Cefoperazone-sulbactam and ornidazole for Gardnerella vaginalis bloodstream infection after cesarean section:A case report

BACKGROUND Gardnerella vaginalis(G.vaginalis)is a facultative anaerobic bacteria known to cause bloodstream infections.However,cases are very rare in clinics.There is very limited clinical experience in the treatment of bloodstream infections caused by G.vaginalis.Therefore,there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G.vaginalis.CASE SUMMARY A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery.The blood cultures suggested an infection due to G.vaginalis,and treatment with cefoperazone-sulbactam was started.After 5 d of treatment,there was a decrease in the hemogram;however,the temperature and C-reactive protein levels remained high.Based on clinical experience and a review of literature,the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam.Following a week of treatment,the temperature,hemogram and C-reactive protein levels returned to normal,and blood cultures turned negative,suggesting a therapeutic effect of the combination treatment.CONCLUSION This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G.vaginalis following a cesarean section.

Effectiveness of Gardnerella vaginalis culture and Nugent scoring in identifying bacterial vaginosis in pregnant women

Background:Bacterial vaginosis(BV),a lower genital tract syndrome,has been linked to adverse pregnancy outcomes and is regarded as the prevalent type of vaginal infection in females of childbearing age.Objectives:To determine the accuracy of Nugent scoring and Gardnerella vaginalis culture in the diagnosis of bacterial vaginosis(BV)among pregnant women attending antenatal clinic in Nnamdi Azikiwe University Teaching Hospital,Nnewi,Nigeria.Method:This cross-sectional study evaluated biospecimen from 333 pregnant women enrolled through systematic random sampling technique.Biospecimens of vaginal discharge were tested for BV infection using Amsel’s criteria,Nugent’s score and culture of G.Vaginalis.Using Amsel’s criteria as a“gold standard”,the Nugent’s score and culture of G.vaginalis were estimated.Results:Prevalence of 26.12%,25.82% and 28.20% of BV was found using Amsel criteria,Nugent’s method and culture of G.vaginalis,respectively.No statistical relationship exists between socio-demographic characteristics and BV(P>0.05).Sexual exposure,and vaginal hygienic practices influences BV(P<0.05)infection and also with fishy odor during or after sexual intercourse,Gardnerella morphotypes,Bacteroides morphotypes and BV(P<0.05).An inverse relationship existed between lactobacilli morphotypes and BV.The prevalence of HIV was 5.41% and 16 out of 18 had BV diagnosed using Amsel criteria.Nugent method correlated strongly with Amsel criteria(P<0.05).In comparison with Amsel criteria,it had 78.16% sensitivity,92.68% specificity,79.07% positive predictive value,92.31% negative predictive value and 88.89% accuracy rate.This was in contrast distinction to the culture of G.vaginalis,which had 56.32%sensitivity,81.70% specificity,52.13% positive predictive value,84.10% negative predictive value and 75.08% accuracy rate.Conclusion:Nugent method correlated strongly with Amsel criteria(P<0.05)and had 78.16% sensitivity,92.68% specificity,79.07% positive predictive value,92.31% negative predictive value and 88.89% accuracy rate.Contrariwise,the culture of G.vaginalis had 56.32% sensitivity,81.70% specificity,52.13% positive predictive value,84.10% negative predictive value and 75.08% accuracy rate for BV diagnosis.

An update on Gardneralla vaginalis associated bacterial vaginosis in Malaysia

Objective: To update the status of Gardnerella vaginalis(G. vaginalis) as a causative agent of bacterial vaginosis(BV) in Malaysia and to define its epidemiology, metronidazole resistance and virulence properties.Methods: It is a single-centre(Gynaecology clinic at the Hospital Kuala Lumpur,Malaysia) prospective study with laboratory-based microbiological follow up and analyses. Vaginal swabs collected from the patients suspected for BV were subjected to clinical BV diagnosis, isolation and identification of G. vaginalis, metronidazole susceptibility testing, vaginolysin and sialidase gene PCR, Piot's biotyping and amplified ribosomal DNA restriction analysis genotyping.Results: Among the 207 patients suspected for BV, G. vaginalis was isolated from 47 subjects. G. vaginalis coexisted with Trichomonas vaginalis and Candida albicans in 26 samples. Three G. vaginalis isolates were resistant to metronidazole. Biotyping revealed 1 and 7 as the common types. Amplified ribosomal DNA restriction analysis genotype II was found to be more common(n = 22; 46%) than I(n = 12; 25.53%) and III(n = 13;27.6%). All genotype I and III isolates carried the sialidase gene, while 91.6% and 84.6%contained the vaginolysin gene. Genotype I was significantly associated with postgynaecological surgical complications and abortions(P = 0.002).Conclusions: The existence of pathogenic G. vaginalis clones in Malaysia including drug resistant strains should not be taken lightly and needs to be monitored as these may bring more complications especially among women of child bearing age and pregnant women.

Comparison of main lactobacillus species between healthy women and women with bacterial vaginosis

Background The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understanding the etiology of these diseases. This study aimed to compare the characteristics of main lactobacillus species between healthy women and women with bacterial vaginosis （BV） by quantitative culture and PCR methods. Main lactobacillus species include L. crispatus , L. gasseri, L. jensenii and L. iners.Methods A total of 150 Women attending Gynecology Outpatient Clinic of Beijing Friendship Hospital, were diagnosed as having BV because three or more of the following criteria were met （standard of Amsel＇s composite criteria）： homogeneous discharge, elevated vaginal pH （pH 〉4.5）, production of amines, and presence of ＂clue＂ cells. Those with less than three of the criteria were considered as healthy. Simultaneously, smears were made of vaginal fluid and Gram stained, then were assessed qualitatively as normal （grade Ⅰ）, intermediate （grade Ⅱ）, or consistent with BV （grade Ⅲ）. Gardnerella vaginalis were identified by using Vitek 2 Compact and PCR methods. Lactobacillus species were identified by PCR methods. Gardnerella vaginalis and lactobacilli colony counts were determined by calculating the most number of colonies of each species in the appropriate plates （colonies between 10 and 300）, corrected by the dilution of the sample in the plates, and multiplied by 10 （to account for plating 100 μl）, in order to get colony forming units per milliliter of vaginal secretion.Results BV was diagnosed in 31% （46/150） patients using the composite criteria, the remainder being regarded as healthy. The majority of patients with BV had a smear assessed as grade Ⅲ （91%, 42/46） and minority of them had a smear assessed as grade Ⅱ（9%, 4/46）. The majority of healthy women had a smear assessed as grade Ⅰ （64%, 67/104）. Smears assessed as grade Ⅱwere found （36%, 37/104） among patients diagnosed as healthy, with less than three of the composite criteria. L. crispatus was cultured from 94% of healthy women and 83% of women with BV, with the former colonies count average value of 106 and the latter of 103. L. gasseri, L. iners, and L. jensenfi were cultured from 85%, 68% and 43% of healthy women; and 28%, 89% and 44% of BV women, respectively.Conclusions The quantities of four lactobacillus species except L. jensenii had a significant difference between healthy women and women with BV. Our results provide support for the negative association between L. iners and L. gasseri. Although L. crispatus were existent both in healthy and BV positive women＇s vagina, the numbers of L. crispatus were significantly different for the dominant number in healthy women. Smears of vaginal fluid and Gram stain play an important guiding role in bacteria culture.