Use of nonoxynol-9 and changes in vaginal lactobacilli.

Several in vitro studies have shown nonoxynol-9 (N-9) to be toxic to lactobacilli, especially to strains that produce H2O2. Data from a randomized, double-blind, placebo-controlled crossover trial that investigated the safety and toxicity of 2 weeks of daily vaginal application of an N-9 gel were analyzed, to examine the effect of N-9 use on vaginal lactobacilli and bacterial vaginosis. In vivo, N-9 promoted sustained colonization by H2O2-producing lactobacilli among women already colonized (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-2.7). In addition, use of N-9 for 2 weeks reduced the likelihood of bacterial vaginosis (RR, 0.5; 95% CI, 0.3-1.0). In contrast, N-9 use by women initially colonized only by non-H2O2-producing lactobacilli resulted in loss of vaginal lactobacilli (RR, 2.5; 95% CI, 1.2-5.3). These data suggest that daily use of N-9 does not adversely affect vaginal colonization by H2O2-producing lactobacilli but that such use may promote loss of non-H2O2-producing strains.

Pattern of bacterial infections and antimicrobial susceptibility at the Kenyatta National Hospital, Nairobi, Kenya.

To monitor clinically significant isolates and their antimicrobial susceptibilities, all specimens sent to microbiology laboratory of the Kenyatta National Hospital were cultured on appropriate media. The susceptibility of the isolates was performed on Muller Hinton or diagnostic sensitivity test (DST) agar using comparative discs diffusion technique. The results were then entered into Microbe Base 2 computer programme. A total of 7416 clinically significant isolates were collected from 1991 to 1995. The most commonly isolated organisms were E.coli, Klebsiella and Staphylococcus aureus. Most of these hospital acquired infections had multiple resistance to conventional antimicrobials, namely, penicillin, tetracyclines, gentamicin, trimethoprim/sulphamethoxazole and ampicillin. The resistance pattern was high among both gram negative and positive bacteria isolates. Beta-lactamase production amongst them were 51%, 69.3%, 79.6% respectively. Prevalence of methicillin resistant Staphylococcus aureus was 39.8%. Addition of clavulanic acid to amoxycillin increased Staphylococcus aureus susceptibility three fold. The emergence of multiple drug resistance calls for a continuous monitoring and reviewing of antibiotic policy in the hospital and the country at large.

Community acquired bacterial infections and their antimicrobial susceptibility in Nairobi, Kenya.

The purpose of the study was to determine the pattern and antimicrobial sensitivity on community acquired bacterial strains in Nairobi, Kenya. Clinical specimens collected from out-patient clinics at the Kenyatta National Hospital were cultured on appropriate media and identified according to Cowen and Steel's manual. The antimicrobial sensitivity was determined using comparative disc diffusion techniques. Between 1991 and 1995, there were a total of 1659 positive cultures comprising 30 different bacterial species. Out of the overall gram negative isolates (61.9%), E.coli and Klebsiella spp formed over 70%. Among the gram positive, Staphylococcus aureus, Enterococcus and coagulase negative staphylococcus spp constituting 41%, 26% and 18% respectively were the most common. Most organisms showed multiple resistance patterns to commonly used antimicrobials similar to hospital acquired infections. The gram negative isolates were resistant to cotrimoxazole, ampicillin, tetracyclines, chloramphenicol, and sulphamethoxazole. However, the sensitivity of these organisms to gentamicin and kanamycin was between 60 and 90%. Among the gram positive isolates, there was a high resistance to penicillin and tetracyclines (60-90%) while the resistance to lincomycin, minocycline and chloramphenicol was low (5-50%). All isolates were, however, highly sensitive to cephalosporins and fluoroquinolones. Beta-lactamase production among, E.coli, Klebsiella spp and Staphylococcus aureus was 48.9%, 76.7%, 76.1% respectively. Methicillin resistance for Staphylococcus aureus was 59.2%. Indiscriminate use of antibiotics in the community may have selected for resistant strains. This calls for urgent need to review policies on prescription practices.