003c/strong\u003e [1]. Male infertility can be caused by a variety of conditions, including lifestyle choices, endocrine abnormalities, varicocele, ejaculatory disorders, hypogonadism, excessive alcohol use, genetic defects, sperm dysfunction, and urogenital tract infections. Diversity of microorganisms, in particular, viruses and bacteria have been identified as the urogenital tract pathogens which cause subfertility [1].\u003c/p\u003e\n\u003cp\u003eIn addition to impairing spermatogenesis and male fertility, bacterial infections can have detrimental effects on other areas of the male genital tract [1]. Bacteria can cause sperm cell damage in a variety of ways, including \u003cstrong\u003eacrosome dysfunction, DNA fragmentation, and cell membrane peroxidation\u003c/strong\u003e [1]. Toxins and metabolites released by bacteria or the direct attachment of bacteria to sperm cells, which triggers signaling pathways linked to inflammation, oxidative stress, and apoptosis, can also have detrimental effects, impairing semen parameters [1].\u003c/p\u003e\n\u003cp\u003eInvasion of various microorganisms into the male reproductive tract could be detrimental to the semen quality as well as sperm function [1]. Furthermore, bacteria of semen can contaminate the female genital tract during ejaculation, potentially causing gynecological disorders such as ectopic pregnancy, cervicitis, endometritis, and embryonic or fetal death [1]. Urogenital tract infections and \u003cstrong\u003ebacteriospermia\u003c/strong\u003e are considered leading causes of male infertility [2].\u003c/p\u003e\n\u003cp\u003eMale genital tract infections can generate \u003cstrong\u003eAnti-sperm Antibodies (ASAs)\u003c/strong\u003e which result in an autoimmunity response [3]. The advent of antibiotic resistance in bacteria has made choosing prescribed therapy more strenuous and expensive [4]. Regular screening of organisms that cause various infections and identifying their \u003cstrong\u003eantibiotic susceptibility pattern\u003c/strong\u003e is crucial for guiding clinicians to select a relevant antibiotic for empirical treatment of infections [4]. Male genitourinary tract infections are responsible for around 15% of cases of male infertility [5]. The impact of male urogenital bacteria on spermatogenesis, sperm functions, and bacterial sensitivity/resistance patterns toward antibiotics is the focus of the current study [1].\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Definition and Etiology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBacteriospermia\u003c/strong\u003e (infection with bacteria in the semen) [6] is a major cause of male infertility, directly leading to abnormal semen parameters and impaired sperm functions. The mechanisms of injury are multifactorial, including: decreased sperm motility, deterioration of spermatogenesis, changed acrosome response, generation of excessive \u003cstrong\u003eReactive Oxygen Species (ROS)\u003c/strong\u003e leading to higher \u003cstrong\u003eDNA fragmentation index\u003c/strong\u003e, generation of \u003cstrong\u003eAnti-sperm Antibodies (ASAs)\u003c/strong\u003e due to breach of the blood-testis barrier, and obstruction in the genital tract secondary to chronic inflammation and fibrosis [7].\u003c/p\u003e\n\u003cp\u003eInfections caused by gram-positive and gram-negative bacteria are collectively responsible for an estimated 15% of primary male infertilities [1]. These bacterial species often cause \u003cstrong\u003einflammation in the male accessory glands\u003c/strong\u003e (such as prostatitis or epididymitis) which ultimately results in gland dysfunction, potential blockage, and impaired semen production and parameters [1, 15].\u003c/p\u003e\n\u003cp\u003eThe severity of inflammation is often indicated by \u003cstrong\u003eleukocytospermia\u003c/strong\u003e (a condition diagnosed by observing \u003cstrong\u003e10 or more pus cells per ×40 microscopic objective lens (HPF)\u003c/strong\u003e in the seminal fluid) [5]. Leukocytospermia is problematic because these immune cells, while combating infection, generate excessive ROS, which causes damaging oxidative stress to the spermatozoa's membrane and DNA [5]. Furthermore, specific bacterial components, such as endotoxins, are recognized by innate immune receptors on the sperm itself (e.g., Toll-like receptors 2 and 4), triggering cellular damage and apoptosis [16].