Incidence of Bacteria in Female Students

Incidence of Bacteria in Female Students

CHAPTER ONE

Objectives of the Study

General Objective

To determine the incidence of bacteria, isolate uropathogens, and determine their antibiotic susceptibility patterns among female students (patients) Lagos State University Teaching Hospital.

Specific Objectives

1. To determine the prevalence of UTI among female students (patients) in Lagos State University Teaching Hospital
2. To determine the most common bacterial isolate that causes UTIs among female students (patients) in Lagos State University Teaching Hospital.
3. To determine the antimicrobial susceptibility patterns of the identified bacterial isolates of UTIs among female students (patients) in Lagos State University Teaching Hospital

CHAPTER TWO

 LITERATURE REVIEW

Infections of the Urinary Tract

Microbial colonization of the urinary epithelial cells as well as tissue invasion and multiplication of uropathogens is termed as urinary tract infection (UTI). This is one of the site of bacterial invasions and a number of women have recurrent UTIs at a particular point in their life. Implicated microorganisms, could be bacteria, fungi, protozoa and viruses. Usually bacteria are more prevalent and invasive. The symptoms of UTIs are dysuria, polyuria, burning feeling in the bladder, fever, nausea, flank pain; urine is milky and may have a foul smell (Momoh et al., 2011).

In most parts of the Sub-Saharan Africa, as well as in other developing parts of the world, UTI is a health problem occurring among patients of all ages (Tula and Lyoha, 2014). For the last thirty years uropathogens have caused multidrug resistant in urinary tract and has become a growing concern worldwide (Mitta et al., 2009). Studies have shown that drug resistance problem in Africa comes from factors like indiscriminate use of antibiotics, inappropriate advertisement of medicines, lack of awareness and prescription by quacks over the counters (Khoshbakht et al., 2020).

Bacteriuria increases with age in both men and women but has a higher prevalence among the very young and very old. The prevalence of UTI is significantly higher for women than men until men attain the age of 60. Women aged 15-29 have the highest distributions of symptomatic infection (Foxman, 2010).

The prevalence of UTI

The prevalence of UTI is usually higher in females than in males. The higher prevalence is UTI in females is attributed to the nature of their urinogental tract; the urethra of the female is much shorter and closer to the anus than in males and it also lacks the bacteriostatic properties of prostratic secretions. The UTI occur highest in the sexually active age group. This may be a result of increased sexual activity with sexually active group which predisposes them to UTI. I gender related prevalence of uropathogens among the patients gram negative rods are main cause of UTIs in both sexes. They are usually found in the perineum of the large intestines as commensals (Ogbukagu et al., 2016).

Transmission of Uropathogens

Microorganisms move from normal flora in the rectum, enter the urinary tract via the urethra into the bladder in healthy patients (Kalantar et al., 2008). Uropathogens consequently colonize epithelium of the urethra in the ascending route. This route enhances acceleration of microorganisms in female patients who are soiling around the perineum, use urinary catheters and spermicidal agents (Foxman, 2010). About half of the infections ascend into the upper urinary tracts in patient with cystitis and infections of pyelonephritis which are caused by ascension of the bacteria from the bladder through the ureters and into the renal pelvic region (Patel et al., 2012). Pregnancy and urethral obstruction aid in attachment of uropathogens inhibiting urethral peristalsis. Microorganisms enter the renal parenchymal cells through the collecting ducts and reach the pelvic region resulting in inflammation of the urinary tract (Manikandan et al., 2011).

₦3,000.00 – DOWNLOAD CHAPTERS 1-5 PROCEED TO DOWNLOAD Added to cart

 

CHAPTER THREE

MATERIALS AND METHODS

Study Area 

The study was carried out among UTI patients in Lagos State University Teaching Hospital. Lagos State University Teaching Hospital popularly known as LASUTH is a state-owned teaching hospital in Lagos, Nigeria, attached to the Lagos State University. It is in Ikeja – the state’s capital. LASUTH also shares structures with the College of Medicine, Lagos State University. The hospital was established in 1955 from a small cottage health centre by the Old western region. It was converted to a teaching hospital in July 2001.

