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Composition of Vaginal Microbiota and Their Antibiotic Susceptibility in Symptomatic Women

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Composition of Vaginal Microbiota and Their Antibiotic Susceptibility in Symptomatic Women International Journal of Reproduction, Contraception, Obstetrics and Gynecology Gopalan U et al. Int J Reprod Contracept Obstet Gynecol. 2017 Feb;6(2):427-432 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20170190 Original Research Article Composition of vaginal microbiota and their antibiotic susceptibility in symptomatic women Ushadevi Gopalan1*, Sathiyakala Rajendiran1, Karthika Jayakumar2, Ranganathan Karnaboopathy3 1Department of Obstetrics and Gynecology, 2Department of Microbiology, 3Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India Received: 30 December 2016 Revised: 06 January 2017 Accepted: 18 January 2017 *Correspondence: Dr. Ushadevi Gopalan, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Bacterial vaginosis is the most prevalent lower genital tract infection in women of reproductive age. The aim of this study was to identify the causative organism in patients with vaginal discharge and to study the sensitivity of the organism to antibiotics. Methods: This was a hospital based prospective study in Department of Obstetrics and Gynecology in a tertiary care hospital over a period of two years. 2062 women with complaints of vaginal discharge were subjected to a high vaginal swab and the sample was cultured, the organisms were identified and antibiotic susceptibility was tested. Results: There was no growth found in 40.7% of patients. E. coli was found to be the most common organism isolated followed by Klebsiella pneumonia and Klebsiella oxytoca. Candida species was isolated in 1.4 % of women. An increased frequency of vaginal infection was found in the age group 26-35 years, followed by age group 36-45 years. 73.2% of the organisms were sensitive to Imipenam, 70.4 % to Amikacin and 65.7% to Gentamycin. There were 10 MRSA strains isolated all of which were sensitive to Vancomycin, Amikacin and Gentamycin. Conclusions: Our study provides information about the different microorganisms present in women with vaginal discharge. Since pathogenic bacteria were more common than Candida species it is recommended to offer treatment to patients after taking a high vaginal swab. Appropriate antibiotics based on culture and sensitivity has to be given along with antifungal agents. Keywords: Bacterial vaginosis, Culture and sensitivity, High vaginal swab, Vaginal discharge INTRODUCTION pelvic inflammatory disease, postpartum and postabortal endometriosis.4-7 It is the most common cause of vaginal Vagina is a complex ecosystem consisting of a variety of symptoms prompting women to seek medical care.8 microorganism.1 Females are more prone to urinary and vaginal infections because of the anatomical and The human body harbors hundreds of organisms of gram functional proximity to anal canal and due to the short positive and gram negative varieties in the lower one urethra.2 Bacterial vaginosis is the most prevalent lower third of the vagina.9 Infection or inflammation of the genital tract infection in women of reproductive age vagina is called vaginitis. The two most common causes throughout the world.3 It affects millions of women of vaginitis are bacterial vaginitis and Candida annually and is strongly associated with several adverse vaginitis.10 The causative organisms may be sexually health outcomes including preterm labor and delivery, transmitted, endogenous or iatrogenic. Abnormal vaginal discharge may be the only symptom of bacterial vaginitis February 2017 · Volume 6 · Issue 2 Page 427 Gopalan U et al. Int J Reprod Contracept Obstet Gynecol. 2017 Feb;6(2):427-432 and many affected women are asymptomatic.11 Zhou et al The sample was cultured using Mac Conkey agar for have suggested that a certain number of women who do gram negative bacteria and blood agar and chocolate agar not have any symptoms have vaginal communities that for gram positive bacteria at 370C and incubated for 48 resemble bacterial vaginosis.12 hrs. Conventional methods and biochemical tests were performed and the organism was identified as per As vaginitis causes lots of discomfort to the woman and NCCLS guidelines.14 Antibiotic susceptibility was tested her quality of life is affected we should diagnose and treat using disc diffusion methods by incubating at 370C for 24 the condition correctly. Treating women with vaginal hrs. All women found