Microbial profile and antimicrobial resistance patterns in high vaginal swabs from reproductive age women: A study from North India

Abstract

Background: The vaginal microbiota plays a crucial role in maintaining reproductive health, and its imbalance can predispose women to bacterial vaginosis (BV), candidiasis, and other infections. Regional variations, influenced by environmental and cultural factors, warrant localized studies. This study aimed to determine the microbial diversity, prevalence of BV, and antimicrobial resistance patterns among reproductive-age women in Kashmir. Materials and Methods: A cross-sectional study was conducted among 343 women aged 18–45 years attending gynecology clinics in Kashmir, India. High vaginal swabs (HVS) were processed for Gram staining, culture, and antibiotic susceptibility testing following CLSI guidelines. BV was diagnosed using the Nugent scoring system. Results: Microbial growth was detected in 39.7% (136/343) of samples, with Klebsiella spp. (12.37%), E. coli (5.67%), and Enterococcus spp. (5.67%) being the most prevalent isolates. Fungal growth due to Candida spp. accounted for 4.12%, while 4.64% showed mixed growth. Based on Nugent scoring (n=101), BV was observed in 22.8% of cases, 12.3% showed intermediate score, and 64.9% exhibited normal flora. Antibiotic susceptibility testing revealed high resistance to β-lactams and fluoroquinolones, whereas carbapenems, polymyxins, and aminoglycosides retained good activity. Enterococcus spp. were universally sensitive to vancomycin, linezolid, and penicillin G. Conclusion: The study highlights significant antimicrobial resistance among vaginal pathogens, emphasizing the need for region-specific antibiotic stewardship and diagnostic surveillance. Routine Gram staining with Nugent scoring, coupled with culture-based analysis, can enhance diagnostic accuracy and promote rational antibiotic use in reproductive health management.