HIGH VAGINAL SWABS;

FREQUENCY AND ANTIMICROBIAL SUSCEPTIBILITY OF GRAM NEGATIVE RODS ISOLATED FROM HIGH VAGINAL SWABS

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.