Doctor of Medicine Proves Risk Factors for Failure of Bacterial Vaginosis Treatment in Pregnant Women

Located in Dr. A A. Made Djelantik, Faculty of Medicine, Udayana University, Denpasar, a Doctoral Promotion examination has taken place with the promotion candidate, dr. Anak Agung Gede Raka Budayasa, Sp.OG, Subsp.KFm with the dissertation title "High Levels of Interleukin-1β, Interleukin-8 and Sialidase of Vaginal Fluid in Pregnant Women with Bacterial Vaginosis as a Risk Factor for Failure of Treatment with Metronidazole." (20/6/2023)

 

In the last two decades, the prevalence of bacterial vaginosis (BV) treatment failure with metronidazole has increased, especially in pregnant women of less than 20 weeks' gestation, which is associated with an increased risk of both maternal and perinatal morbidity and mortality. The causes of treatment failure are not known for certain. The failure of this treatment is thought to be related to the virulence of the bacteria which is indicated by an increase in the immune response and the virulence factor of the bacteria which is indicated by the levels of IL-1β, IL-8 and sialidase enzymes respectively. This study aims to prove that high levels of IL-1β, IL-8 and sialidase in the vaginal fluid of pregnant women with BV are risk factors for treatment failure with metronidazole.

 

This observational nested case control study was conducted at the Midwifery Polyclinic at Sanjiwani Hospital from July to September 2022. The sample was pregnant women less than 20 weeks of gestation with BV and the material for examination was vaginal discharge. A total of 52 samples of pregnant women with BV infection who were treated with metronidazole were divided into two equal groups, namely 26 samples experienced treatment failure as the case group and 26 samples experienced recovery as the control group. Examination of IL-1β, IL-8 and sialidase levels was carried out using the ELISA technique at the Integrated Biomedical Laboratory Unit, Faculty of Medicine, Udayana University, Bali. Data were analyzed with the help of IBM SPSS Statistics 21. In this study it was found that pregnant women infected with BV with high levels of IL-1β, IL-8 and sialidase had a risk of failure of treatment with metronidazole of 7.93, 3.6 and 5 respectively .12 times higher than pregnant women with low IL-1β,IL-8 and sialidase levels. With multivariate analysis, it was found that high levels of IL-1β and sialidase played a role in treatment failure with adjusted odds ratios of 8.61 and 7.43, respectively, while high levels of IL-8 were not significant as risk factors for treatment failure ( p = 0.119)

 

The novelty of this study is that there has been no previous publication regarding the use of pro-inflammatory cytokines IL-1β, IL-8 and germ virulence factors, namely sialidase taken from vaginal fluids to analyze the relationship with failure of BV treatment with metronidazole. The results showed that high levels of IL-1β and sialidase, as risk factors for treatment failure with metronidazole, are new findings.

 

The implication of the results of this study is the proven presence of germs with high virulence causing inflammatory reactions and high immune responses, characterized by high levels of IL-1β, IL-8 and the presence of bacterial virulence factors which are characterized by high sialidase levels in the vaginal fluid of pregnant women. as a risk factor for failure of metronidazole treatment in BV cases. This theory could explain treatment failure in BV infection and strengthen existing theories. This research can be the basis for further research by conducting cohort studies to prove whether high levels of IL-1β and sialidase can be predictors of treatment failure and clinical trials for the treatment of BV infection in pregnant women with a combination of metronidazole with anti-inflammatory drugs or sialidase inhibitors compared to metronidazole Alone.

The exam was led by the Deputy Dean for Academic Affairs and Planning Dr. dr. I Gede Eka Wiratnaya, Sp.OT (K)., with a team of examiners:

1. Dr. dr. Ketut Suwiyoga, Sp.OG., Subsp.Onk (Promoter)

2. Prof. drh. I Nyoman Mantik Astawa, Ph.D (Co-promoter I)

3.Dr. dr. I Nyoman Gede Budiana, Sp.OG., Subsp.Onk (Co-promoter II)

4. Dr. dr. I Made Bakta, Sp.PD-KHOM

5. Prof. Dr. dr. I Made Jawi, M. Kes

6. Dr. dr. John J. E. Wantania, Sp.OG(K)

7.Dr. dr. Urged Made Wihandani, M.Kes

8.Dr. dr. A A. Ngurah Jaya Kusuma, Sp.OG., Subsp.K.Fm, MARS

9.Dr. err. nat. dr. Ni Nyoman Ayu Dewi, M.Sc

10.Dr. dr. I Nyoman Wande, S.Ked., Sp.PK(K)

 

While academic invitations are:

1.Dr. dr. I Wayan Megadhana, Sp.OG., Subsp., Urogin.Re

2.Dr. dr. I Gede Megaputra, Sp.OG, Subsp., Urogin.Re

3Dr. dr. Tjokorda Gde Agung Suwardewa, Sp.OG., Subsp., K.Fm

4.Dr. dr. I Nyoman Hariyasa Sanjaya, Sp.OG., Subsp., K.Fm

5.Dr. dr. I Wayan Artana Putra, Sp.OG., Subsp, K.Fm

 

In this exam, Dr. dr. Anak Agung Gede Raka Budayasa, Sp.OG., Subsp.KFm., was declared as the 386th Doctoral Graduate of the Doctoral Degree in Medical Sciences, Faculty of Medicine, Udayana University with a very satisfactory predicate.