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03.03.2021 | Original Article

Bacterial biofilm formation on vaginal ring pessaries used for pelvic organ prolapse

verfasst von: Felicity G. Gould, Marcus P. Carey, Erica L. Plummer, Gerald L. Murray, Jennifer A. Danielewski, Sepehr N. Tabrizi, Suzanne M. Garland

Erschienen in: International Urogynecology Journal | Ausgabe 2/2022

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Abstract

Introduction and hypothesis

The objective of this study was to characterize the bacterial biofilm on vaginal ring pessaries used to treat pelvic organ prolapse and investigate the relationship between biofilm phenotype and patient symptoms and clinical signs that are suggestive of inflammation.

Methods

This was a cross-sectional observational study of 40 women wearing a ring-shaped pessary continuously for at least 12 weeks. Participants underwent a clinical examination, and the pessary was removed. Clinical signs were recorded. A swab from the pessary surface and a high vaginal swab were collected from each woman. Participants completed a questionnaire on symptoms. Pessary biofilm presence and phenotype were determined by scanning electron microscopy (SEM). Vaginal and pessary bacterial composition was determined by 16S rRNA gene sequencing. The relationship between biofilm phenotype and symptoms and clinical signs was assessed using logistic regression.

Results

SEM confirmed biofilm formation on all 40 pessaries. Microbiota data were available for 25 pessary swabs. The pessary biofilm microbiota was composed of bacteria typically found in the vagina and was categorized into Lactobacillus-dominated (n = 10/25 pessaries, 40%) communities and Lactobacillus-deficient communities with high relative abundance of anaerobic/facultative anaerobes (n = 15/25 pessaries, 60%). While increasing age was associated with presence of a Lactobacillus-deficient pessary biofilm (odds ratio = 3.60, 95% CI [1.16–11.22], p = 0.04), no associations between biofilm microbiota composition and symptoms or clinical signs were observed.

Conclusions

Lactobacillus-deficient biofilms commonly form on pessaries following long-term use. However, the contribution of biofilm phenotype to symptoms and clinical signs remains to be determined.

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Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6. https://doi.org/10.1067/mob.2002.123819.CrossRefPubMed

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6. https://doi.org/10.1016/S0029-7844(97)00058-6.CrossRefPubMed

Obstetricians ACo, Bulletins-Gynecology GCoP, Society AU. Pelvic organ prolapse: ACOG practice bulletin, number 214. Obstet Gynecol. 2019;134(5):e126–42. https://doi.org/10.1097/AOG.0000000000003519.CrossRef

Sarma S, Ying T, Moore KH. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG. 2009;116(13):1715–21. https://doi.org/10.1111/j.1471-0528.2009.02380.x.CrossRefPubMed

Donlan RM. Biofilms: microbial life on surfaces. Emerg Infect Dis. 2002;8(9):881–90. https://doi.org/10.3201/eid0809.020063.CrossRefPubMedPubMedCentral

Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284(5418):1318–22. https://doi.org/10.1126/science.284.5418.1318.CrossRefPubMed

Hardy L, Cerca N, Jespers V, Vaneechoutte M, Crucitti T. Bacterial biofilms in the vagina. Res Microbiol. 2017;168(9-10):865–74. https://doi.org/10.1016/j.resmic.2017.02.001.CrossRefPubMed

Trautner BW, Darouiche RO. Catheter-associated infections: pathogenesis affects prevention. Arch Intern Med. 2004;164(8):842–50. https://doi.org/10.1001/archinte.164.8.842.CrossRefPubMedPubMedCentral

Swidsinski A, Mendling W, Loening-Baucke V, Swidsinski S, Dorffel Y, Scholze J, et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol. 2008;198(1):97 e91-96. https://doi.org/10.1016/j.ajog.2007.06.039.CrossRef

10.

Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020;19(1):5. https://doi.org/10.1186/s12941-020-0347-4.CrossRefPubMedPubMedCentral

11.

Gunawardana M, Moss JA, Smith TJ, Kennedy S, Kopin E, Nguyen C, et al. Microbial biofilms on the surface of intravaginal rings worn in non-human primates. J Med Microbiol. 2011;60(Pt 6):828–37. https://doi.org/10.1099/jmm.0.028225-0.CrossRefPubMedPubMedCentral

12.

Fregosi NJ, Hobson DTG, Kinman CL, Gaskins JT, Stewart JR, Meriwether KV. Changes in the vaginal microenvironment as related to frequency of pessary removal. Female Pelvic Med Reconstr Surg. 2018;24(2):166–71. https://doi.org/10.1097/SPV.0000000000000520.CrossRefPubMedPubMedCentral

13.

Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.CrossRefPubMed

14.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36. https://doi.org/10.1007/s11136-011-9903-x.CrossRefPubMedPubMedCentral

15.