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study Design and Patient Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was an observational study conducted on a cohort of patients presenting for infertility evaluation. A total of \u003cstrong\u003e249 subjects\u003c/strong\u003e were included in the study. The final classification of the 249 men was: \u003cstrong\u003eNormozoospermia (n=146, 58.6%)\u003c/strong\u003e, \u003cstrong\u003eAsthenozoospermia (n=34, 13.7%)\u003c/strong\u003e, \u003cstrong\u003eOligoasthenoteratozoospermia (OAT) (n=25, 10%)\u003c/strong\u003e, \u003cstrong\u003eOligoasthenozoospermia (n=21, 8.4%)\u003c/strong\u003e, \u003cstrong\u003eTeratozoospermia (n=4, 1.6%)\u003c/strong\u003e, \u003cstrong\u003eAsthenoteratozoospermia (n=8, 3.2%)\u003c/strong\u003e, \u003cstrong\u003eOligozoospermia (n=7, 2.8%)\u003c/strong\u003e, \u003cstrong\u003eAzoospermia (n=2, 0.8%)\u003c/strong\u003e, and \u003cstrong\u003ePolyzoospermia (n=2, 0.8%)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Semen Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemen samples were analyzed according to the established World Health Organization (WHO) guidelines [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInitial Macroscopic Examination:\u003c/strong\u003e Included assessment of \u003cstrong\u003eLiquefaction\u003c/strong\u003e, \u003cstrong\u003eSemen viscosity\u003c/strong\u003e, \u003cstrong\u003eAppearance of the ejaculate\u003c/strong\u003e, \u003cstrong\u003eSemen volume\u003c/strong\u003e, and \u003cstrong\u003eSemen pH\u003c/strong\u003e [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInitial Microscopic Investigation:\u003c/strong\u003e Focused on \u003cstrong\u003eSperm Motility\u003c/strong\u003e (Progressive Motility (PR), Non-Progressive Motility (NP), Immotility (IM)), \u003cstrong\u003eSperm Vitality\u003c/strong\u003e, \u003cstrong\u003eSperm Numbers\u003c/strong\u003e, and \u003cstrong\u003eSperm Morphology\u003c/strong\u003e (head, midpiece, and tail) [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Microbial Isolation and Identification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemen samples were cultured for bacterial isolation. The most frequently isolated organisms, documented by their \u003cstrong\u003ecolony-forming units\u003c/strong\u003e (CFUs), included: \u003cstrong\u003eKlebsiella\u003c/strong\u003e (\u003cstrong\u003en=89, 35.7%\u003c/strong\u003e), \u003cstrong\u003eEnterococcus\u003c/strong\u003e (\u003cstrong\u003en=66, 26.5%\u003c/strong\u003e), \u003cstrong\u003eStaphylococcus\u003c/strong\u003e (\u003cstrong\u003en=35, 14.1%\u003c/strong\u003e), and \u003cstrong\u003eE. Coli\u003c/strong\u003e (\u003cstrong\u003en=31, 12.4%\u003c/strong\u003e), among others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Antibiotic Susceptibility Testing (AST)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe antimicrobial resistance was identified primarily using the \u003cstrong\u003eDisk Diffusion Method\u003c/strong\u003e (Kirby-Bauer method). The measured \u003cstrong\u003ezone of inhibition\u003c/strong\u003e determined the isolate classification as \u003cstrong\u003eSusceptible (S)\u003c/strong\u003e, \u003cstrong\u003eIntermediately susceptible (I)\u003c/strong\u003e, or \u003cstrong\u003eResistant (R)\u003c/strong\u003e. The panel of antibiotics tested included Cephalosporins (CN, CFM, CTX, CXM, CAZ, CPD), Penicillins (AMX, AMP, PIT), Carbapenems (MRP, IPM), Aminoglycosides (G, AK), Quinolones/Fluoroquinolones (CIP, NX, LE), and others (E, NIT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData processing was performed using \u003cstrong\u003eIBM SPSS Statistics version 11\u003c/strong\u003e. The \u003cstrong\u003eKolmogorov–Smirnov test\u003c/strong\u003e determined data distribution. \u003cstrong\u003eONE way ANOVA\u003c/strong\u003e and the \u003cstrong\u003eTukey test\u003c/strong\u003e were used for multiple comparisons. The \u003cstrong\u003eChi-square test\u003c/strong\u003e was used for categorical variables. A \u003cstrong\u003eP-value of \u0026lt;0.05\u003c/strong\u003e was considered to be statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.7 Ethical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Institutional Ethics Committee. Written \u003cstrong\u003einformed consent\u003c/strong\u003e was obtained from all participants.