Study Population

The study targeted and female outpatients and inpatients presenting with symptoms and signs of UTI which include dysuria, polyuria, fever, nausea, and flank pain were sampled for this study. Baseline demographic data including age, sex, level of education and risk factors such as catheterization, history of UTI, also out and in patients were also collected. Samples were collected during the period between June and December 2020.

Study design

The study employed a cross-sectional survey design including in and out patients presenting symptoms of UTI were analyzed.

Sampling design

Purposive sampling was used to select patients with UTI symptoms and then simple random sampling was used to select 10 patients per week until sample of 385 was reached. This design was appropriate to the study since it provided baseline information concerning antibiotic susceptibility pattern of bacterial uropathogens  inpatients and outpatients in  Lagos State University Teaching Hospital.

CHAPTER FOUR

RESULTS

Prevalence of urinary tract infection

Of the 385 urine specimens processed, 112(29.0 %) showed significant growth whereas the majority of the urine samples that is 273 (71 %) showed no growth. Fresh samples were collected from patients by mid-stream catch method in sterile universal bottles (Plate 1). The assessment of associated risk factors showed gender (χ²= 0.116, P=0.0412), age group (P=0.0120), History of UTI (χ²=0.555, P=0.004) and symptoms of UTI (χ²=0.895, P=0.017) were significant. Level of education (χ²=2.742, P=0.523) and catheterization (χ²=0.17, P=0.054) were not significant (Table 4.1).

The age between 25-34 years had the highest number of positive samples 125 (32.4 %) followed the age between 15-24 years which had 124 (32.2 %). Age group of 55 and above had least number of positive samples 12 (3.1 %) (Table 4.1). Female, 239 (62.1%) were the highest while male were 146 (37.9%). Among the patients in difference sex showed significance difference (χ²=0.116, P=0.0412).  Patients who had history of UTI were 341 (88.6%) while those having no History of UTI were 42 (10.9%).

CHAPTER FIVE

DISCUSION, CONCLUSIONS AND RECOMMEDATIONS

Discussion

The prevalence of urinary tract infections among female students (patients) in Lagos State University Teaching Hospital was 29.1 %. However, this study is in agreement with other reports which stress that UTI in Lagos National Hospital, Lagos was 26.7 % (Nabbugodi et al., 2015) and in Khartoum North Hospital, Sudan it was 14.0 % (Hamdan et al., 2011), Mwanza North – Western Tanzania 12.1 % (Masinde et al., 2009) and Addis Ababa, Ethiopia was 11.6 % (Kolawole et al., 2009) which were lower rates than that of Lagos State University Teaching Hospital.

The high prevalence of infection in females (62.1 %) reported in this study is due to short urethra in females which may predispose them to ascending infection. Most women normally clean perineum area backward from the anus to the vulva instead of forward from vulva to the anus that can cause urinary tract infection. This practice keeps bacteria from getting into the urethra after a bowel movement. Sexual activity moves microorganisms from bowel to vaginal cavity and then urethral opening thus increasing the chances of prevalence of UTI in female patients from organisms that are normal flora of perianal and vaginal regions. There is a need to have high standard of cleanliness in females which will help in reducing the incidence of UTI. The presence of antimicrobial substances in prostatic fluid in males and longer urethra make them less prone to UTIs (Khoshkht et al., 2020; Tula and Iyoh, 2014). There was no significant difference between patient’s level of education and UTI (P=0.523). This is because they were equally infected. This agrees with studies carried out in

Tanzania and Sudan (Masinde et al., 2009; Namdam et al., 2011). The prevalence of UTI in patients with previous history of infection was significantly higher than of those without previous history (p=0.004).The results agreed with studies carried out in Pakistan due to the presence of multidrug resistant microorganisms from those who had a previous history of UTI ((Sabir et al., 2002;Amin et al., 2009). This might be due to presence of resistance strains from those who had previous history of urinary tract infection. The prevalence of UTI among the patients with previous history of catheterization was significantly higher than those without history of previous catheterization (P=0.0504). These findings were in agreement with previous report in Gonder (Mengistu et al., 2002) and was associated with predisposing factors such long duration of catheterization and contamination of the urinary system during inserting of caterers (Amin et al., 2009).

