South pacific Journal of Pharma and Bio Science 17

Transcription

1 Microbial associates of Endocervical swabs of women with Pelvic inflammatory disease and fertility disorders OBIAJURU, I. O. C 1* OGBULIE, J. N 2 and ONUOHA, C. A 3 1. Dept. of Medical Microbiology, Imo State University, Orlu Campus 2. Dept. of Microbiology, Federal University of Technology, Owerri 3. Department of Microbiology, Imo State University, Owerri. Abstract: The microbial associates of endocervical swabs of women with pelvic inflammatory disease (PID) and fertility disorders in Orlu, Imo State was studied between October 2014 and February, Endocervical swab (ECS) and High vaginal (HVS) were collected from 210 women aged 20 years and above at the obstetrics and Gynaecology Department, Imo State University Teaching Hospital Orlu. The samples were examined bacteriologically using culture technique. The bacterial isolates were subjected to antibiotic sensitivity tests using commercially prepared antibiotic discs. The findings showed that 168 (80%) HVS and 111 (52.9%) ECS were infected with different species of bacteria and fungi. The prevalence of microbial infections was higher (80%) in HVS than endocervical swabs (52.9%). The most prevalent bacterial isolate was omitted in Staphylococcu aureus while the least prevalent isolates were Pseudomonas aeruginosa (1.4%) and Streptococcus species (1.4%). Prevalence of infection was higher amongst older women age 41 and above than younger women aged years. Also, prevalence of infection was higher amongst women with pelvic inflammatory disease (83.3% HVS and 57.9% ECS) than those with fertility disorders (75% HVS and 45%ECS). Staphylococcus aureus and Pseudomonas aeruginosa exhibited the highest percentage of susceptibility to Ceftazidine. Streptococcus agalactiae and Escherichia coli exhibited the highest percentage of susceptibility to Azetronem. Klebsiella species exhibited the lowest percentage of susceptibility to erythromycin. Prevalence of multi antibiotic resistance was higher amongst isolates from High vaginal swabs than isolates from endocervical swabs. Pseudomonas aeruginosa exhibited the highest prevalence (33.3%) of multi antibiotic resistance, followed by Escherichia coli (20.8%). The findings of this study suggest that pelvic inflammatory disease and fertility disorders may be caused or complicated by microbial infections. Introduction: Microbial infection is a growing public health problem of concern worldwide. Of all microbial infections of man, sexually transmitted infections (STI), urinary tract infections (UTI) and reproductive tract infections (RTI) are the most common. Over 1 million people are infected every day with STI, UTI and/or RTI (AAFP, 1999; Obiajuru et al., 2005). Sexually transmitted infections are infections that affect the reproductive tract and are transmitted sexually to areas beyond the reproductive tract e.g syphilis, human immune deficiency virus, etc. (WHO, 1998). STIs are passed from person to person through unprotected sex or genital contact. They also include infections of the female reproductive tract due to complications of reproductive events or procedures performed on the reproductive tract such as child birth, miscarriage or abortion, insertion of intra uterine device and gynaecological or obstetrics surgery. South pacific Journal of Pharma and Bio Science 17

2 Urinary tract infections was omitted in affect part of the urinary tract. When it affects the lower urinary tract, it is known as cystitis (bladder infection). When it affects the upper urinary tract, it is known as pyelonephritis (kidney infection). The main cause of both infections is Escherichia coli. Other bacteria, viruses or fungi may rarely be the cause. Public health implications of STI, RTI and/or UTI cannot be over emphasized, notwithstanding, clinicians and healthcare providers have not given adequate attention to them. The general public also appears to attach little or no importance to these groups of infections (Obiajuru and Ogbulie, 2008). Most of these infections have grave consequences on the victims yet they are so neglected that they are neither known nor have names in the