Plummer EL, Vodstrcil LA, Danielewski JA, Murray GL, Fairley CK, Garland SM, et al. Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: acceptability, tolerability and impact on the genital microbiota of couples - a pilot study. PLoS One. 2018;13(1):e0190199. https://doi.org/10.1371/journal.pone.0190199.CrossRefPubMedPubMedCentral

16.

Martin M. Cutadapt removes adapter sequences from high-throughput sequencing reads. EMBnet J. 2011;17(1):10–2.CrossRef

17.

Caporaso JG, Kuczynski J, Stombaugh J, Bittinger K, Bushman FD, Costello EK, et al. QIIME allows analysis of high-throughput community sequencing data. Nat Methods. 2010;7(5):335–6. https://doi.org/10.1038/nmeth.f.303.CrossRefPubMedPubMedCentral

18.

Schmieder R, Lim YW, Rohwer F, Edwards R. TagCleaner: identification and removal of tag sequences from genomic and metagenomic datasets. BMC Bioinformatics. 2010;11:341. https://doi.org/10.1186/1471-2105-11-341.CrossRefPubMedPubMedCentral

19.

Callahan BJ, McMurdie PJ, Rosen MJ, Han AW, Johnson AJ, Holmes SP. DADA2: high-resolution sample inference from Illumina amplicon data. Nat Methods. 2016;13(7):581–3. https://doi.org/10.1038/nmeth.3869.CrossRefPubMedPubMedCentral

20.

Quast C, Pruesse E, Yilmaz P, Gerken J, Schweer T, Yarza P, et al. The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res. 2013;41(Database issue):D590–6. https://doi.org/10.1093/nar/gks1219.CrossRefPubMed

21.

Oksanen J, Blanchet FG, Friendly M, Kindt R, Legendre P, McGlinn D, Minchin PR, O’Hara RB, Simpson GL, Solymos P, Stevens MHH, Szoecs E, Wagner H (2016) vegan: Community Ecology Package. R package version 2.4-1 edn.,

22.

Rohart F, Gautier B, Singh A, Le Cao KA. mixOmics: an R package for ‘omics feature selection and multiple data integration. PLoS Comput Biol. 2017;13(11):e1005752. https://doi.org/10.1371/journal.pcbi.1005752.CrossRefPubMedPubMedCentral

23.

Hardy L, Jespers V, De Baetselier I, Buyze J, Mwambarangwe L, Musengamana V, et al. Association of vaginal dysbiosis and biofilm with contraceptive vaginal ring biomass in African women. PLoS One. 2017;12(6):e0178324. https://doi.org/10.1371/journal.pone.0178324.CrossRefPubMedPubMedCentral

24.

Miller L, MacFarlane SA, Materi HL. A scanning electron microscopic study of the contraceptive vaginal ring. Contraception. 2005;71(1):65–7. https://doi.org/10.1016/j.contraception.2004.07.015.CrossRefPubMed

25.

Crucitti T, Hardy L, van de Wijgert J, Agaba S, Buyze J, Kestelyn E, et al. Contraceptive rings promote vaginal lactobacilli in a high bacterial vaginosis prevalence population: a randomised, open-label longitudinal study in Rwandan women. PLoS One. 2018;13(7):e0201003. https://doi.org/10.1371/journal.pone.0201003.CrossRefPubMedPubMedCentral

26.

Brotman RM, Shardell MD, Gajer P, Fadrosh D, Chang K, Silver MI, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2014;21(5):450–8. https://doi.org/10.1097/GME.0b013e3182a4690b.CrossRefPubMedPubMedCentral

27.

Hillier SL, Lau RJ. Vaginal microflora in postmenopausal women who have not received estrogen replacement therapy. Clin Infect Dis. 1997;25(Suppl 2):S123–6. https://doi.org/10.1086/516221.CrossRefPubMed

28.

Heinemann C, Reid G. Vaginal microbial diversity among postmenopausal women with and without hormone replacement therapy. Can J Microbiol. 2005;51(9):777–81. https://doi.org/10.1139/w05-070.CrossRefPubMed

29.

Gliniewicz K, Schneider GM, Ridenhour BJ, Williams CJ, Song Y, Farage MA, et al. Comparison of the vaginal microbiomes of premenopausal and postmenopausal women. Front Microbiol. 2019;10:193. https://doi.org/10.3389/fmicb.2019.00193.CrossRefPubMedPubMedCentral

30.

Alnaif B, Drutz HP. Bacterial vaginosis increases in pessary users. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(4):219–22; discussion 222-213. https://doi.org/10.1007/pl00004026.CrossRefPubMed

Titel: Bacterial biofilm formation on vaginal ring pessaries used for pelvic organ prolapse
verfasst von: Felicity G. Gould
Marcus P. Carey
Erica L. Plummer
Gerald L. Murray
Jennifer A. Danielewski
Sepehr N. Tabrizi
Suzanne M. Garland
Publikationsdatum: 03.03.2021
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 2/2022
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-021-04717-x

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Bacterial biofilm formation on vaginal ring pessaries used for pelvic organ prolapse