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 249 subjects were included in the study, and their positive culture profiles were correlated with their concluded semen analysis impressions. Statistical analysis, including ONE way ANOVA and the Tukey test for multiple comparisons, was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Distribution of Clinical Impressions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 249 men with positive semen cultures, the distribution of clinical impressions was highest for \u003cstrong\u003eNormozoospermia (n=146, 58.6%)\u003c/strong\u003e, followed by \u003cstrong\u003eAsthenozoospermia (n=34, 13.7%)\u003c/strong\u003e, and \u003cstrong\u003eOligoasthenoteratozoospermia (n=25, 10%)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Microbial Isolation Profile\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe highest incidence of bacterial isolates from positive semen cultures was found to be \u003cstrong\u003eKlebsiella (n=89, 35.7%)\u003c/strong\u003e, followed by \u003cstrong\u003eEnterococcus (n=66, 26.5%)\u003c/strong\u003e, and \u003cstrong\u003eStaphylococcus (n=35, 14.1%)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Bacterial Isolates from Positive Semen Culture Profile (n=249)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOrganism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKlebsiella\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnterococcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStaphylococcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eE. Coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStreptococcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePseudomonas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixed Colony\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus \u0026amp; Pseudomonas\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella \u0026amp; Staphylococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eE. Coli \u0026amp; Klebsiella\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eE. Coli \u0026amp; Enterococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eEnterococcus \u0026amp; Proteus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus \u0026amp; Enterococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnterobacter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProteus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e249\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Comparison of Semen Parameters by Clinical Impression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe semen parameters (Concentration (Conc.), Total Motility (TM), Progressive Motility (PM), Non-Progressive Motility (NPM), Immotility (IM), Vitality, Normal forms, and Volume) varied significantly across the different clinical impressions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Comparison of Semen Parameters by Clinical Impression\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"734\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eImpression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConc.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNPM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVitality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNormal forms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVolume\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsthenoteratozoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsthenozoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAzoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormozoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOAT (Oligoasthenoteratozoospermia)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOligoasthenozoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOligozoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePolyzoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e305.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeratozoospermia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Antibiotic Susceptibility Testing (AST)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe AST results show the resistance and susceptibility patterns of the isolated organisms to the panel of 18 antibiotics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Percentage Resistance of Bacterial Isolates to Tested Antibiotics (%R)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"740\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOrganism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCFM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCTX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCXM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCAZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAMX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAMP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNIT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePIT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIPM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCPD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eE. Coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eEnterococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKlebsiella\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e38.