vernacular of many tribes and countries (Acholonu, 1998). When disease causing organisms was omitted in travels from the cervix to the upper genital tract, pelvic inflammatory disease may occur. Infection of the endo - cervical mucosa with pathogenic bacteria is the first step in the disease process for developing pelvic inflammatory disease (PID) in women preceding infection by other pathogens (Anchana, et al., 2013). The presence of pathogenic bacteria is associated with the acute phase protein phase response and the severity of pelvic inflammatory disease and the extent of the infertility (Momoh et al 2009; Hermann, 2007; Metzidie et al 2006). Vaginal and cervical infections have long been recognized as one of the major causes of reduced fertility in humans (Sheldon et al., 2007), the infections are most often caused by opportunistic microorganisms and a variety of species have been isolated (Deb et al., 2004). Micro-organisms have been found in different parts of the female reproductive tract. Endo - cervical culture, a laboratory test is used to isolate and identify infective microbes in the female genital tract. During a vaginal examination, the health care provider uses a swab to take samples of mucus and cells from the endo - cervix. This is the area around the opening of the uterus. The samples are sent to a laboratory. There, they are placed in a special dish (culture). They are then watched to see if bacteria, virus, or fungus grow. Further tests may be done to identify the specific organism and determine the best treatment. Pelvic inflammatory disease and fertility disorders are common health challenges in many parts of the world. The socio economic consequences of PID and fertility disorders are many. Many marriages have broken as a result of fertility disorders and pelvic inflammatory disease has caused many patients to be absent from work or business for prolonged periods leading to loss of income or revenue. Health workers adopt different measures in treatment and management of PID and fertility disorders. In Nigeria hospitals, Endo - cervical culture is usually done to determine the cause of vaginitis, pelvic pain, an unusual vaginal discharge, or other signs of infection. Organisms that are usually present in the vagina are there in the expected amounts. In management of fertility disorders, many health care providers rarely give attention to microbial infections. The present study was undertaken to determine possible relationship between fertility disorders, pelvic inflammatory disease and microbial infections. In addition, the study aims to determine the age related prevalence of microbial associates of Endo cervical swab and high vaginal swab of women with pelvic inflammatory disease and fertility disorder in Imo State and determine the susceptibility pattern of the bacterial associates to antibiotics commonly used in Nigeria. South pacific Journal of Pharma and Bio Science 18

3 Materials and Methods: Study area : This study was carried out at Imo State University Teaching Hospital (IMSUTH), Orlu in Imo State, south - eastern Nigeria. Imo State situates on the latitude 5 O 29 N and 7 O 2 E. It comprises of 3 geo political zones: Owerri, Orlu and Okigwe. With the exit of Aba following the creation of Abia State from the old Imo State, Orlu has emerged the commercial city of Imo State, with an international market and several city and rural markets. Of the 27 Local Government Areas in Imo State, Orlu zone has 12 Local government Areas, each of these has a General Hospital. Orlu zone has several recreational facilities and tourist attraction centres including Oguta wonder lake and Palm Beach village in Awo omamma. Orlu has a good network of roads that link the urban and sub urban centres with rural communities as well as with other States like Rivers State and Anambra State. Selection of patients: The patients used for this study were selected from women presenting with pelvic inflammatory disease in the department of Obstetrics and Gynaecology and those attending clinics for fertility disorders at the family planning unit of Imo State University Teaching Hospital, Orlu between October 2014 and