High Vaginal Swabs; Frequency and Antimicrobial Susceptibility of Gram Negative Rods Isolated From High Vaginal Swabs

Abstract

ABSTRACT… Normal vaginal flora contains a wide range of microorganisms. Hydrogen peroxide produced by Lactobacillus strains plays a vital role in maintaining the microenvironment of the vagina and in the inhibition of overgrowth of potentially pathogenic bacteria. Bacterial vaginosis BV is the main reason of vaginal discharge. Many gram positive and gram negative rods i.e. E.coli, Klebsiella, Proteus, Acinetobacter and Pseudomonas spp. are major contributors in bacterial vaginosis. Aim: The present study was conducted to elucidate the frequency of various gram-negative rods in high vaginal swabs and sensitivity pattern of bacteria to antibiotics that are currently used. Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynecology of Benazir Bhutto Hospital Rawalpindi, a tertiary health care center for the people of Rawalpindi. Period: January 2015 to May 2016. Material and Methods: A total of 220 High vaginal swabs (HVS) were collected both from indoor and outdoor patients presenting with symptoms of vaginal discharge aged between 20 to 65 years. Swabs were inoculated on blood, Chocolate and MacConkey's agar. After overnight incubation plates were examined for growth, colonial morphology, final confirmation was done on the basis of biochemical testing and API 20-E system (BioMerieux, France) up to species level. Antibiotic sensitivity testing was done by (modified Kirby-Bauer's) disc diffusion method using amikacin, ampicillin, amoxicillin clavulanic acid, imipenem, ceftazidime, tigecycline, ciprofloxacin, sulzone and cefixime. After overnight incubation plates were examined to read the susceptibility zone. Results: Out of 220 HVS samples, 100 samples showed bacterial growth and confirmed as Gram negative bacilli. Age wise distribution of infection showed highest rates b/w age 20-30 was 36% followed by 31-40 (23%), 41-50 (25%) and 11% above 50 years of age. Bacteria isolated from HVS were E.coli (53%), Klebsiella (22%), Pseudomonas (12%), citrobacter (6%), Proteus (5%) and Acinetobacter (2%) respectively. Highly sensitive antibiotics against bacteria were imipenem (96%), sulzone (90%) and Ciprofloxacin (88%), whereas least affective antibiotics against gram negative rods were penicillins (ampicillin, amoxicillin-clavulanic acid), amikacin due to indiscriminate use of antibiotics. Conclusion: High prevalence of gynecological infections demands that the patients who have vaginosis must be investigated regularly and carefully through culture and identification of causative bacteria. Emergence of antibiotic resistance must be controlled in order to avoid improper use, frequent abuse, insufficient dosages, trouble-free availability of antibiotics and treatment schedule must be designed subsequent to proper laboratory investigations. Key words:HVS, Bacterial vaginosis, Imipenem, E.coli, Sulzone.

Frequency of Microorganisms in High Vaginal Swabs Obtained from women in OPD presenting with Vaginal Discharge

“…Accepted on 05-02-2023 the most frequent cause of abnormal vaginal discharge. Bacterial vaginosis (BV), vulvo-vaginal candidiasis (VVC), or trichomoniasis are linked to 70% of all causes of vaginal discharge 6 .Bacterial vaginosis, which accounts for up to 50% of all infections, is the most prevalent of the three reasons described 7 .…”