EXTENDED SPECTRUM BETA LACTAMASE (ESBL) PRODUCING ESCHERICHIA. COLI AND KLEBSIELLA PNEUMONIA FROM URINARY TRACT INFECTION PATIENTS IN FEDERAL MEDICAL CENTER, UMUAHIA.

ABSTRACT

Extended spectrum  Lactamase (ESBL) producing Enterobacteriaceae have become widespread in hospitals and are increasing in community settings where they cause a variety of infections. 40 clinical isolates from federal medical centre, Umuahia patients was investigated. The isolates were made of 22 Escherichia coli and 18 Klebsiella pneumoniae. Antimicrobial susceptibility was determined by disc diffusion method. ESBL producers were determined by the double disc method using ceftazdime and cefuroxime. Out of the 40 isolates, ESBL producers are made of 15 (68.2%) E. coli and 12 (66.7%) K. pneumonia. ESBL producing isolates were found be in higher proportions from in patients 12 (30%) than out patients. ESBL producing isolates were also found to be more among the female patients 30 (75%) than the male patients 10 (25%). However, nitrofuration and ciprofloxacin was found to have excellent performance against the urinary isolates tested and therefore is recommended for the treatment of infections caused  by Escherichia coli and Klebsiella pneumonia.

TABLE OF CONTENTS

CHAPTER ONE

1.0     INTRODUCTION

1.1     Aim of the Study

1.2     Objective of the Study

CHAPTER TWO

2.0     LITERATURE REVIEW

2.1     Characteristics Of Escherichia Coli

2.2     Characteristics Of Klebsiella Pneumoniae

2.3     Entry Of Bacteria Into The Urinary Tract

2.4     Types Of Urinary Tract Infection

2.4.1 Lower And Upper  Urinary Tract Infections

2.4.2 Complicated And Uncomplicated Urinary Tract Infections

2.5     The Epidimology Of Urinary Tract Infection

2.6     Risk Factors To Urinary Tract Infection

2.6.1 Anatomical And Physiological Factors

2.6.2  Age

2.6.3  Urinary Catheterization

2.6.4  Sex And Contraception

2.6.5  Diabetes Mellitus

2.7     Diagnosis                                                                                

2.8     Treatment And Prevention

2.8.1 Treatment

2.8.2 Prevention

2.9     Antibiotic Susceptibility

CHAPTER THREE

MATERIALS AND METHODS

3.0     Collection Of Clinical Isolates

3.1     Media For Isolation

3.2     Media Preparation

3.3     Material Sterility                               

3.4     Urine Culture

3.4     Test Organism             

3.5     Gram Staining

3.6     Biochemical Tests

3.6.1 Indole Test

3.6.2 Oxidase Test      

3.6.3 Citrate Test

3.6.4 Motility Test

3.7     Antimicrobial Susceptibility Testing

References

CHAPTER ONE

1.0    INTRODUCTION

Urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract, such as urethra, bladder and kidney.

Symptoms which include frequent urination and painful urination, and cloudy urine. The main causal agent is Escherichia coli. Although urine contains a variety of fluids, salts, and waste products. It does not usually have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they may cause a UTI.

 UTIs are caused by the presence of bacteria in the urine, although fungi and viruses could be involved, and are 14 times more common among women than men. This is because of the shortness and width (5cm) of the female urethra to the vagina which makes it liable to trauma during sexual intercourse as well as bacteria being passed from the urethra into the bladder (Ebie et al., 2001).

In males, the length of the urethra (20cm) provides a distance barrier that excludes micro-organism from urinary bladder. UTI is a common disorder that occurs in approximately in 25% of young women and 5% of all women during their life time. Majority of women have the current infection within one year (Siiri et al., 2009)

UTI can be asymptomatic or symptomatic and it is characterized by a wide range of symptoms from mild voiding irritation to bacteramia, sepsis or even death (Ranjbare et al., 2009). Infection of the urinary tract could manifest differently depending on the site of the infection and the length of time involved (Takahar, 2011). Those that affect the lower urinary tract called cystitis involve the bladder alone with the symptoms which include frequent urination, painful urination, and burning sensation. Those that affect the upper urinary tract referred to as pylelonephritis involve the kidneys and other organs. The symptoms include fever and flank pain during urination in addition to those of the lower urinary tract (Sarah, 2010). If UTI is not diagnosed early and treated adequately, it may result into chronic illness and long term renal damage (Adeji and Opokiv, 2004).

In all suspected cases of UTI, culture of the urine is the first step in diagnosis. Urine culture is traditional the gold standard for diagnosing UTI. Sensitivity and specificity will vary depending on the threshold colon used and whether a specimen is obtained by catheterization or other methods (Gibson and Toscano, 2012).

Extended spectrum Beta-lactamses (ESBLs) were first describe in 1983. The Beta-lactamses produced by bacteria are known to protect against the lethal effect of peniculins, cephalosporoins and monobactams on their cell wall synthesis. ESBLs have found most commonly in uropathogens like k.pneumoniae and E. coli other enterobacteria and non-fermenting Gram negative rods also produce ESBLS bit to a lesser extent (Goussard and couruclin, 1999; Bush and Jacoby, 2010).

Extended spectrum beta-lactamases (ESBLs) are among the important cause of multi-drug resistant infections throughout the world (Livermore et al, 2007). Bacteria carrying such enzymes have long been recognized as the incidence of such health care associated infections and the incidence of such organisms also appear to be increasing in the community, typically as source of urinary tract infections (Pitout et al., 2005).

                The ESBL producing bacteria are increasingly causing urinary tract infections both in hospitalized and out patients. This is making the therapy of UTI difficult and promoting greater use of expensive broad spectrum antibiotics, such as carbapenems (Mekki et al., 2010).

Detection of ESBLs using conventional antimicrobial susceptibility methods and delay in the detection and reporting of ESBL production by Gram negative baclli are associated with prolonged hospital stay, increase morbidity, mortality and health care costs (Mehrgan and Rahbar, 2008).

Infections due to ESBL product organisms such as Escherichia coli, Klebsiella, Pseudomonas, Citrobacter, Enterobacter, Salmonella, Proteus, and Shigella species can pose major heat, to life and often difficult and expensive to heat, and can delay discharge from hospital (Lee et al;2006).

Drug resistance among bacteria causing UTI has increased since the introduction of UTI chemotherapy. The increased prevalence of drug resistance bacteria has made susceptibility testing particularly vital. Antibiotic sensitivity can be tested with these cultures, making them useful in the selection of antibiotic treatment.         

Basic infection control measures can help to prevent such spread but these steps may be undermined in high pressure care settings by rapid bed turn over in hospitals, or between care settings, overcrowding, adequate fluid intake, water, practicing good hygiene, cleaning genital area and overstretching of medical wards within hospitals (P.rout et al., 2005).

1.1 Aim of the Study

This study was done to detect ESBL producing E. coli and K. pneumoniae in urinary tract infection (UTI) patients in Federal Medical Center, Umuahia (FMC) Nigeria.

1.2 Objective of the Study

1.     To isolates and identify the two organisms (E. coli and K. pneumoniae) that are implicated in these infections.

2.   To determine the rate of ESBLs producing E. coli and K. Pneumonae among UTI patient in Federal Medical Center Umuahia.

3.     To carryout antimicrobial susceptibility pattern of the isolates.

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