February, Ethical permit was obtained from Imo State University Teaching Hospital, Orlu. The patients were approached on individual basis by the field assistants and the objectives of the study explained to them. Those who indicated willingness to participate in the study were enlisted. Data and sample collection: The instrument used for collection of data in this study was a structured questionnaire comprising of two sections: Section A - Socio demographic data and Section B Clinical record. A registered staff Nurse working at IMSUTH, was recruited as a field assistant to administer the questionnaires to the patients by person to person contact after explaining the objectives of the study to them. Patients who indicated willingness to participate in the study were requested to indicate their consent by signing the consent page of the questionnaire. After submitting the completed questionnaire, each patient was booked for collection of samples (Endo cervical and high vaginal swabs) by a Gynaecologist working at IMSUTH, who was also recruited as field assistant. The samples and completed questionnaires were carried to the Microbiology department for analysis. The study covered 210 adolescent females presenting to Obstetrics and Gynaecology clinic and family planning unit of Imo State University Teaching Hospital, Orlu, between October 2014 and February, Microbiological analyses of samples: The materials used for this study were sterilized using standard methods as in Cheesbrough, (2002), Obiajuru and Ozumba, (2009). Each endo - cervical swab and high vaginal swab, was cultured on duplicate plates of Chocolate agar and CLED medium by streaking method as in Cheesbrough, (2002), Obiajuru and Ozumba, (2009). One set of the chocolate agar plates were incubated anaerobically in anaerobic gas spark at 37 O C for 24 hours. The second set of chocolate agar plates and the CLED agar cultured plated were incubated aerobically at 37 O C for 24 hours. Thereafter, the plates were examined for microbial growth. South pacific Journal of Pharma and Bio Science 19

4 All the isolates were identified, using their growth morphology on different media, Gram s staining, motility test and biochemical identification tests as in Cheesbrough, (2002), Obiajuru and Ozumba, (2009). The findings of the identification tests were compared with Bergy s manual of determinative bacteriology (Holt, 2012). Antibiotic susceptibility tests: All the bacterial isolates were subjected to antibiotic susceptibility tests using Mueller Hinton agar and commercially prepared antibiotic discs of Ofloxacin (Tarivid), Ciprofloxacin, Levofloxacin, Gentamycin, Ampicclox, Erythromycin, Streptomycin, Augumentin, Ceftriaxone, Ceftazidine, Azetreonem and Amoxycillin Clavulanic acid as in Cheesbrough 2002, Obiajuru and Ozumba, The zones of growth inhibitions exhibited by the different antibiotics were measured using transparent metric rule. Multi - antibiotic resistant bacteria species: Any isolate which is resistant to three or more antibiotics out of twelve antibiotics used for the test, was selected as multi antibiotic resistant (MAR Bacteria. Method of data analysis: The data obtained from this study were analyzed statistically using simple percentage analysis and chi square as in Philips (2002). Results: A total of 250 respondents were selected for the study. Of this number, 218 completed and returned their questionnaires and 210 submitted their High vaginal swab (HVS) and Endo-cervical swab (ECS) samples for the study. Others declined submitting their samples. Out of the 210 HVS and ECS samples that were collected, 168 (80%) HVS were infected with different species of bacteria and fungi, while 111 (52.9%) ECS were infected with different species of bacteria and fungi (table 1). Identification of the microbial associates: The microbial associates of endo cervical and vaginal swabs of women with PID and fertility disorders in Orlu were identified using standard bacteriological and mycological techniques. The results (table 1) showed that, 60 (28.6%) HVS and 42 (20.0%) ECS were infected Staphylococcus aureus, 48 (22.9%) HVS and 36 (17.1%) ECS were infected with Escherichia coli, 