Aerobic cervical bacteriology and antibiotic sensitivity patterns in patients with advanced cervical cancer before and after radiotherapy at a national referral hospital in Uganda

Objective: To determine prevalent aerobic cervical bacteria and sensitivity to commonly used antibiotics in patients with advanced cervical cancer before and after 4 weeks of external beam radiotherapy (EBRT). Methods: Cervical swabs were collected prior to the initial radiation dose and after 4 weeks of radiotherapy at Mulago Hospital. Aerobic culture was performed on blood agar, chocolate agar, and MacConkey agar, and incubated at 35-37 degrees for 24-48 hours. Isolates were identified using colonial morphology, Gram staining, and biochemical analysis. Sensitivity testing was performed via Kirby-Bauer disk diffusion and dilution. Differences in the proportions of bacteria isolated before and after radiotherapy were compared. Paired t test was used to obtain differences in sensitivity before and after radiotherapy. Results: Normal flora increased significantly after EBRT (P = 0.02). There was no significant change in overall proportion of positive cultures. Sensitivity to commonly used antibiotics improved (P = 0.05) and resistance significantly decreased (P = 0.005). Significant differences were seen mainly with ciprofloxacin, ceftriaxone, and gentamicin. Conclusion: Four weeks of EBRT did not sterilize the cervix but resulted in an increase in normal flora. Radiotherapy appeared to reduce resistance to commonly used antibiotics. Sensitivity to chloramphenicol was higher than for the more commonly used antibiotics. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.