Prevalence and Antimicrobial Susceptibility of Gram Negative Bacteria in the Urine of Caritas University Students
Chapter One
Aims and objectives
To find out the prevalence of gram negative organisms in the urinary tract among caritas university students.
To investigate their antibiotic sensitivity pattern to enable formulation of drugs for urinary tract infection in our community.
To determine the age and sex prevalence.
To determine the prevalence of bacterial strains and their antimicrobial susceptibility in urine.
To find the pathogenic bacteria commonly responsible with UTI and susceptibility patterns this will help the clinicians to choose the right empirical treatment.
CHAPTER TWO
LITERATURE REVIEW
MICROORGANISMS FOUND IN URINE AND THEIRETIOLOGY
The etiology of is dependent on four factors but bacterial species are the most common are more dominating thereby causing up to 80-85% of all symptomatic UTI in women . There are also factors which enhance the invasion of organisms in the urine. They include sex, age, hospitalization and obstruction in urinary tract. Females which are however believed to be affected more affected more than males have a shorter urether and wider urethra (Archarya, 2011). The anatomical relationships of the females urether and vagina makes the bacteria been massed up the ureter into the bladder during pregnancy and child birth
BACTERIA
Bacteria are subjectively quantified in the urine as few moderate and many can be detected in unstained urine sediments when insufficient in quantity. The rod-shaped bacteria and chains of cocci are often readily identifiable. The most commonly organism responsible for UTI is the Escherichia coli which causes up to 80- 85% of UTI infections. (Takahashi et al. 2006). Following E. coli is Staphylococcus spp especially staphylococcus saprophyticus which is sometimes called micrococcus and cause infection in young women of sexually active age (Mandell et al. 2005). Other organism which causes UTI includes Enterococcus faecalis, Enterococcus feacium, Klebsiella spp, Proteus spp, Pseudomonas spp, Enterobacter, Providence, Morganella spp etc. which occurs in patients with recurrent infections. In some patients with very frequent recurrences or bladder catheters especially in hospitals and nursing home settings where antibiotics are frequently used involves these organism; Acinetobacter spp, Serretia spp, Citrobacter spp etc. Cornyebacterium urealyticum has recognised as an important nosocomial pathogen (Serano et al. 1996).
Findings of Proteus spp may indicate that a paitent has renal calculi as these organism grow in alkaline environment. Anaerobic pathogens are rarely pathogens in the urinary tract. Mycoplasma also causes UTI and detected in the genital infections of infants. These infants become colonized with genital mycoplasma through birth canal since infants born by caeserian sections have mycoplasma than those delivered vaginally. The mycoplasma include mycoplasma hominis and ureaplasma uriticum are common inhabitants of human genital urinary tract and the rate of colonization with these organisms vary greatly among different age groups about 30% of new born infants girls showed vaginal colonization with ureaplasma uriticum and small percentage of boys showed less colonization
VIRUSES
Most times viruses infect the urinary tract during measles, mumps, etc, occurrence. Epithelial cells containing viral inclusions appear in the urine in measles cytoglomerulous infections, variecella and other common infections. Fatal cases of intestinal nephritis associated with mumps increases the infections in urine (Williams et al. 1992). Adeno virus type ii has been isolated from urine of children with acute haemoharrgicystisis who showed serologic evidence of infection by this agent (Lohr, 1991). This means that viruses might be the cause of childhood illness associated with dysuria and pyuria
FUNGI
Yeast and yeast like forms have been known to associate with UTI (Nicolle, 2000). Pathogenic species of Candida in which the predominating is Candida albicans affect the urinary tracts (Nicolle, 2000). Opportunistic infection of candida spp and other yeast are the essential causes of complications in immunocopromised paitients (Lohr, 1991). Some of the factors which enhance the growth of these infections are malnutrition, corticosteroids, antibiotic therapy and debilitating diseases (Lohr, 1991). It has been also observed that vaginal candidiasis prevails more in female children with protein energy malnutrition. Sometimes, urinary tract colonization by candida in healthy or normal patients particularly when associate with long term catheters drainage tend to be much more and in the absence of obstructor is rarely progressive (Komaroff, 2000). Molds are rarely known to cause UTI; however, species of mucor has been reported to produce prostatics, epididymal and renal infections in both young and old.