27 (12.9%) HVS and 15 (7.1%) ECS were infected with Klebsiella species, 27 (12.9%) HVS and 12 (5.7%) ECS were infected with Candida albicans, 3 (1.4%) HVS and 1 (0.5) ECS were infected with Pseudomonas aeruginosa, 3 (1.4) ECS were infected with Proteus mirabilis and 3 (1.4%) HVS and 2 (1.0) ECS were infected with Streptococcus agalactiae. Table 1 summarizes the microbial associates of endo cervical and high vaginal swabs of women with PID and fertility disorders in Orlu. As shown the prevalence of infection was higher (80%) in high vaginal swabs than endo-cervical swabs (52.9%). The most prevalent organisms in both HVS and ECS of women with PID and fertility disorders was Staphylococcus aureus (28.6% in HVS and 20.0% in ECS) while the least prevalent organisms in HVS samples were Pseudomonas aeruginosa (1.4%) and Streptococcus species (1.4%). The least prevalent bacteria in Endo cervical swab (0.5%) was Pseudomonas aeruginosa. South pacific Journal of Pharma and Bio Science 20

5 Proteus mirabilis was not isolated from high vaginal swab BUT IN Endo-cervical swabs, it had prevalence of 1.4%. Age related prevalence of infection amongst women with PID and fertility disorders in orlu: Out of 210 women examined, 46 were aged years, 69 were aged years, 54 were aged years and 45 were aged 51 years and above. The results of the study showed that out of 42 women aged 20 30years, 31 (73.8%) HVS and 21 (50%) ECS were infected. Out of 69 women aged years, 53 (76.8%) HVS and 31 (58.5%) ECS were infected. Of the 54 women aged years, 48 (88.9%) HVS and 34 (63%) ECS were infected and out of 45 women aged 51 years and above, 36 (80%) HVS and 25 (69.4%) ECS were infected. Table 2 summarizes the age related prevalence of micro organisms associated with PID and fertility disorder amongst women in Orlu. As shown, prevalence of infection was higher amongst the older women 41 years and above than younger women years. Analysis of the data using chi square showed significant difference (p < 0.05) in the prevalence of microbial infection between older and younger women. Comparative Analysis of Microbial Associates of Women with PID and those with Fertility disorder: Clinical records of the patients obtained from the hospital showed that out of 210 women examined in the study, 126 (60.0%) had PID and 84 (40.0%) had fertility disorder. Out of 126 women with PID, 105 (83.3%) bacteria in their HVS and 73 (57.9%) had bacteria in their ECS. Also, out of 84 women with fertility disorders, 63 (75%) had bacteria in their HVS and 38 (45.2%) had bacteria in their ECS. Table 3 summarizes the comparative analysis of microbial infections between women with PID and those with fertility disorders in Orlu. As shown, prevalence of infection was higher (83.3% and 57.9%) amongst women with PID than those with fertility disorders (75% and 45.2%). Analysis of the data using chi square revealed significant difference (p < 0.05) in the prevalence of microbial infections between women with pelvic inflammatory disease and those with fertility disorders Antimicrobial susceptibility pattern of micro-organisms associated with PID and fertility diorders: Table 4 summarizes the antimicrobial susceptibility pattern of microbial associates of high vaginal and endo cervical swabs of women with PID and fertility disorders in Orlu. As shown, Staphylococcus aureus, and Pseudomonas aeruginosa isolated from endo-cervical swab, Streptococcus agalactiae, and Escherichia coli from high vaginal swab exhibited the highest percentage of susceptibility to Ceftazidine, while Staphylococcus aureus and Pseudomonas aeruginosa from High vaginal swab, Escherichia coli from ECS, and all Klebsiella isolates exhibited the highest percentage of susceptibility on Azetronen. The least susceptibility by all isolates was exhibited on Erythromycin. Analysis of the data using Chi square showed there was significant difference (p < 0.05) in the susceptibility pattern between the fluoroquinolones (Tarivid, Ciprofloxacin, Levofloxacin) and the first and second generation antibiotics (erythromycin, Ampiclox, Gentamycin, and Streptomycin. As shown, the flouroquinolone exhibited higher degree of susceptibility on the bacterial isolates. Prevalence of multi antibiotic resistant bacteria associated with PID and fertility diorders: The result of this study showed that out of 48 Escherichia coli isolated from high vaginal swabs of women with PID and fertility disorders, 10 (20.8%) exhibited multi antibiotic resistance. Out of 36 Escherichia coli isolated from endo cervical swab of women with PID and fertility disorders, 7 (19.4%) exhibited multi antibiotic resistance. Out of 27 Klebsiella species isolated from high vaginal swabs of South pacific Journal of Pharma and Bio Science 21