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e41.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Percentage Susceptibility of Bacterial Isolates to Tested Antibiotics (%S)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOrganism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCFM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCTX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCXM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCAZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAMX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAMP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNIT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePIT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIPM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCPD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eE. Coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eEnterococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKlebsiella\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e36.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e35.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e34.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e(Note: Data for mixed colonies and rare isolates have been omitted from Tables 3 and 4 for clarity and focus on major isolates).\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe primary objective of this study was to assess the prevalence of bacteriospermia in an infertile male cohort and to correlate bacterial presence with adverse changes in semen parameters. The findings confirmed that bacteriospermia is a significant factor in male subfertility, aligning with global statistics indicating infections are responsible for approximately 15% of male infertility cases [5].\u003c/p\u003e\n\u003cp\u003ePrevalence of Isolates and Comparison to Literature\u003c/p\u003e\n\u003cp\u003eOur analysis of 249 positive cultures (Table 1) revealed that Klebsiella spp. was the dominant isolate (35.7%), followed by Enterococcus spp. (26.5%), and Staphylococcus spp. (14.1%). This finding contrasts with many reports from other regions which often cite \u003cem\u003eE. coli\u003c/em\u003e or \u003cem\u003eEnterococcus\u003c/em\u003e as the most common gram-negative and gram-positive urogenital pathogens, respectively [32, 33]. For instance, some studies emphasize \u003cem\u003eE. coli\u003c/em\u003e as the main gram-negative causative agent [37]. The high prevalence of \u003cem\u003eKlebsiella\u003c/em\u003e in our specific cohort may reflect regional differences in hygiene, common infectious reservoirs, or local prescribing practices that favor resistance in this organism. The presence of mixed colonies (e.g., \u003cem\u003eStaphylococcus \u0026amp; Pseudomonas\u003c/em\u003e) also indicates polymicrobial infection, which can complicate both diagnosis and treatment [1].\u003c/p\u003e\n\u003cp\u003eImpact on Semen Parameters\u003c/p\u003e\n\u003cp\u003eOur results support the hypothesis that bacterial infection, regardless of the severity of growth (scanty, moderate, or heavy), impairs sperm function. Statistical comparison across clinical impressions (Table 2) showed a pronounced negative impact on key parameters.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eOrganisms such as E. Coli, Klebsiella, and their mixed colonies were associated with a decline in sperm concentration, progressive motility (PM), total motility (TM), and normal morphology.\u003c/li\u003e\n \u003cli\u003eThese impairments are likely mediated by the mechanisms of damage discussed in the introduction: bacteria release toxins and metabolites, which in turn induce inflammation and increase the production of Reactive Oxygen Species (ROS) by leukocytes [14, 15]. The resulting oxidative stress causes lipid peroxidation of the sperm membrane, leading to a loss of motility and increased DNA fragmentation, ultimately contributing to asthenozoospermia and teratozoospermia [17, 34].\u003c/li\u003e\n \u003cli\u003eThe fact that a majority of normozoospermic men showed heavy bacterial growth without significant impairment suggests a potential subclinical carrier state or effective local immune suppression, highlighting the need for functional assays (like DNA fragmentation) beyond conventional semen analysis to fully assess bacterial damage [36].