ANALYSIS OF BIOFILM ON VAGINAL RING PESSARIES USED FOR THE TREATMENT OF PELVIC ORGAN PROLAPSE: RESULTS FROM A PILOT STUDY (augs2015.0790175)
Felicity Gould1, Sepehr Tabrizi2, Suzanne Garland2, Marcus Carey1
1. Department of Urogynaecology Royal Women’s Hospital, 2. Department of Molecular Microbiology Royal Women’s Hospital - Melbourne
Bacteria have the potential to colonize the surfaces of any material introduced into the body and to form a biofilm layer. There is growing evidence of the clinical significance of biofilm formation on many medical devices used in vivo. Pathogenic bacteria can become incorporated into biofilms resulting in clinical sepsis and microbial biofilms are widely implicated in chronic infection.1Additionally, biofilm bacteria maybe difficult to cultivate in the laboratory, leading to false negative reports.2 Vaginal pessaries used for pelvic organ prolapse are often associated with a malodourous discharge and this may be secondary to biofilm build up on the pessary.
To detect the presence or absence of bacterial biofilm on vaginal ring pessaries after at least three months of in situ use in management of pelvic organ prolapse. To diagnose the bacterial makeup of any biofilm that may be found.
This was an observational pilot study of 16 consecutive vaginal PVC (Portex) ring pessaries (Smiths Medical, UK) examined after routine removal from participants who are regular vaginal pessary users. Pessaries had been in situ for between 3 and 6 monthsOne pessary was fixed immediately after removal from the vagina with 2% Gluteraldehyde. This pessary was analysed via electron microscopy after fixing one week later. Fifteen pessaries underwent swabbing for molecular microbiological examination in the form of 16s rRNA gene sequencing.
Clear biofilm matrix formation was displayed on the fixed pessary when examined under electron microscopy. A picture of polymicrobial colonization was shown in twelve samples that underwent gene sequencing. Three distinct patterns of colonisation were identified.Of the 12 pessaries that were colonised, 6 displayed predominantly Lactobacillus species, 2 pessaries showed a predominance of Gardnerella vaginalis and 5 pessaries displayed a low yield of mixed flora.
Our pilot study has demonstrated that biofilms develop on PVC vaginal pessaries, and that there is a predominance of distinct biofilm phenotypes. Further studies are required to assess the clinical importance of vaginal pessary biofilms. At our centre we have commenced a larger study to assess to the association between patient factors, patient symptoms and the presence of particular biofilm phenotypes.
1. Science 1999; 284:1318-1322, 2. J Clin Invest 2003; 112:1466-1477:
Contact Details: Dr Felicity Gould - Department of Urogynaecology, Royal Women’s Hospital, Melbourne AUSTRALIA. [email protected]