6 women with PID and fertility disorders, 5 (18.5%) exhibited multi antibiotic resistance. Out of 15 Klebsiella species isolated from endo cervical swab of women with PID and fertility disorders, 3 (20.0%) exhibited multi antibiotic resistance. Out of 3 Pseudomonas aeroginosa isolated from high vaginal swabs of women with PID and fertility disorders, 1 (33.3%) exhibited multi antibiotic resistance. Table 5 summarizers the prevalence of multi - antibiotic resistant bacteria amongst women with Pelvic inflammatory disease and fertility disorders. Although there was imbalance in the population size of the different isolates tested, Pseudomonas aeruginosa exhibited the highest prevalence (33.3%) of multi antibiotic resistance followed by Escherichia coli (20.8% and 19.4% for HVS and ECS isolates respectively.) Analysis of the data using chi square showed there was a significant difference (p < 0.05) in the prevalence of multi antibiotic resistant bacteria between high vaginal isolates and Endo cervical isolated. As shown, the prevalence of multi antibiotic resistant bacteria was higher amongst high vaginal swab isolates than endo cervical swab isolates. Table 1: Microbial Associates of ECS and HVS of Women with PID and in Orlu. ISOLATES HVS ECS Staphylococcus aureus 60 (28.6) 42 (20.0) Escherichia coli 48 (22.9) 36 (17.1) Klebsiella species 27 (12.9) 15 (7.1) Proteus mirabilis 0 (0.0) 3 (1.4) Streptococcus species 3 (1.4) 2 (1.0) Pseudomonas aeruginosa 3 (1.4) 1 (0.5) Candida albicans 27 (12.9) 12 (5.7) TOTAL 168 (80) 111 (52.9) Fertility Disorders Table 2: Age related prevalence of Infection amongst women with PID and Fertility disorder in Orlu Age (years) Number Examined Number Infected (%) HVS ECS (73.8) 21 (50.0) (76.8) 31 (58.5) (88.9) 34 (63.0) 50 Above (80.0) 25 (69.4) Total 168 (80.0%) 111 (52.9%) (p < 0.05) South pacific Journal of Pharma and Bio Science 22

7 Table 3: Comparative analysis of Microbial infections between women with PID and those with Fertility disorders in Orlu SAMPLE PID FERTILITY DISORDER Number Examined Number infected (%) Number Examined Number infected (%) HVS (83.3%) (75%) ECS (57.9%) (45.2%) (p < 0.05) Table 5: Prevalence of Multi Antibiotic Resistant Bacterial Isolates Bacterial Isolate No Tested Multi Antibiotic Resistant Strains No of MAR (%) Isolate Source of Isolates Escherichia coli HVS Escherichia coli ECS Klebsiella species HVS Klebsiella species ECS Pseudomonas aeruginosa HVS (p < 0.05) South pacific Journal of Pharma and Bio Science 23

8 Table 4: Antimicrobial susceptibility pattern of microbial associates of high vaginal and endocervical swabs from women with PID and fertility disorders in Orlu. Bacterial Isolates Source Number Examined Percentage Susceptibility (%) Tariv Cipro Levo Genta Ampicl Erythr Strept Augum Amoxy/ Clavu Ceftri Ceftaz Azetre Staph aureus HVS Staph aureus ECS Streptococcus HVS agalactia Streptococcus ECS agalactia Escherichia coli HVS Escherichia coli ECS Klebsiella HVS species Klebsiella ECS species Pseudomonas HVS aeruginosa Pseudomonas aeruginosa ECS Proteus mirabilis ECS (p < 0.05) South pacific Journal of Pharma and Bio Science 24

