HIGH VAGINAL SWABS;

Abstract

Normal vaginal flora contains a wide range of microorganisms. Hydrogen peroxideproduced by Lactobacillus strains plays a vital role in maintaining the microenvironment of thevagina and in the inhibition of overgrowth of potentially pathogenic bacteria. Bacterial vaginosisBV 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 inbacterial vaginosis. Aim: The present study was conducted to elucidate the frequency of variousgram-negative rods in high vaginal swabs and sensitivity pattern of bacteria to antibiotics thatare currently used. Study Design: Cross sectional study. Setting: Department of Obstetricsand Gynecology of Benazir Bhutto Hospital Rawalpindi, a tertiary health care center for thepeople of Rawalpindi. Period: January 2015 to May 2016. Material and Methods: A total of220 High vaginal swabs (HVS) were collected both from indoor and outdoor patients presentingwith symptoms of vaginal discharge aged between 20 to 65 years. Swabs were inoculated onblood, Chocolate and MacConkey’s agar. After overnight incubation plates were examined forgrowth, colonial morphology, final confirmation was done on the basis of biochemical testingand API 20-E system (BioMerieux, France) up to species level. Antibiotic sensitivity testing wasdone by (modified Kirby-Bauer’s) disc diffusion method using amikacin, ampicillin, amoxicillinclavulanic acid, imipenem, ceftazidime, tigecycline, ciprofloxacin, sulzone and cefixime. Afterovernight incubation plates were examined to read the susceptibility zone. Results: Out of 220HVS 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 rodswere penicillins (ampicillin, amoxicillin-clavulanic acid), amikacin due to indiscriminate use ofantibiotics. Conclusion: High prevalence of gynecological infections demands that the patientswho have vaginosis must be investigated regularly and carefully through culture and identificationof causative bacteria. Emergence of antibiotic resistance must be controlled in order to avoidimproper use, frequent abuse, insufficient dosages, trouble-free availability of antibiotics andtreatment schedule must be designed subsequent to proper laboratory investigations.