In Vitro Investigation and Molecular Study of Normal Flora Isolated from Infant Stool against MDR and PDR Bacterial Vaginosis Among Women in Erbil City
In Vitro Investigation and Molecular Study of Normal Flora Isolated from Infant Stool
DOI:
https://doi.org/10.63841/iue32660Keywords:
Bacterial vaginosis, Biofilm, Normal flora, Multi-drug resistance MDRAbstract
In women of reproductive age, bacterial vaginosis (BV) is the most common lower genital tract infection globally. A fishy malodor and a thin vaginal discharge are common symptoms shared by women with BV.
BV causes the vagina to become less acidic than normal, which leads to an increase in "bad" bacteria. Although women of any age can have BV, those in reproductive age (15–41 years old) are more vulnerable. BV cannot be spread through swimming pools or toilets, nor is it a sexually transmitted disease.Using Vitek 2 Compact technology, 50 pathogenic bacterial specimens were extracted from women who had been diagnosed with vaginosis. These specimens were then analyzed for species identification and antibiotic sensitivity profiling.In women with bacterial vaginosis, S. aureus, E. coli, and K. pneumoniae are the most often discovered bacteria .Antibiotic resistance profiling showed concerning patterns: 14% of the specimens showed signs of pandrug resistance (PDR), 25% showed signs of extended drug resistance (XDR), and 50% showed signs of multidrug resistance (MDR).Two approaches are used to assess the biofilm test. Congo red staining method and tissue culture plate method. 20 Beneficial bacteria strains were extracted from infant fecal and used as normal flora against pathogenic bacteria by method called agar well diffusion method, only 2 bacteria used (K. pneumoniae and P. aeruginosa).The efficiency of bactericidal treatment was assessed using zone of inhibition analysis. zones with a diameter of 24–28 mm. Additionally, these probiotic organisms were able to significantly reduce the biofilm formation capacity of both high and moderate biofilm-forming isolates., . Beneficial bacterial strains isolated from the intestinal flora of newborns show great potential as innovative treatment options for treating pathogens that cause vaginosis and are resistant to antibiotics. These organisms are interesting candidates for probiotic-centered interventions in treating persistent and treatment-resistant vaginosis infections because of their combination bactericidal and biofilm-inhibiting properties, as well as their biological origin and proven safety parameters.While integron genetic elements (classes I and II) were found in pathogenic specimens using multiplex polymerase chain reaction with percent 100%.
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References
K. Lakshmi, S. Jr. Aishwarya Chitralekha, and G. A. Menezes, "Review on infectious vaginitis," Res. J. Pharm. Biol. Chem. Sci., vol. 4, no. 67, 2013.
A. Bitew, Y. Abebaw, D. Bekele, and A. Mihret, "Prevalence of bacterial vaginosis and associated risk factors among women complaining of genital tract infection," Int. J. Microbiol., vol. 2017, p. 4919404, 2017.
J. S. Coleman and C. A. Gaydos, "Molecular diagnosis of bacterial vaginosis: an update," J. Clin. Microbiol., vol. 56, no. 9, pp. 10-1128, 2018.
A. Atia, "Prevalence of bacterial vaginosis and their antibiotic susceptibility among women attending different private clinics in Tripoli, Libya," Libyan J. Med. Sci., vol. 5, no. 2, pp. 79-82, 2021.
G. G. G. Donders and G. Bellen, "Aerobic vaginitis: No longer a stranger," Res. Microbiol., vol. 168, pp. 845–858, 2017.
B. M. Faught and S. Reyes, "Characterization and treatment of recurrent bacterial vaginosis," J. Womens Health (Larchmt), vol. 28, no. 9, pp. 1218–1226, 2019.
C. A. Muzny, J. Balkus, C. Mitchell, J. D. Sobel, K. Workowski, and J. Marrazzo, "Diagnosis and management of bacterial vaginosis: summary of evidence reviewed for the 2021 centers for disease control and prevention sexually transmitted infections treatment guidelines," Clin. Infect. Dis., vol. 74, no. S2, pp. S144–S151, 2022.