9 Discussion: Out of the 210 HVS and ECS samples that were collected, 168 (80%) HVS were infected with different species of bacteria and fungi, while 111 (52.9%) ECS were infected with different species of bacteria and fungi The microbial associates of endo cervical and vaginal swabs of women with PID and fertility disorders in Orlu were identified using standard bacteriological and mycological techniques. The results (table 1) showed that, 60 (28.6%) HVS and 42 (20.0%) ECS were infected Staphylococcus aureus, 48 (22.9%) HVS and 36 (17.1%) ECS were infected with Escherichia coli, 27 (12.9%) HVS and 15 (7.1%) ECS were infected with Klebsiella species, 27 (12.9%) HVS and 12 (5.7%) ECS were infected with Candida albicans, 3 (1.4%) HVS and 1 (0.5) ECS were infected with Pseudomonas aeruginosa, 3 (1.4) ECS were infected with Proteus mirabilis and 3 (1.4%) HVS and 2 (1.0) ECS were infected with Streptococcus agalactiae. Table 1 summarizes the microbial associates of endo cervical and high vaginal swabs of women with PID and fertility disorders in Orlu. As shown the prevalence of infection was higher (80%) in high vaginal swabs than endo-cervical swabs (52.9%). The most prevalent organisms in both HVS and ECS of women with PID and fertility disorders was Staphylococcus aureus (28.6% in HVS and 20.0% in ECS) while the least prevalent organisms in HVS samples were Pseudomonas aeruginosa (1.4%) and Streptococcus species (1.4%). The least prevalent bacteria in Endo cervical swab (0.5%) was Pseudomonas aeruginosa. Proteus mirabilis was not isolated from high vaginal swab BUT IN Endo-cervical swabs, it had prevalence of 1.4%. Out of 210 women examined, 46 were aged years, 69 were aged years, 54 were aged years and 45 were aged 51 years and above. The results of the study showed that out of 42 women aged 20 30years, 31 (73.8%) HVS and 21 (50%) ECS were infected. Out of 69 women aged years, 53 (76.8%) HVS and 31 (58.5%) ECS were infected. Of the 54 women aged years, 48 (88.9%) HVS and 34 (63%) ECS were infected and out of 45 women aged 51 years and above, 36 (80%) HVS and 25 (69.4%) ECS were infected. Table 2 summarizes the age related prevalence of micro organisms associated with PID and fertility disorder amongst women in Orlu. As shown, prevalence of infection was higher amongst the older women 41 years and above than younger women years. Analysis of the data using chi square showed significant difference (p < 0.05) in the prevalence of microbial infection between older and younger women. Clinical records of the patients obtained from the hospital showed that out of 210 women examined in the study, 126 (60.0%) had PID and 84 (40.0%) had fertility disorder. Out of 126 women with PID, 105 (83.3%) bacteria in their HVS and 73 (57.9%) had bacteria in their ECS. Also, out of 84 women with fertility disorders, 63 (75%) had bacteria in their HVS and 38 (45.2%) had bacteria in their ECS. Table 3 summarizes the comparative analysis of microbial infections between women with PID and those with fertility disorders in Orlu. As shown, prevalence of infection was higher (83.3% and 57.9%) amongst women with PID than those with fertility disorders (75% and 45.2%). Analysis of the data using chi square revealed significant difference (p < 0.05) in the prevalence of microbial infections between women with pelvic inflammatory disease and those with fertility disorders Antimicrobial susceptibility pattern of Micro-Organisms associated with PID and Fertility Diorders: Clinical records of the patients obtained from the hospital showed that out of 210 women examined in the study, 126 (60.0%) had PID and 84 (40.0%) had fertility disorder. Out of 126 women with PID, 105 South pacific Journal of Pharma and Bio Science 25

10 (83.3%) bacteria in their HVS and 73 (57.9%) had bacteria in their ECS. Also, out of 84 women with fertility disorders, 63 (75%) had bacteria in their HVS and 38 (45.2%) had bacteria in their ECS. Table 3 summarizes the comparative analysis of microbial infections between women with PID and those with fertility disorders in Orlu. As shown, prevalence of infection was higher (83.3% and 57.9%) amongst women with PID than those with fertility disorders (75% and 45.2%). Analysis of the data using chi square revealed significant difference (p < 0.05) in the prevalence of microbial infections between women with pelvic inflammatory disease and those with fertility disorders Antimicrobial susceptibility pattern of micro-organisms associated with PID and fertility Diorders: Table 4 summarizes the antimicrobial susceptibility pattern of microbial associates of high vaginal and endo cervical