Tarana M N, Shamsuzzaman S M
Dr Mst Naznin Tarana, Research Student, Department of Microbiology, Dhaka Medical College, Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2018 Oct;27(4):834-842.
Pathogenic microorganisms are important cause of maternal and neonatal infections which are transmitted from colonized vagina of mother. The purpose of the present study was to detect the potential pathogens other than Group B Streptococcus in vaginal swab of pregnant women. This prospective cross sectional study was conducted from July 2013 to June 2014 at Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 224 vaginal swab samples were studied. Gram stain Nugent score was applied for all vaginal smear to detect bacterial vaginosis. Organisms were isolated and identified by wet film microscopy, Gram stain, biochemical tests, culture and PCR. Toxic shock syndrome toxin-1 gene and drug resistance genes such as mecA, vanA, vanB were detected among isolated Staphylococcus aureus. Antimicrobial susceptibility was done by disc diffusion method. Double disc synergy test was used to detect ESBL (Extended spectrum beta lactamases) producers. MIC (Minimum inhibitory concentration) of oxacillin and vancomycin were done for Staphylococcus aureus to detect MRSA (Methicillin resistant Staphylococcus aureus) and VRSA (Vancomycin resistant Staphylococcus aureus). Of the 224 samples, 44(19.64%) were Staphylococcus aureus, 22(9.8%) were Escherichia coli. Bacterial vaginosis was found in 12(5.36%) cases. Among the 9(21.43%) phenotypically identified ESBL producers, 4(18.18%) were Escherichia coli, 2(25%) were Klebsiella pneumoniae. Ninety six percent and 91% of the Escherichia coli were sensitive to colistin and imipenem. All the Klebsiella spp. was sensitive to colistin and all the Proteus spp. and the Pseudomonas aeruginosa were sensitive to imipenem and colistin. Of the 44 Staphylococcus aureus, 5(11.36%) were MRSA, 2(4.54%) were VRSA, 2MRSA were PVL gene positive and 2(4.54%) were positive for TSST-1 gene by PCR. All the isolated MRSA and VRSA were sensitive to linezolid. One of the two VRSA strains had MIC of vancomycin 64μg/ml and another had 128μg/ml. VRSA strains were positive for vanB gene, no VRSA was positive for vanA gene. Vaginal ecosystem study with the detection of pathogens can be helpful in the prevention of preterm delivery, premature rupture of membrane, chorioamnionitis, neonatal, puerperal and maternal-fetal infections.
致病微生物是导致母婴感染的重要原因，这些感染是通过母亲定植的阴道传播的。本研究的目的是检测孕妇阴道拭子中除B族链球菌以外的潜在病原体。这项前瞻性横断面研究于2013年7月至2014年6月在孟加拉国达卡达卡医学院医院进行。共研究了224份阴道拭子样本。对所有阴道涂片应用革兰氏染色 Nugent评分来检测细菌性阴道病。通过湿片显微镜检查、革兰氏染色、生化试验、培养和PCR分离并鉴定微生物。在分离出的金黄色葡萄球菌中检测中毒性休克综合征毒素-1基因以及mecA、vanA、vanB等耐药基因。采用纸片扩散法进行药敏试验。使用双纸片协同试验检测超广谱β-内酰胺酶（ESBL）产生菌。对金黄色葡萄球菌进行苯唑西林和万古霉素的最低抑菌浓度（MIC）检测以检测耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素金黄色葡萄球菌（VRSA）。在224份样本中，44份（19.64%）为金黄色葡萄球菌，22份（9.8%）为大肠杆菌。12例（5.36%）发现有细菌性阴道病。在9例（21.43%）表型鉴定为ESBL产生菌中，4例（18.18%）为大肠杆菌，2例（25%）为肺炎克雷伯菌。96%的大肠杆菌对黏菌素和亚胺培南敏感。所有克雷伯菌属对黏菌素敏感，所有变形杆菌属和铜绿假单胞菌对亚胺培南和黏菌素敏感。在44份金黄色葡萄球菌中，5份（11.36%）为MRSA，2份（4.54%）为VRSA，2份MRSA的Panton-Valentine杀白细胞素（PVL）基因呈阳性，2份（4.54%）通过PCR检测TSST-1基因呈阳性。所有分离出的MRSA和VRSA对利奈唑胺敏感。两株VRSA菌株中一株万古霉素的MIC为64μg/ml，另一株为128μg/ml。VRSA菌株vanB基因呈阳性，无VRSA菌株vanA基因呈阳性。对病原体进行检测的阴道生态系统研究有助于预防早产、胎膜早破、绒毛膜羊膜炎、新生儿、产褥期及母婴感染。
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