S. Basak, P. Singh, and M. Rajurkar, "Multidrug resistant and extensively drug resistant bacteria: a study," J. Pathog., vol. 2016, p. 4065603, 2016.
S. M. Shamsuzzaman, "Multidrug-resistant, Extensively drug-resistant and Pan drug-resistant bacteria and antimicrobial therapy in combination," Bangladesh J. Med. Microbiol., vol. 9, no. 2, pp. 1–2, 2015.
V. Shashikala, F. Ali, N. Lokare, and J. Matew, "Diabetic foot ulcers and biofilm formation-The culprits," Int. J. Biomed. Adv. Res., vol. 7, pp. 428-433, 2016.
K. Harika, V. P. Shenoy, N. Narasimhaswamy, and K. Chawla, "Detection of biofilm production and its impact on antibiotic resistance profile of bacterial isolates from chronic wound infections," J. Glob. Infect. Dis., vol. 12, no. 3, pp. 129-134, 2020.
Y. Lei, Y. Yan, J. Zhong, Y. Zhao, Y. Xu, T. Zhang, H. Xiong, Y. Chen, X. Wang, and K. Zhang, "Enterococcus durans 98D alters gut microbial composition and function to improve DSS-induced colitis in mice," Heliyon, vol. 10, no. 7, 2024.
X. Chen, Y. Lu, T. Chen, and R. Li, "The female vaginal microbiome in health and bacterial vaginosis," Front. Cell. Infect. Microbiol., vol. 11, p. 631972, 2021.
A. E. Osagie and S. H. Olalekan, "Multiple Drug resistance: a fast growing threat," Bio Med, vol. 21, pp. 2574-1241, 2019.
P. A. uri-Morales, E. Guzmán-Morales, and E. De la Paz-Nicolau, "Emerging and Re-emerging Diseases," Gac. Med. Mex., vol. 151, pp. 626-631, 2015.
J. Davies and D. Davies, "Origins and evolution of antibiotic resistance," Microbiol. Mol. Biol. Rev., vol. 74, pp. 417-433, 2010.
A. Pormohammad, R. Pouriran, H. Azimi, and M. Goudarzi, "Prevalence of integron classes in Gram-negative clinical isolated bacteria in Iran: a systematic review and meta-analysis," Iran. J. Basic Med. Sci., vol. 22, no. 2, p. 118, 2019.
M. Sunde, G. S. Simonsen, J. S. Slettemeås, I. Böckerman, and M. Norström, "Integron, plasmid and host strain characteristics of Escherichia coli from humans and food included in the Norwegian antimicrobial resistance monitoring programs," PLoS One, vol. 10, p. e01287, 2015.
A. C. Oladele, D. A. A. Mopelola, and T. O. S. Temitope, "Prevalence of multi-drug resistant pathoge isolated from high vaginal swab in Nigeria," Afr. J. Microbiol., vol. 5, no. 26, pp. 4577-4582, 2011.
B. A. Forbes, D. F. Sahm, and A. S. Weissfeld, Bailey & Scott's Diagnostic Microbiology, 12th ed. Philadelphia, PA, USA: Mosby Elsevier Company, 2007, pp. 216-245, 856-870.
Nagaraja P. Antibiotic resistance of Gardnerellavaginalis in recurrent bacterial vaginosis. Indian Journal of Medical Microbiology; 200826 (2): 155- 157.
Kareem Raheem, Z. and Abdulhamid Said, L., 2023. Antibiotic susceptibility profile of bacteria causing aerobic vaginitis in women in Iraq. Archives of Razi Institute, 78(1), pp.31-43.