swabs of women with PID and fertility disorders in Orlu. As shown, Staphylococcus aureus, and Pseudomonas aeruginosa isolated from endo-cervical swab, Streptococcus agalactiae, and Escherichia coli from high vaginal swab exhibited the highest percentage of susceptibility to Ceftazidine, while Staphylococcus aureus and Pseudomonas aeruginosa from High vaginal swab, Escherichia coli from ECS, and all Klebsiella isolates exhibited the highest percentage of susceptibility on Azetronen. The least susceptibility by all isolates was exhibited on Erythromycin. Analysis of the data using Chi square showed there was significant difference (p < 0.05) in the susceptibility pattern between the fluoroquinolones (Tarivid, Ciprofloxacin, Levofloxacin) and the first and second generation antibiotics (erythromycin, Ampiclox, Gentamycin, and Streptomycin. As shown, the flouroquinolone exhibited higher degree of susceptibility on the bacterial isolates. Prevalence of multi antibiotic resistant bacteria associated with PID and fertility Diorders: The result of this study showed that out of 48 Escherichia coli isolated from high vaginal swabs of women with PID and fertility disorders, 10 (20.8%) exhibited multi antibiotic resistance. Out of 36 Escherichia coli isolated from endo cervical swab of women with PID and fertility disorders, 7 (19.4%) exhibited multi antibiotic resistance. Out of 27 Klebsiella species isolated from high vaginal swabs of women with PID and fertility disorders, 5 (18.5%) exhibited multi antibiotic resistance. Out of 15 Klebsiella species isolated from endo cervical swab of women with PID and fertility disorders, 3 (20.0%) exhibited multi antibiotic resistance. Out of 3 Pseudomonas aeroginosa isolated from high vaginal swabs of women with PID and fertility disorders, 1 (33.3%) exhibited multi antibiotic resistance. Table 5 summarizers the prevalence of multi - antibiotic resistant bacteria amongst women with Pelvic inflammatory disease and fertility disorders. Although there was imbalance in the population size of the different isolates tested, Pseudomonas aeruginosa exhibited the highest prevalence (33.3%) of multi antibiotic resistance followed by Escherichia coli (20.8% and 19.4% for HVS and ECS isolates respectively.) Analysis of the data using chi square showed there was a significant difference (p < 0.05) in the prevalence of multi antibiotic resistant bacteria between high vaginal isolates and Endo cervical isolated. As shown, the prevalence of multi antibiotic resistant bacteria was higher amongst high vaginal swab isolates than endo cervical swab isolates. South pacific Journal of Pharma and Bio Science 26

11 References: 1. Acholonu, A. D. W (1998): Trichomoniasis: A little recognized sexually transmitted disease but with grave consequences. A paper presented at the second Sir Kashin Ibrahim Memorial Public Lecture. Nigeria Academy of Sciences, Lagos 2. Aisemberg, J., Vercelli, C., Billi, S., Ribeiro, M. I., and Ogandpo, D. (2007): Nitric oxide mediates prostaglandins deleterious effect on lipopolysaccharide triggered murine fetal resorption. Proceedings of the National Academy of Science, USA. 104: Andrews W. W., Goldenberg, R. L., Hauth, J. C., Cliver, S. P., CConner, M. and Goepfert, A. R. (2005): Endometrial microbial colonization and plasma cell endometritis after spontaneous or induced preterm versus term delivery. American Journal of Gynaecology and Obstetrics. 193 (3Pt 1): Bergstron, S. (1992): Reproductive failure as a health priority in the third World: a review. East African Medical Journal. 69: Call, D. R., Davis, M. A and Sawant, A.A. (2008): Antimicrobial resistance in Beef and dairy cattle production. Animal Health Research Reviews. 9: Chesbrough M (2002): Medical Laboratory Manual for Tropical Countries. ELSA with Tropical Health Technology Butterworth Heinemann Ltd Oxford 1: Comhaire, F. H, Mahmoud, A. M. A, Depuydt C. E., Zalata, A. A., Christopher, A. B. (1999): Mechanisms and effects of male genital tract infections on sperm quality and fertilizing potential: The anthropologists viewpoint. Humman Reproductiopn update 5: Daniels, J. B. Call, D. D, Hancock,W., Sischo, M., Baker, K and Besseer, T. E. (2009): The role of ceftiofur in the selection and dissemination of bla CMY-2 mediated cephalosporin resistance in Salmonella enterica and commensal Escherichia coli isolated from cattle. Applied and Environmental Micrtobiology75: Deb, K., Chaturvedi, M. M, and Jaiswal, Y. K. (2004): Comprehending the role of LPS in Gram negative bacterial vaginosis: ogling into the causes of unfulfilled child wish. Archives of Gynaecology and Obstetrics. 