\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe current study demonstrates a high prevalence of bacteriospermia in infertile men, with \u003cem\u003eKlebsiella spp.\u003c/em\u003e being the most frequent isolate, and confirms the negative impact of specific bacteria on critical semen parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResistance patterns are a critical finding:\u003c/strong\u003e Resistance towards Meropenem (42.90%), Ampicillin (41.00%), Amikacin (40.00%), and Gentamicin (42.60%) suggests a significant and growing problem of \u003cstrong\u003eantimicrobial resistance (AMR)\u003c/strong\u003e within our patient population. This high level of resistance against commonly used antibiotics likely reflects frequent and indiscriminate use, leading to the emergence of drug-resistant bacteria [4].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBased on the observed sensitivity patterns, Cefalexin, Cefixime, Cefotaxime, Erythromycin, Nitrofurantoin, and Ampicillin appear to be potential drugs of choice for empirical treatment [37].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTherefore, regular screening of bacterial pathogens along with an updated antibiotic susceptibility profile is essential in the management of infertile men. This approach will provide clear insight into bacterial epidemiology and guide clinicians toward effective, targeted antibiotic therapy.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e The study protocol was reviewed and approved by the Institutional Ethics Committee. Written informed consent was obtained from all participants prior to their enrollment in the study and sample collection. All patient data were anonymized and handled in strict compliance with the principles of the Declaration of Helsinki and institutional guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e [No funding was received for this study.]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e \u003cstrong\u003eMURALIDHAR BABU C V:\u003c/strong\u003e Conceptualization, methodology, data acquisition, and original draft preparation. \u003cstrong\u003eDr. Mir Jaffar:\u003c/strong\u003e Data validation, supervision, and manuscript review. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eOghbaei H, Ghoroghchian M, Mirjalili E, Alihassani M, Kargar M. Effects of bacteria on male fertility: Spermatogenesis and sperm function. \u003cem\u003eLife Sci\u003c/em\u003e. 2020;256:117891.\u003c/li\u003e\n \u003cli\u003eWaqqar S. Bacteriospermia among Asymptomatic Infertile Males, a Trigger for Morphological and Physiological Deterioration of Spermatozoa. \u003cem\u003eGlob J Intellect Dev Disabil\u003c/em\u003e. 2017;2(2):45–48.\u003c/li\u003e\n \u003cli\u003eArchana SS, Selvaraju S, Binsila BK, Arangasamy A, Krawetz SA. Immune regulatory molecules as modiemen and fertility: A reviewfiers of s. \u003cem\u003eMol Reprod Dev\u003c/em\u003e. 2019;86(11):1485–1504.\u003c/li\u003e\n \u003cli\u003eSalisu NA, Nas FS, Diso SU, Ali M. Antibiotic Sensitivity Pattern of Bacteria Isolated from Semen of Male Patients with Infertility Attending Murtala Muhammad Specialist Hospital Kano, Nigeria. \u003cem\u003eAdv Biomed Biosci\u003c/em\u003e. 2018;1(5):63–67.\u003c/li\u003e\n \u003cli\u003ePagliuca C, Sessa M, Pirozzi C, Giugliano A, Rago R, Nappi A, et al. Microbiological Evaluation and Sperm DNA Fragmentation in Semen Samples of Patients Undergoing Fertility Investigation. 2021. p. 1–12.\u003c/li\u003e\n \u003cli\u003ePeriasamy M, Elanchezhian M, Muthiah S. Bacteriospermia – An Important Factor Which Needs More Attention in Infertility Care. \u003cem\u003eBiosci Biotechnol Res Asia\u003c/em\u003e. 2020;17(2):285–291.\u003c/li\u003e\n \u003cli\u003eVilvanathan S, Arivalagan A, Thirunavukkarasu A, Bhuvaneshwari A, Nandhini E. 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IntechOpen; 2018.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. \u003cem\u003eWHO Laboratory Manual for the Examination and Processing of Human Semen\u003c/em\u003e. 5th ed. Geneva: World Health Organization; 2010.\u003c/li\u003e\n \u003cli\u003eStassen L, Armitage CW, van der Heide DJ, Beagley KW, Frentiu FD. Zika virus in the male reproductive tract. \u003cem\u003eViruses\u003c/em\u003e. 2018;10(4):198.\u003c/li\u003e\n \u003cli\u003eAgarwal A, Rana M, Qiu E, AlBunni H, Bui AD, Henkel R. Role of oxidative stress, infection and inflammation in male infertility. \u003cem\u003eAndrologia\u003c/em\u003e. 2018;50(11):e13126.