He, Y., Na, R., Niu, X., Xiao, B., Yang, H. (). Lactobacillus rhamnosus and Lactobacillus casei Affect Various Stages of Gardnerella Species Biofilm Formation. Front. Cell. Infect. Microbiol. 2021, 11.
Dantas-Medeiros, R., Zanatta, A. C., de Souza, L. B. F. C., Fernandes, J. M., Amorim-Carmo, B., Torres-Rêgo, M., et al. (2021). Antifungal and Antibiofilm Activities of B-Type Oligomeric Procyanidins From Commiphora leptophloeos Used Alone or in Combination With Fluconazole Against Candida spp. Front. Microbiol. 12
Furtuna, D.K., Debora, K. and Wasito, E.B., 2018. Comparison of microbiological examination by test tube and Congo red agar methods to detect biofilm production on clinical isolates. Folia Medica Indonesiana, 54(1), pp.22-28
Umadevi S, Kandhakumari G, Joseph N M, Kumar S, Easow J M, Stephen S and Singh U K. (). Prevalence and antimicrobial susceptibility pattern of ESBL producing Gram Negative Bacilli. Dept. of Microbiology Mahatma Gandi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry, 2011: 607-402
Clinical and Laboratory Standards Institute, Performance Standards for Antimicrobial Susceptibility, Clinical and Laboratory Standards Institute, Annapolis, MD, USA, 2018
Taneja N, Rao P, Arora J and Dogra A. (2008). Occurrence of ESBL and AmpC β-lactamase and susceptibility to newer antimicrobial agents in complicated UTI. Indian Journal of Med Res; 127: 85-88.
Mahmud, M.A Assessing Factors that Shape Neonatal Gut Microbiota in Erbil Province/Iraq. Jordan Journal of Biological Sciences, 15(3),. 2022.
Mariya Divanshi, A.S., Sudhakaran, A., Beena, A.K., James, L. and Aysha, C.H., Isolation and characterization of a lactic acid bacterium from infant Feces. The Pharma Innovation Journal, 9(5).2020
Y. Kristina and I. K. Putri, "A Comprehensive Review of Probiotic Mechanisms and Their Implementation in Gastrointestinal Health Management," Sci. Get J., vol. 2, no. 2, pp. 39-48, 2025.
C. Valgas, S. M. De Souza, E. F. A. Smânia, et al., "Screening methods to determine antibacterial activity of natural products," Braz. J. Microbiol., vol. 38, pp. 369–380, 2007.
M. Balouiri, M. Sadiki, and S. K. Ibnsouda, "Methods for in vitro evaluating antimicrobial activity: A review," J. Pharm. Anal., vol. 6, no. 2, pp. 71-79, 2016.
F. Serapide, R. Pallone, A. Quirino, N. Marascio, G. S. Barreca, C. Davoli, R. Lionello, G. Matera, and A. Russo, "Impact of Multiplex PCR on Diagnosis of Bacterial and Fungal Infections and Choice of Appropriate Antimicrobial Therapy," Diagnostics, vol. 15, no. 8, p. 1044, 2025.
J. Al-Daamy, R. M. Ali, and A. Y. Ahlam Kadhum, "Prevalence of Gardnerella vaginalis among women suffering from bacterial vaginosis in Al-Najaf Al-Ashraf city/Iraq," Drug Invent. Today, vol. 11, 2019.
M. J. Khulaif and A. H. Al-Charrakh, "Detection of class 1 integron and antibiotic resistance of β-lactamase-producing Escherichia coli isolated from four hospitals in Babylon, Iraq," Med. J. Babylon, vol. 20, no. 2, pp. 375-382, 2023.
C. Ren, Y. Zhao, and Y. Shen, "Analysis of the effect of integrons on drug-resistant Staphylococcus aureus by multiplex PCR detection," Mol. Med. Rep., vol. 7, no. 3, pp. 719-724, 2013.