positive for culture and sensitivity discharge empirically with antifungal therapy assuming were treated with appropriate antibiotics. Data obtained that the causative organism is Candida without taking a was analyzed for distribution of microorganism with high vaginal swab culture and sensitivity is still in respect to age, number and percentage of women from practice.10 Another existing treatment for bacterial whom the particular microorganism was isolated and the vaginosis-oral or vaginal administration of metronidazole antibiotic sensitivity. Analysis was done using Microsoft is plagued by high failure rates with recurrence of Excel Program. Based on the data analysis results were symptoms in 54% of women within three months of obtained regarding the age specific organism, infectivity antibiotic treatment.13 pattern and antibiotic sensitivity pattern. The aim of this study was to identify the causative RESULTS organism in patients with vaginal discharge and to study the sensitivity of the organism to antibiotics. By studying The data from the high vaginal swab culture and the sensitivity of these strains of organism we may be sensitivity results of the 2062 women were analyzed by able to decide on a suitable treatment protocol for these percentage analysis using SPSS software. Of the 2062 women and alleviate the misery of these women with women around 1222 (59.3%) had positive vaginal vaginal discharge. cultures. Total of 23 microorganisms were isolated. METHODS Table 1 shows the frequency and percentage of symptomatic women in the different age groups in the This was a hospital based prospective study conducted in study. There were 307 women (14.9%) in the age group the Department of Obstetrics and Gynecology in a 18-25 yrs, 793 women (38.5%) in the age group 26-35 tertiary care teaching hospital over a period of two years yrs, 624 women (30.3 %) in the age group 36-45 and 338 from October 2014 to September 2016. 2062 women women (16.4 %) aged above 45 years. aged between 18 and 60 years who had presented to the gynecology OPD with complaints of vaginal discharge Table 1: Age distribution of the patients. were included in the study. Informed consent was taken from the patient. During the visit the patient was put into Age group (Years) Frequency Percent (%) lithotomy position and a sterile Cusco’s speculum was 18-25 307 14.9 introduced into the vagina and a high vaginal swab was 26-35 793 38.5 taken using aseptic precautions. The swabs were 36-45 624 30.3 transported to the microbiology laboratory immediately Above 45 338 16.4 and processed. Total 2062 100.0 Table 2: Distribution of microorganism with respect to age. Age group No growth K. pneumoniae K. oxytoca Acinetobacter Chlamydia E. coli 18-25 115(5.6%) 33(1.6%) 28(1.4%) 12(0.6%) 1(0.05%) 54(2.6%) 26-35 344(16.7%) 74(3.6%) 52(2.5%) 33(1.6%) 6(0.3%) 117(5.7%) 36-45 255(12.4%) 56(2.7%) 50(2.4%) 33(1.6%) 4(0.2%) 108(5.2%) Above 45 126(6.1%) 22(1.1%) 20(1%) 12(0.6%) 1(0.05%) 96(4.7%) Total 840(40.7%) 185(9%) 150(7.3%) 90(4.4%) 12(0.6%) 375(18.2%) Table 3: Distribution of microorganism with respect to age. Pseudomonas Enterococcus Streptococcus Age group Staphylococcus Citrobacter aeruginosa fecalis pyogenes 18-25 12(0.6%) 21(1%) 8(0.4%) 4(0.2%) 6(0.3%) 26-35 46(2.2%) 48(2.3%) 15(0.7%) 19(0.9%) 11(0.5%) 36-45 24(1.2%) 38(1.8%) 11(0.5%) 10(0.5%) 15(0.7%) Above 45 15(0.7%) 16(0.8%) 4(0.2%) 9(0.4%) 6(0.3%) Total 97(4.7%) 123(6%) 38(1.8%) 42(2%) 38(1.8%) International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 6 · Issue 2 Page 428 Gopalan U et al. Int J Reprod Contracept Obstet Gynecol. 2017 Feb;6(2):427-432 Table 4: Distribution of microorganism with respect to age. Proteus Streptococcus Coagulase negative Proteus Enterobacter Age group MRSA vulgaris pneumonia staphylococcus mirabilis aerogenes 18-25 0 2(0.1%) 3(0.1%) 0 0 0 26-35 4(0.2%) 2(0.1%) 3(0.1%) 0 1(0.05%) 2(0.1%) 36-45 1(0.05%) 0 3(0.1%) 2(0.1%) 5(0.2%) 1(0.05%) Above 45 4(0.2%) 0 1(0.05%) 0 3(0.1%) 2(0.1%) Total 9(0.4%) 4(0.2%) 10(0.5%) 2(0.1%) 9(0.4%) 5(0.2%) Table 5: Distribution of microorganism with respect to age. C. Pseudomonas Staphylococcus Morganella Age group C. Koseri Candida Freundii putida saprophyticus morganii 18-25 0 0 1(0.05%) 1(0.05%) 0 6(0.3%) 26-35 1(0.05%) 1(0.05%) 0 0 1(0.05%) 13(0.6%) 36-45 0 0 0 0 0 8(0.4%) Above 45 0 0 0 0 0 1(0.05%) Total 1(0.05%) 1(0.05%) 1(0.05%) 1(0.05%) 1(0.05%) 28(1.4%) Table 2 to 5 shows the distribution of the different Other organisms such as Citrobacter, Streptococcus organism with respect to age.
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