\u003c/li\u003e\n \u003cli\u003eFraczek M, Kurpisz M. Mechanisms of the harmful effects of bacterial semen infection on ejaculated human spermatozoa: Potential inflammatory markers in semen. \u003cem\u003eFolia Histochem Cytobiol\u003c/em\u003e. 2015;53(3):201–217.\u003c/li\u003e\n \u003cli\u003eFujita Y, Tsuji M, Narimoto K, Ito S, Hisasue S, Tsukamoto T, et al. Toll-like receptors (TLR) 2 and 4 on human sperm recognize bacterial endotoxins and mediate apoptosis. \u003cem\u003eHum Reprod\u003c/em\u003e. 2011;26(10):2799–2806.\u003c/li\u003e\n \u003cli\u003eDomes T, Lo KC, Grober ED, Mullen JBM, Mazzulli T, Jarvi K. The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters. \u003cem\u003eFertil Steril\u003c/em\u003e. 2012;97(5):1050–1055.\u003c/li\u003e\n \u003cli\u003eValls AS, Valls AS, Frau PP. Sperm Cryopreservation in Ruminant Species. In: \u003cem\u003eRuminant Reproduction\u003c/em\u003e. IntechOpen; [Year].\u003c/li\u003e\n \u003cli\u003eOlusegun A, Adeogun R, Adesina AA. [Title missing]. IntechOpen. 2012.\u003c/li\u003e\n \u003cli\u003eRhee KY, Gardiner DF. Clinical relevance of bacteriostatic versus bactericidal activity in the treatment of gram-positive bacterial infections. \u003cem\u003eClin Infect Dis\u003c/em\u003e. 2004;39(5):755–756.\u003c/li\u003e\n \u003cli\u003eSingh K, Mishra A, Sharma D, Singh K. \u003cem\u003eAntiviral and Antimicrobial Potentiality of Nano Drugs\u003c/em\u003e. Elsevier Inc.; 2019.\u003c/li\u003e\n \u003cli\u003eTaylor TM, Davidson PM, David JRD. Food Antimicrobials – An Introduction. In: \u003cem\u003eFood Antimicrobials\u003c/em\u003e. CRC Press; 2020. p. 1–12.\u003c/li\u003e\n \u003cli\u003eZhang Y, Su J, Wu D. Physiology and Pathology of Multidrug-Resistant Bacteria: Antibodies- and Vaccines-Based Pathogen-Specific Targeting. In: \u003cem\u003ePhysiol Pathol Immunol\u003c/em\u003e. IntechOpen; 2017.\u003c/li\u003e\n \u003cli\u003eUpadhya RK, Shenoy L, Venkateswaran R. Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine. \u003cem\u003eJ Anaesthesiol Clin Pharmacol\u003c/em\u003e. 2018;34(3):46–50.\u003c/li\u003e\n \u003cli\u003eMax M. Antibiotics, antibiotic resistance and environment. \u003cem\u003eEncycl Environ\u003c/em\u003e. 2019. p. 1–9.\u003c/li\u003e\n \u003cli\u003eGanewatta MS, Rahman MA, Tang C. Emerging Antimicrobial Research against Superbugs: Perspectives from a Polymer Laboratory. \u003cem\u003eJ South Carolina Acad Sci\u003c/em\u003e. 2017;15(1).\u003c/li\u003e\n \u003cli\u003eMicrobiology C. CHROMagar™ Orientation For isolation and differentiation of urinary tract pathogens. \u003cem\u003eJ Clin Microbiol\u003c/em\u003e. 1996;34:1788–1793.\u003c/li\u003e\n \u003cli\u003evan Belkum A, Burnham CAD, Rossen JWA, Mallard F, Rochas O, Dunne WM. Innovative and rapid antimicrobial susceptibility testing systems. \u003cem\u003eNat Rev Microbiol\u003c/em\u003e. 2020;18(5):299–311.\u003c/li\u003e\n \u003cli\u003eDarai G, Sonntag H-G. Resistenzentwicklung. In: \u003cem\u003eLexikon der Infektionen des Menschen\u003c/em\u003e. Springer; 2009. p. 703–706.\u003c/li\u003e\n \u003cli\u003eCompounds Oils, Plant Extracts, and Their Isolated Gram-Negative Bacteria to Essential Sensitivity of ESBL-Producing Disk Diffusion Method. [Source missing].\u003c/li\u003e\n \u003cli\u003eLeader T, Mic IN, Technology GS. P / T Etest®. [Source missing]. p. 0–2.\u003c/li\u003e\n \u003cli\u003eAgyepong E, Bedu-Addo K. Semen parameters and the incidence and effects of bacteriospermia in male partners of infertile couples attending a fertility clinic in the Kumasi Metropolis, Ghana. \u003cem\u003eInt J Reprod Contraception Obstet Gynecol\u003c/em\u003e. 2018;8(1):99.\u003c/li\u003e\n \u003cli\u003eAl-Jebouri MM, Mdish SA. Tracing of Antibiotic-Resistant Bacteria Isolated from Semen of Iraqi Males with Primary Infertility. \u003cem\u003eOpen J Urol\u003c/em\u003e. 2019;09(01):19–29.\u003c/li\u003e\n \u003cli\u003eFraczek M, Huras H, Kurpisz M. The effect of bacteriospermia and leukocytospermia on conventional and nonconventional semen parameters in healthy young normozoospermic males. \u003cem\u003eJ Reprod Immunol\u003c/em\u003e. 2016;118:18–27.\u003c/li\u003e\n \u003cli\u003eAgarwal A, Sharma RK. Automation is the key to standardized semen analysis using the automated SQA-V sperm quality analyzer. \u003cem\u003eFertil Steril\u003c/em\u003e. 2007;87(1):156–162.\u003c/li\u003e\n \u003cli\u003eFernández JL, Johnston S, Gosálvez J. Sperm Chromatin Dispersion (SCD) Assay. In: \u003cem\u003eA Clinical Guide to Sperm DNA Chromatin Damage\u003c/em\u003e. Springer; 2018. p. 137–152.