Isolation and Identification of Bacterial Pathogens

The prevalence of Gram-negative bacteria was 68.3 % (82) while Gram-positive isolates 31.7 % (38) which was similar to rates 75 % and 25 %, respectively of isolation of Gram-negative and Gram-positive bacteria reported in Lagos National

Hospital, Nigeria. The same rates of isolation of Gram-negative and Gram-positive bacteria of 60 % and 40 % were reported in Tirkur Anbessa Specialized Hospital Addis Abba, Ethiopia (Assefa et al., 2008). Comparable rates of 61.9 % and 38.1 % reported in Tanzania (Sabrina et al., 2010). This could be associated with moisture and watery environment of the mucosal surface of the patients which helps in the invasion of bacteria to the uroepithelial cells. The initial attachments of microorganisms onto urinary tract tissues allow their replication and tissue invasion resulting into bladder infection and pyelonephritis in patients (Amin et al., 2009).

Among the isolates, E.coli was the most predominant organism in Lagos State University Teaching Hospital with total isolation prevalence of 55 %. These findings were more than those reported in other countries such as Yemen, 41.5 % Nigeria, 42.1 %, Khartoum North Hospital, and in Sudan, 42.4 % (Hilbert et al., 2011). These high rates were due to the presence of the normal flora in the rectal and vaginal area. Anatomical and functional changes of females make it difficult to maintain personal hygiene and as result increase the risk of acquiring UTI (Shieve et al., 1986; Masinde et al., 2009). Grampositive cocci coagulase negative were the second dominant pathogens with total isolation prevalence of 20.8 %. These findings were lower than those reported from Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia 16 % (Hilbert et al., 2011) and Tanzania 16.7 % (Masinde et al., 2009). Gram-positive cocci coagulase negative were more common in urine samples among the sexually active young women (25-34 years). This is probably due to the fact that they are normal flora of both asymptomatic and patients thus take the advantage of the weak defence mechanisms. These organisms can be spread by hands or transmitted by animate or inanimate objects (Pelcar et al., 2003).

Antimicrobial Susceptibility Pattern of Bacterial Uropathogens.

Susceptibility pattern of Gram-negative bacteria showed that all of the isolates were sensitive to nitrofurantoin (100 %). The rest of isolates were sensitive to ciprofloxacin

(79.8 %), cefotaxime (75.3 %), amoxicilin-clavulinic acid (72.8 %) gentamicin (67.6 %), nalidixic acid (65.6 %) cotrimoxazole (46.6 %) and ampicillin (44%). It was in contrary, to a study done at Tikur Ahbessa Specialized Hospital Addis Ababa,

Ethiopia (Assefa et al., 2008) which indicated that their susceptibility pattern of Gram-negative bacteria were Gentamicin (93.3 %), Chloramphenical (83.3%), Contrimoxazole (73.3 %) and amoxicilin-clavulinic acid (70 %) were highly resistant. Availability and indiscriminate use of commonly used antibiotics without health care workers prescription lead to an increased multidrug resistance. Due to the increasing multidrug resistance among uropathogens, the health care workers are left with a limited choice of routinely used antibiotics to choose from for the treatment of urinary tract infections (Jaiswal et al., 2020). This can be attributed the fact that bacteria undergo mutation which makes their susceptibility vary from one geographical to the other (Gupta et al., 2001).