S. M. Mohammed-Amin, B. M. Jaralla, K. M. Ali, and H. Tawfeeq, "Prevalence of Bacterial Vaginosis among Married Women in Kalar District, Iraqi Kurdistan Region," Passer J. Basic Appl. Sci., vol. 3, no. 2, pp. 194-199, 2021.
E. Ranjit, B. R. Raghubanshi, S. Maskey, and P. Parajuli, "Prevalence of bacterial vaginosis and its association with risk factors among nonpregnant women: A hospital based study," Int. J. Microbiol., vol. 2018,
A. Bitew, Y. Abebaw, D. Bekele, and A. Mihret, "Prevalence of bacterial vaginosis and associated risk factors among women complaining of genital tract infection," Int. J. Microbiol., vol. 2017
V. Bhakta, S. Aslam, and A. Aljaghwani, "Bacterial vaginosis in pregnancy: prevalence and outcomes in a tertiary care hospital," Afr. J. Reprod. Health, vol. 25, no. 1, pp. 49-55, 2021.
A. Omole-Ohonsi, Z. Mohammed, and U. Ihesiulor, "Vaginal discharge in pregnancy in Kano, Northern Nigeria," Niger. Med. Pract., vol. 50, p. 68, 2006.
Z. A. Abdelaziz, M. E. Ibrahim, N. E. Bilal, and M. E. Hamid, "Vaginal infections among pregnant women at Omdurman Maternity Hospital in Khartoum, Sudan," J. Infect. Dev. Ctries., vol. 8, no. 4, pp. 490–497, 2014.
R. K. Jarjees, "Bacteriological study of the incidence of genitourinary tract infection in diabetic women in Erbil," M.Sc. thesis, Coll. Sci., Univ. Salahaddin, Erbil, Iraq, 2006.
S. S. Ahmad and F. A. Ali, "Evaluation of Different Detection Methods of Biofilm Formation in the Clinical Isolated from Pregnant and Non-Pregnant Women with Genital Tract Infection," Insert Journal Name if availab, 2026.
D. Greenwood, R. C. B. Slack, and J. F. Peutherer, Medical Microbiology: A Guide to Microbial Infections: Pathogenesis, Immunity, Laboratory Diagnosis and Control, 6th ed. New York, NY, USA: Churchill Livingstone, 2002, p. 276.
O. A. Olowe, O. B. Makanjoula, R. Olowe, and D. A. Adekanle, "Prevalence of Vulvovaginal candidiasis, Trichomoniasis & Bacterial vaginosis Among Pregnant women receiving Ante-natal care in Southwestern Nigeria," Eur. J. Microbiol. Immunol., vol. 4, no. 4, pp. 193-197, 2014.
D. Nahar, G. Soni, A. E. Chand, and S. Mourya, "Bacterial etiology and their antibiogram in aerobic vaginitis patients at Tertiary Care Hospital, Kota, Rajasthan," Int. J. Sci. Stud., vol. 4, no. 3, pp. 103–107, 2016.
A. Bitew, Y. Abebaw, D. Bekele, and A. Mihret, "Prevalence of bacterial vaginosis and associated risk factors among women complaining of genital tract infection," Int. J. Microbiol., vol. 2017, pp. 1–8.
S. Bhooshan, S. Gupta, A. Agarwal, and P. Kumar, "Antibiotic resistance-renewed fear in Gardnerella vaginalis and its role in bacterial vaginosis," IOSR J. Dent. Med. Sci., vol. 15, no. 7, pp. 63-66, 2016.
F. Foglia, M. T. Della Rocca, F. Montella, M. Vasco, A. Chianese, C. Zannella, A. De Filippis, E. Finamore, and M. Galdiero, "Aerobic vaginitis: antibiotic resistance trend and future actions of antimicrobial diagnostic stewardship," New Microbiol., vol. 47, pp. 164-171, 2024.