PROTOZOA
Protozoan infections of the urinary tract area sexually transmitted disease in man and woman. Trichomonas vaginalis, protozoan is a flagellated protozoan and causes trichomoniasis in female, it causes urethritis and protitis and sometimes may be asymptomatic in both sex (Gender et al. 1993). When the bladder is affected, dysuria sometimes may be severe and acute. The occurance of trichomoniasis is much higher in women than men affecting about 20% of females during reproduction years. It is reported that trichomoniasis causes about 12-15% of non-gonococci urethritis in men.
CHAPTER THREE
MATERIALS AND METHODS
Freshly voided mid-stream urine samples were received between July 2012 and August 2012 and a total of 60 samples were collected from both male and female students of Caritas University.
SAMPLE COLLECTION
On the urine sample were indicated the name, age, sex, room number, state of origin including the date and time of collection. Only students who had not been on antibiotic preceding one week of sample collection were enrolled. The reasons for requesting urine microscopy/culture/sensitivity, is to identify or indicate urinary tract infection associated with gram negative organisms. 15-20ml of clean catch mid-stream urine samples were collected after clear instructions on collections including cleaning the genitalia before voiding of urine.
Early morning mid-stream urine samples were collected using sterile made mouthed containers with screw cap tops. Each of the samples were observed with the naked eyes to ascertain if the urine was clear or cloudy (turbid) and the colour of the urine was also observed.
CHAPTER FOUR
RESULT
A total of 60 samples were collected from Caritas University students were investigated. Out of the 60 samples, 34 samples were females while 26 samples were males with age range of 18-25yrs. Out of the 60 samples, 48 samples were positive, 21 were female while 22 were males. The remaining samples that showed no significant bacterial growth were discarded. Out of 26 samples from males 21 were positive with prevalence rate of 43.3% while 34 samples from females gave 27 were positive with prevalence rate of 56.7% as shown in table 1.Therefore, the prevalence rate of positive cases for male and females were 43.7% and 56.3% respectively.
CHAPTER FIVE
DISCUSSION, CONCLUSION, RECOMMENDATION.
DISCUSSION
The overall prevalence of UTI in this study was 80% and females were significantly more affected than males. Previous reports (Aimel et al. 1973; Robert et al. 1993) of studies carried out in different parts of the world indicates higher incident among females than males, this may be explained by the fact that females pass short urethra. Also the spread of normal flora in faecal materials from the anus to the vagina from where the bladder could be infected as a result of poor anal cleaning could be responsible for the observed result in female urine sample.
The prevalence of UTI in Caritas University which is found to be 80% is quite alarming . This figure is higher than the prevalence rate of 51.35% recorded by Savi et al. (2011) and 60% obtained in another study in the north central region of Nigeria. This calls for caution among the female students in Caritas University. The high rate maybe due the increase in female with poor hygienic practice and also indiscriminate sexual behaviour among the female students.
E.coli was the commonest organism isolated, this is in conformity with the previous work done by Handeau et al. 2011. The least resistance by the bacterial isolates to antimicrobial agents was observed to be Tetracycline, Cotrimozole, Ampicillin, Cephalexin as seen from this study. The factors contributing to those resistance may be due to indiscriminate abuse of antibiotic by students. Other factors may include poor quality of drugs, poor storage and exposed drug (Okeke et al. 1999) etc. the reduction of antibiotics prescription and dispensation have been associated with reduced antibiotic resistance (Schiemann et al. 2010)
CONCLUSION
This study has revealed that UTI among female students is a very difficult health problem which must be properly addressed. This has also revealed that the most causative organisms of UTI in this university, community among the female students are the gram negative organisms which were shown to be sensitive to the following drugs. Gentamycin, Ofloxacin and Nitrofurantoin. It could be suggested that in the face of clear UTI symptoms and in the absence of physician or clinician of these three drug abuse (Gentamycin, Ofloxacin and Nitrofurantoin) could be procured and used and with an experienced doctor is seen for confirmation.
RECOMMENDATION
This is the appropriate time to investigate infection control measures which are lacking in the most health care institutions, firm, industries etc. There is also need to establish the sense and control surveillance agencies. There is need for interaction between physicians and microbiology department because there have been cases where by the antibiotics tested are different from those frequently prescribed since the laboratories use only the susceptibility diffusion disc available to them.
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