Abstract
Antimicrobial Resistance Patterns in Gardnerella vaginalis Isolates from a Pregnant South African Population
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Bacterial vaginosis treatment includes broad-spectrum antibiotics, metronidazole, and clindamycin. However, in clinical settings, increasing antimicrobial resistance has resulted in recurrent BV. This study aimed to determine susceptibility patterns of G. vaginalis isolates to various antibiotics. Additionally, the genetic diversity of isolates (G. vaginalis clades) was investigated and linked to antimicrobial resistance.
Methods: In total, n=150 enrolled pregnant women, 18 years and older, were provided two self-collected vaginal swabs, used for BV diagnosis and G. vaginalis culture. Genetic diversity assessments of isolates were based on genetic differences in the tuf gene using clade-specific primers in a quantitative polymerase chain reaction (PCR). Antimicrobial susceptibility profiles were generated using the Sensititre™ Anaerobe MIC Plate (ThermoFisher Scientific, United States).
Results: In this study, 49.3% of the women were BV negative, 28.7% were intermediate and, 22% were positive. Sixteen G. vaginalis isolates were successfully cultured from this population. The genotyping/clade PCR detected three clades with frequencies of 100% for clade 1, 37.5% for clade 2 and 43.8% for clade 4. Multiple clades were found in 62.5% of isolates. Only fourteen isolates were viable for susceptibility testing, of which, 8/14 (57.1%) were susceptible to metronidazole (MIC of ≤8μg/ml) and 6/14 (42.9%) were resistant (MIC of ≥32μg/ml).
Conclusion: This study reported on the resistance patterns of clinical G. vaginalis isolates, with high levels of metronidazole resistance observed. Obtaining approvals for clindamycin and vancomycin for future treatment of BV should be considered in our current setting.
Keywords: Gardnerella vaginalis, Antimicrobial resistance, Clindamycin, Genetic diversity
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