Antimicrobial susceptibility patterns of uropathogenic microorganisms associated with vesico-vaginal fistula ( VVF ) patients in Abakaliki , South eastern Nigeria

1 Department of Applied Microbiology, Faculty of Science, Ebonyi State University, P. M. B. 053 Abakaliki, Ebonyi State, Nigeria. 2 Department of Biotechnology, Faculty of Science, Ebonyi State University, P. M. B. 053 Abakaliki, Ebonyi State, Nigeria. 3 Department of Science Laboratory Technology, Akanu-Ibiam Federal Polytechinic, Unwana, P. M. B. 1007, Ebonyi State, Nigeria. 4 Department of Biological Science, Faculty of Science, Federal University Ndufu-Alike, Ikwo, Ebonyi State, Nigeria.


INTRODUCTION
Vaginal fistula is an abnormal connection occurring between the vagina and the bladder, or the rectum, *Corresponding author.E-mail: ben_iyke70@yahoo.com.Tel: +2348134136233.
Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License resulting in constant leakage of urine or faeces or both (Wall, 2006).Vesico-vaginal Fistula (VVF) is an abnormal tract extending between bladder (vesico) and the vagina that allow continuous involuntary discharge of urine into the vaginal vault and often caused by sexual violence or rape and prolonged obstructed labour during childbirth (Iroha et al., 2016;Forsgren et al., 2009).Research has shown that VVF patients are usually young girls who have no formal education, no means of livelihood, and given out in marriage by their poverty-stricken parents to poverty-stricken husbands.As a result, patients like that are normally malnourished in pregnancy and no personal income to take care of themselves and to attend antenatal clinics (Bimbola and John, 2013).The frequency of VVF is largely under-reported in developing countries and fistulas found in the industrialized countries are caused by radiation therapy for malignant disease or through accidental surgical injury to the bladder during hysterectomy (Wall, 2006).Studies have shown that poverty is a serious contributing factor to the development of VVF.The World Health Organizations report on obstetric fistula (1991), says that VVF patients "come almost exclusively from poor families and communities".Communities can be poor if they lack basic facilities to take care of their members.It is common in communities where teenagers are given out in marriage early in life (Yabaya and Auta, 2006;Hadley, 2002).
Access to skilled maternal care can help predict, identify and treat such labour (WHO, 2005).The emergence of antimicrobial resistance makes the effective management and treatment of urinary tract infection especially in VVF patients difficult.This research studies the antimicrobial susceptibility patterns of uropathogenic microorganisms associated with vesico-vaginal fistula (VVF) patients in VVF units at National Obstetrics Fistula Centre, Abakaliki, South east Nigeria.

Sample collection
A total of 108 mid-stream urine samples were collected from 54 patients at National Obstetrics Fistula Centre, Abakaliki, South east Nigeria.Two sets of mid-stream urine samples were collected from each VVF patient (pre-surgery and post-surgery).Urine samples from pre-surgery VVF patients were collected prior to surgery while post-surgery urine samples were collected four days after surgery.All mid-steam urine samples were aseptically collected using clean universal sampling bottles and immediately transported to Applied Microbiology laboratory, Ebonyi State University for bacteriological analysis.

Bacteriological analysis
Urine samples were cultured on media such as MacConkey agar, nutrient agar, blood agar and cysteine lactose electrolyte deficient (CLED) medium (Oxoid, UK) for the isolation of uropathogenic bacteria.All the culture media were aseptically prepared according to the manufacturers' instructions and the isolated bacteria were phenotypically identified according to the standard microbiology techniques (Cheesbrough, 2010)
Our findings affirmed that VVF patients are prone to microbial colonization and these microbes show various degree of susceptibility to different classes of antibiotics.This is in accordance with the work of Dalela et al. (2003) that reaffirmed that uropathogens from VVF patients exhibited various degrees of resistance to antibiotics in their different studies.Our study has revealed the antibiotic susceptibility patterns of uropathogenic bacteria associated with VVF patients and also proffered the possible antibiotics that could be used to combat the menace.
Currently, uropathogenic microorganisms associated with VVF patients is preventable and treatable, but VVF disease is still a problem and difficult to prevent in developing countries such as Nigeria.We therefore recommend the abolishment of early girl child marriage and female genital mutilation, provision of primary health care system in rural communities and the use of skilled attendants at every birth, monitoring of every labour with the partograph for early recognition of obstructed labour, and caesarian section (CS) surgery during labour in patients with small pelvis to enable safe delivery of their babies.Finally, constant laboratory evaluation of antibiotics used in the treatment of uropathogenic microorganisms from VVF patients is paramount in avoiding antibiotic resistance menace.

Table 1 .
Prevalence of uropathogenic isolates from urine samplesof pre and post-surgicalVVF patients.

Table 2 .
Antimicrobial susceptibility patterns of uropathogenic Staphylococcus aureus isolated from pre and postsurgery VVF patients.

Table 3 .
Antimicrobial susceptibility patterns of uropathogenic Enterococcus faecalis isolated from pre and post-surgery VVF patients.

Table 4 .
Antimicrobial susceptibility patterns of uropathogenic Klebsiella pneumoniae isolated from pre and postsurgery VVF patients.

Table 5 .
Antimicrobial susceptibility patterns of uropathogenic Proteus mirabilis isolated from pre and post-surgery VVF patients.Table6).Our work is in concord with the work of other researchers.Lin et al., Mansour et al. (2009)esence of bacteriuria among patients.Mansour et al. (2009)isolated E. coli (59%),

Table 6 .
Antimicrobial susceptibility patterns of uropathogenic Escherichia coli isolated from pre and post-surgery VVF patients.