Nitrofurantoin was found to be effective (100 %) to both Gram-positive and Gramnegative bacteria this finding agrees with a previous report in Nigeria (Mitemo and Kikuvi, 2004). It is used as a drug of choice for the treatment of uropathogens. Few of the isolated uropathogens showed resistance to more than two of the commonly used antibiotics. This was in agreement with findings reported in Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia (Toronko et al., 2009) and could be due to abuse, misuse and underuse of antibiotics (Oladeinde et al., 2011). Prevalence of multidrug resistance in this study was about 85 % of the uropathogens isolated. The findings of multidrug resistance were similar to the prevalence isolates (85 %) reported by Kimando and Okemo (2010) of Lagos university. A lower (74 %) rate was reported in Tikur Anblessa Specialized Hospital Addis Ababa, Ethiopia (Assefa et al., 2008). This resistance rate could be attributed to antibiotic misuse or abuse (Albrich et al., 2004). This could be attributed to few laboratory facilities to efficiently carry out culture and sensitivity which could lower drug resistance. This could be due to inappropriate administration of antibiotics in empirical therapies and lack of correct infection control strategies which cause a shift to increase prevalence of resistance organisms in the community and hospitals (Gupta et al., 2001; Kariuki et al., 2012).

Conclusions

The prevalence of UTI in Lagos State University Teaching Hospital was 29.1 %. coli was the highest among 120 the isolates. Females had a higher (62.1 %) prevalence of UTI than males (37.9 %). Urinary tract infection was associated with the previous infection and with patients who had the history of catheterization.

• All isolates were sensitive to nitrofuratoin, cefotaxime and amoxicillinclavulinic acid. High resistance was observed in gentamicin, nalidixic acid, ampicillin and cotrimoxazole.
• In the 120 isolates were resistant for more than two antibiotics were recorded in 108 (90 %) isolates. Antibiotic susceptibility patterns of all patients with bacterial uropathogens will reduce multidrug resistance.

Recommendations

1. There is a need for continuous surveillance of antibiotic to the currently used antibiotics in management of urinary tract infections covering the entire Lagos state.
2. Lagos state to enforce policies formulated by pharmacy and poison board to prevent misuse or underuse of antibiotics by giving prescription to only patients with results of culture and sensitivity and therefore treatment UTIs should be based on and sensitivity in order to limit multidrug resistance.
3. Continuous follow up to provide an update of laboratory diagnosis of urinary tract infections in order to reduce multidrug resistance bacteria in UTI patients.
4. Health care workers should enforce health education to patients in order to adhere to the treatment and thereby reducing drug resistance.
5. Screening for resistance and identify modes of transmission.

REFERENCES

• Aladag, J. and Durak, K. (2009). Investigation of some antibiotics susceptibilities, plasmid profiles and ESBL characteristic of Klebsiella system infections. Applied Science Journal, 6: 630-636.
• Albrich, W., Monnet, D. and Harbarth, S. (2004). Antibiotic selection and resistance in Streptococcus pneumonia and Streptococcus pyogenes. Emerging Infectious Diseases, 38:363-371.
• Alemu, A. Moges F. Shiferans, Y. Tafess, A., Kassu, A, and Agegn, A. (2012). Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant Women at University of Gondar Teaching Hospital, Northwest Ethiopia. International Journal of Pharmaceutical Sciences 5: 1-15.
• Alliance for the Prudent Use of Antibiotics (APUA) (2011). Final Report: Situation Analysis and Needs Assessment of Antibiotic Resistance in Uganda and Zambia. 1–22.
• Anderson, C., Martin, M. and Hultgren, C. (2004). Host subversion by formation of intracellular bacterial communities in the urinary tract. Microbes’ Infections, 6: 1094.
• Annapurna, S and Lakshmi, V. (2020). Antibiotic susceptibility pattern and MAR index of Urinary tract isolates. International Journal of Pharmaceutical Sciences, 1: 474-478.
• Assefa, A., Asrat, D., Woldeammud, Y., Hiwot, G. and Abdella A. (2009). Melesse drug susceptibility of urinary tract infections in women at Tikur Anbessa specialized hospital Addis Ababa. Ethiopian. Ethiopian Medical Journal, 46:227-235.
• Assefa, A., Asrat, D., Woldeamnuel, Y., Abdella, A. and Melesse, T. (2008). Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at Tibur Anbessa Specialized Hospital Addis Ababa, Ethiopia. Ethiopian Medical Journal 46: 227-235.

₦3,000.00 – DOWNLOAD CHAPTERS 1-5 PROCEED TO DOWNLOAD Added to cart