270: Deb, K., Chaturvedi, M. M, and Jaiswal, Y. K.(2005): Gram negative bacteria LPS induced poor uterine receptivity and implantation failure in mouse: allterations in IL 1beta expression in the preimplantation embryo and uterine horns. Infectious Diseases in Obstetrics and Gynaecology. 13: Golshani, M., Taheri, S., Eslami, G., Suleimani- Rahbar, A. A., Fallah, F and Goudarzi, H. (2006): Genital tract infection in asyptomatic infertile men and its effect on semen quality. International Journal of Public Health. 35: Hermann, T. (2007): Aminoglycoside antibiotics: old drugs and new therapeutic approaches. Cell. Mol. Life Science 64: Holt, J. G. N, R, Krieg, P. H. A, Sneath, J. T. Stanley, and S. T. Williams (eds) (2002): Bergy s Manual of determinative Bacteriology. Baltimore Md: Williams and Wilkins Pub. Co., Maryland 14. Khalili, M. B. and Sharifi Yazdi, M. K. (2001): The effect of bacterial infection on the quality of human s spermatozoa. International Journal of Public Health. 30: Lane, M. C., Alteri, C. J., Snith, S. N. and Mobley, H. L (2007): Expression of flagella is coincident with uropathogenic Eschjerichia coli ascension to the upper urinary tract. Proceedings of the National Academy of Science, USA. 104: South pacific Journal of Pharma and Bio Science 27

12 16. Leke, R. J. Oduma, J. A., Bassol Maygoitia, S., Bacha, A. M and Grigor, K. M. (1993): Regional and geographical variations in infertility: effects on environmental, cultural and socioeconomic factors. Environmental Health Perspective. 101: Metzidie, E., Manolis, E. N., Pournaras, S., Sofianou, D. and Tsakris, A. (2006): Spread of an unusual penicillin and imipenem resistant but ampicillin susceptible phenotype among Enterococcus faecalis clinical isolates. Antimicrobial Chemotherapy. 57(1): Momoh, A. M., Okoli, R. I., Ohaju Obodo, J. O., Samuel, S. O. Ogiehor, I. S., Okolo, P. O. and Momoh, A. A.(2009): Pattern of bacterial isolates and antibiogram in urinary traction. Journal of Applied Basic Sciences. 5(1): Naessons, A, Fouulon, W., Debrucker, P., Devroey, P, and Lauwer, S, (1986): recovery of Micro organisms in semen. Fertility and Sterility 45: Obiajuru, I. O. C. and Ozumba, U. C. (2009): Laboratory Methods for Medical Microbiology and Parasitology. Lifeway Amalgamations, Owerri. ISBN: p Philips, L. O. (2002): Bayelsian Statistics for Social Scientists. Whitefriar Press London p Pitout, J. D. D., Deirdre, L. C., Daniel, B. G., Chow, B. L. Melissa, McCrack, Michael R. M. and Kevin, B. L. (2009): Molecular Epidemiology of CTX M producing Escherichia coli in the Calgary Health Region: Emergence of CTX- M 15 producing isolates. Antimicrobial Agents Chemotherapy 51(4): Runciman, D. J., Anderson, G. A. and Malmo, J. (2009): Comparison of two methods of detecting purulent vaginal discharge in post partum dairy cows and effect of intra uterine cephapirin on reproductive performance. Australian Veterinary Journal 87: Seils - Pascoe, R., L.S. Neinstein, J. Pennbridge, (1998)Comparison between vaginal swab and endocervical swab during pelvic examination. Journal of Adolescent Health 25. Sheldon, I. M, Cronin, J., Geotze, L., Donofrio, G. Schuberth, H. J (2009): Defining Postpartum uterine Disease and Mechanisms of Infection and Immunity in the female Reproductive tract in Cattle. Biology of Reproduction 81: Torres, A. G., Zhou, X and Kaper, J. B (2007): Adherence of diarrheagenic Escherichia coli strains to epithelial cells. Infections and Immunity. 73: Williams, E. J., Fischer, D. P., Noakes, D. E., England G. C. and Rycroft, A (2007): The relationship between uterine pathogen growth density and ovarian function in the postpartum dairy cow. Theriogenology. 68: South pacific Journal of Pharma and Bio Science 28