ABSTRACT
Normal
vaginal flora contains a wide range of microorganisms. 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 bacteria in high vaginal swabs and sensitivity pattern of
bacteria to antibiotics that are currently used Material and Methods used are a total of 6 High vaginal swabs (HVS) which
were collected from patients presenting with symptoms of vaginal discharge.
Swabs were inoculated on blood and Chocolate agar. After overnight incubation
plates were examined for growth, colonial morphology, final confirmation was
done on the basis of biochemical testing. Antibiotic sensitivity testing was
done by (modified Kirby-Bauer’s) disc diffusion method using amikacin(30μg), ampicillin(10μg), amoxicillin(10μg),) clavulanic acid,
imipenem(10μg), ciprofloxacin(10μg), and cefixime(5μg). After overnight incubation
plates were examined to read the susceptibility zone. Results showed that Highly sensitive antibiotics against
bacteria were imipenem (27mm), and Ciprofloxacin (28mm) whereas least affective antibiotics against gram
negative rods were penicillins, amikacin due to indiscriminate use of
antibiotics. In 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.
CHAPTER
ONE
1.1 INTRODUCTION
1.2 Background
of the Study
Antimicrobial resistance is a global concern,
particularly pressing in developing nations where infectious diseases, poverty and malnutrition
are endemic. Infections caused by resistant bacteria have been shown to be more
frequently associated with increased morbidity and mortality than those caused
by susceptible pathogens. In areas of concentrated use, such as hospitals,
antimicrobial resistance lead to
hospital stays, increased health care costs and in extreme cases untreatable
infections. The lack of clinical microbiology laboratories to identify the
specific etiologic agents and their antimicrobial susceptibility testing has
increased empirical therapy which in turn leads to emergence of AMR. Moreover,
self-antibiotic prescription, lack of access to
local antibiogram data and poor awareness of prescriber about AMR were the
leading local factors for AMR development in Ethiopia (Aberaet al., 2014).
Studies have shown that besides the temporal changes
in profile of infecting microorganisms and pattern of resistance over time,
antimicrobial resistance profile of bacteria varies among population because of
difference in geography, local antimicrobial prescribing practices and
prevalence of resistant bacterial strains. Such differences are never stable
and may change rapidly especially in places where misuse of antibiotics are
common particularly in developing countries. A systematic review in Ethiopia has
also indicated a trend towards an increasing resistance rates among pathogens
such as Escherichia coli, Proteus, Klebsiella, Pseudomonas,Citrobacter
and Acenotobacter to commonly
prescribed antibiotics, including Ampicillin, Amoxicillin, Amikasin, Imipenem,
Cefixime and Ciprofloxacin (Moges et al.,2014).
Thus, up to date information on microbial resistance is needed at local level
to guide the rational use of the existing antimicrobials.
The
adult human vagina is a complex biota containing a profusion of
microorganisms. These can be either
unicellular or multicellular and are present everywhere in nature. They
include bacteria, fungi, archaea,
protists, some microscopic
plants such as green
algae and animals
such as planktons
and palanarian. On account of
their nature, viruses may or may not be included. Bacteria and
yeast form normal
flora of this ecosystem, which is normally found on
the skin and every opening of the body such as mouth, ears, rectum and vagina.
Even a
neonate carries specific
flora of his/
her mother and soon develops own floral community. This flora persists till death of
the individual. An adult human carries normal flora consisting of more than 200 bacterial species. Normally these are harmless and are involved
in benefiting their hosts. Yet some are parasitic in nature, living at the
expense of their host, and some are even pathogenic.These pathogenic microbes,
after getting a chance, invade their
hosts and lead
to opportunistic infection. These diseases caused by
normalflora are termed endogenous diseases (Khan
et at.,2002).
Resistance of bacteria to antimicrobial agents is an
imminent threat to patient management all over the world. This issue has
plagued policy makers and clinicians everywhere but there seems to be no simple
way of circumventing the problem. Rapidly rising antibiotic resistance is a
challenge to comprehensive patient care in all branches of medical science. The
interaction between various clinical bacteria and the antimicrobial agents is a
complex issue involving the prokaryotic adaptive mechanisms and genetic
changes. This complex interaction must
be studied in depth in order to achieve a sustainable and effective solution to
the looming threat of antibiotic resistance. Earlier, the problem of antibiotic
resistance was primarily a concern for not so comical infections. But now, even
community acquired infections are caused by organisms with high levels of
antibiotic resistance. As a report had demonstrated, such multi-drug resistant
community acquired infections can be a cause of significant.
Earlier, such drug resistant organisms were said to
infect mainly patients with identifiable risk factors or profound immune suppression.
But now, reports are showing such infections in seemingly normal healthy
persons. Also, such drug-resistant infections may complicate the newly emerging
infectious diseases. For example, influenza epidemics are sometimes reported to
be complicated by superadded infection with drug-resistant bacteria (Hageman et al., 2004). The issue of drug
resistance in clinical bacteria is such a vital threat that the UN held a
special assembly in 2016 to address only this issue. In that assembly, the
issue was said to be of as much importance as climate change and it was deemed
to require a global response (Farr, 1994) and non-pregnant
women attending the University of Maiduguri
Teaching Hospital (UMTH), Maiduguri, Nigeria”.
1.3 Antibiotic Sensitivity
Antibiotic sensitivity
is a term
used to describe
the susceptibility of bacteria to antibiotics. Antibiotic sensitivity
testing (AST) is usually carried
out to determine
which antibiotic will be
most successful in
treating a bacterial infection in vivo. Testing for
antibiotic sensitivity is
often done by the Kirby-Bauer method
while other methods include the
Stokes method, E-test (also based
on antibiotic diffusion) and
Agar and
Broth dilution methods (for Minimum
Inhibitory Concentration
determination). Muller Hinton agar is
most frequently used
in this antibiotic susceptibility test. Our study
was aimed at the isolation, identification and antibiotic sensitivity testing
of URINARY TRACT INFECTION (UTI) causing bacteria
1.4 AIM
To isolate, identify and check antibiotic
sensitivity of bacteria implicated in URINARY
TRACT INFECTION (UTI)s.
1.5 OBJECTIVES
OF THE STUDY
·
To isolate bacteria from the urinary tract of women of
child-bearing age using vaginal swab.
·
To identify the isolated bacteria.
To determine the antibiotic sensitivity of bacteria
isolated.================================================================
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