\u003c/li\u003e\n \u003cli\u003eBhatt CP, Mishra S, Bhatt AD, Lakhey M. Bacterial pathogens in semen culture and their antibiotic susceptibility pattern in vivo. \u003cem\u003eInt J Biomed Res\u003c/em\u003e. 2015;5:5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7799013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7799013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Infertility, defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year [1], affects over 20% of couples. Male factors contribute to up to 60% of cases, with \u003cstrong\u003eurogenital tract infections\u003c/strong\u003eleading to \u003cstrong\u003ebacteriospermia\u003c/strong\u003e being a significant etiological agent [2]. These infections impair sperm function through mechanisms like acrosome dysfunction, DNA fragmentation, and inducing oxidative stress, contributing to idiopathic infertility [1, 14]. This study aimed to determine the prevalence of bacterial pathogens in semen, quantify their adverse effects on semen parameters, and analyze their antibiotic susceptibility patterns to optimize clinical treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was an observational study conducted on \u003cstrong\u003e249 positive semen cultures\u003c/strong\u003e evaluated following the WHO 5th Edition guidelines [12]. Bacterial pathogens were isolated and identified using standard culture methods. Antibiotic susceptibility testing (AST) was performed using the Kirby-Bauer disk diffusion method. Data were analyzed using ONE-way ANOVA and the Tukey test (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 249 bacterial isolates were analyzed. The most frequent isolates were \u003cstrong\u003eKlebsiella (35.7%)\u003c/strong\u003e, followed by \u003cstrong\u003eEnterococcus (26.5%)\u003c/strong\u003e, and \u003cstrong\u003eStaphylococcus (14.1%)\u003c/strong\u003e. Bacteriospermia was significantly associated with abnormal semen profiles, including \u003cstrong\u003eoligoasthenoteratozoospermia (OATS)\u003c/strong\u003e, showing a statistically significant difference in sperm concentration, total motility, progressive motility, vitality, and normal forms compared to normozoospermia (p\u0026lt;0.05). \u003cem\u003eKlebsiella\u003c/em\u003e isolates showed high resistance to \u003cstrong\u003eAmpicillin (41.0%)\u003c/strong\u003e and \u003cstrong\u003eCefuroxime (38.0%)\u003c/strong\u003e. Conversely, high sensitivity was observed for \u003cstrong\u003eNitrofurantoin (36.7%)\u003c/strong\u003e, \u003cstrong\u003eGentamicin (35.2%)\u003c/strong\u003e, and \u003cstrong\u003eAmikacin (34.5%)\u003c/strong\u003e against \u003cem\u003eKlebsiella\u003c/em\u003e isolates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eBacteriospermia presents a major challenge in male infertility management. The high prevalence of drug-resistant isolates, particularly \u003cem\u003eKlebsiella\u003c/em\u003e, underscores the critical necessity of targeted, culture-guided therapy using sensitive agents like Gentamicin or Nitrofurantoin to improve fertility outcomes.\u003c/p\u003e","manuscriptTitle":"Impact of Bacteria on Semen Parameters and Their Antibiotic Susceptibility Pattern in Infertile Men","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 17:07:02","doi":"10.21203/rs.3.rs-7799013/v1","editorialEvents":[{"type":"communityComments","content":3},{"type":"editorInvitedReview","content":"","date":"2025-11-07T17:46:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80061703797813818333275031472022643457","date":"2025-11-07T17:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13325323022633873668253789703318328138","date":"2025-11-01T01:02:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T08:15:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230157828421921339197408440628473541485","date":"2025-10-31T07:55:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"779034001242757034054516291094907537","date":"2025-10-31T04:52:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-30T13:31:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-10T20:15:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-10T03:55:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T03:54:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Microbiology","date":"2025-10-07T11:20:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e07cb673-f8e7-47fe-bdd0-a47be192a2e7","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T17:07:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 17:07:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7799013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7799013","identity":"rs-7799013","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}