A. Bitew, A. Mengist, H. Belew, Y. Aschale, and A. Reta, "The prevalence, antibiotic resistance pattern, and associated factors of bacterial vaginosis among women of the reproductive age group from Felege Hiwot Referral Hospital, Ethiopia," Infect. Drug Resist., vol. 14, p. 2685, 2021.
I. A. A. Al-Kraety, S. G. Al-Muhanna, S. R. Banoon, and A. Ghasemian, "Bacterial vaginosis pattern and antibiotic susceptibility testing in female patients using high vaginal swabs," Biodiversitas J. Biol. Divers., vol. 23, no. 6, 2022.
A. Swidsinski, W. Mendling, V. Loening-Baucke, A. Ladhoff, S. Swidsinski, P. Hale, and H. Lochs, "Adherent biofilms in bacterial vaginosis," Obstet. Gynecol. J., vol. 106, no. 5, pp. 1013–1023, 2005.
T. Mathur, S. Singhal, S. Khan, D. J. Upadhyay, T. Fatma, and A. Rattan, "Detection of biofilm formation among the clinical isolates of Staphylococci: An evaluation of three different screening methods," Indian J. Med. Microbiol., vol. 24, no. 1, pp. 25-29, 2006.
S. Bose, M. Khodke, S. Basak, and S. K. Mallick, "Detection of biofilm producing Staphylococci: Need of the Hour," J. Clin. Diagn. Res., vol. 3, pp. 1915-1920, 2009.
A. Swidsinski, W. Mendling, V. Loening-Baucke, A. Ladhoff, S. Swidsinski, P. Hale, and H. Lochs, "Adherent biofilms in bacterial vaginosis," Obstet. Gynecol. J., vol. 106, no. 5, pp. 1013–1023, 2005.
S. Er, "Comparison of the Microtiter Plate Method and the Congo Red Agar Technique in the determination of Staphylococcal Biofilm," Mugla J. Sci. Technol., vol. 10, no. 1, pp. 128-132, 2024.
S. Bose, M. Khodke, S. Basak, and S. K. Mallick, "Detection of biofilm producing Staphylococci: Need of the Hour," J. Clin. Diagn. Res., vol. 3, pp. 1915-1920, 2009.
S. S. Ahmad and F. A. Ali, "Detection of ESBL, AmpC and Metallo Beta-Lactamase mediated resistance in Gram-negative bacteria isolated from women with genital tract infection," Eur. Sci. J., vol. 10, no. 9, 2014.
C. H. S. Al-Haidari, "Microbiological study of urinary tract infection, Antibiotics susceptibility pattern and Extend Spectrum Beta Lactamase prevalence among children in Erbil city," M.Sc. thesis, Coll. Med., Hawler Medical Univ., Erbil, Iraq, 2010.
R. K. Jarjees, "Bacteriological study of the incidence of genitourinary tract infection in diabetic women in Erbil," M.Sc. thesis, Coll. Sci., Univ. Salahaddin, Erbil, Iraq, 2006.
M. Megawati, M. Yuwono, and R. Primaharinastiti, "Antibacterial activity of Randu Honey against some bacterial pathogens using agar well diffusion method," Riset Informasi Kesehatan, vol. 14, no. 1, pp. 49-57, 2025.
M. Balouiri, M. Sadiki, and S. K. Ibnsouda, "Methods for in vitro evaluating antimicrobial activity: A review," J. Pharm. Anal., vol. 6, no. 2, pp. 71–79, 2016.
M. Mirnezami, R. Ranjbar, M. Niakan, and M. H. Ahmadi, "Frequency of antimicrobial resistance and class 1 and 2 integrons in Escherichia coli strains isolated from urinary tract infections," Iran. J. Pharm. Res., vol. 19, no. 3, p. 282, 2020.
S. Farshad, A. Japoni, and M. Hosseini, "Low distribution of integrons among multidrug resistant E. coli strains isolated from children with community-acquired urinary tract infections in Shiraz, Iran," Pol. J. Microbiol., vol. 57, pp. 193-198, 2008.
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