PREVALENCE AND ANTIMICROBIAL SUSCEPTIBILITY OF BACTERIA IN URINE SAMPLES OF STUDENTS OF MICHAEL OKPARA UNIVERSITY OF AGRICULTURE UMUDIKE, UMUAHIA, ABIA STATE

                                                            ABSTRACT

Bacteriuria is identified when urine specimens have at least 105 cfu/ml of a uropathogen isolated in the absence of signs or symptoms of urinary infection. Urinary Tract Infection (UTI) is defined as the microbial invasion of any of the tissues of the urinary tract extending from the renal cortex to the urethral meatus. Females are however believed to be more affected than males. This is due to the short and wider female urethra and its proximity to the anus. The most commonly isolated microorganism in bacterial UTI are the Gram negative bacilli including E. coli, Citrobacter spp., Enterobacter aerogenes, Pseudomonas aeruginosa, Proteus spp., Klebsiella spp. The Gram postive bacterial UTI are  Enteroccocus spp and Staphlococcus spp. There are two major modes of bacterial entry into the genitourinary tract, ascending route and hematogenous route. To establish the diagnosis of bacteriuria, a urine specimen for culture is necessary. Treatment of UTI with the appropriate antibiotic can minimize mortality, morbidity and any renal damage from acute UTI. Antimicrobial resistance is as a result of overuse, misuse and in many cases abuse of drugs. The midstream portion of urine is then collected in plastic sterile, wide-mouthed container which should be covered with a tightly fitted lid. The media used for this study were MaConkey agar, Nutrient agar, Maueller Hinton Agar and Mannitol salt agar. The bacterial isolates were identified based on their colonial morphology, cultural charaterictics, Gram stain reaction and biochemical tests. Antimicrobial sensitivity testing was performed. The result of this study revealed that Escherichia coli is the most prevalence bacteria with 41%. This study shows the necessity of obtaining sensitivity test reports before the start of antibiotic treatment in case of suspected urinary tract infection.

TABLE OF CONTENTS

Title                                                                                                                                        i

Certification                                                                                                                           ii

Dedication                                                                                                                              iii

Acknowledgments                                                                                                                  iv

Table of contents                                                                                                                    v

List of tables                                                                                                                           vi

Abstract                                                                                                                                  vii

CHAPTER ONE                                                                                        1

1.0       INTRODUCTION                                                                                                      1

1.1       Aims and Objectives                                                                                                  3

1.1.1    Specific objectives                                                                                                     3

CHAPTER TWO                                                                                

2.0       LITERATURE REVIEW                                                                                           4

2.1       Microorganisms found in urine and their etiology                                                    4

2.1.1     Bacteria                                                                                                                     4

2.1.2    Fungi and virus                                                                                                           5

2.1.3    Protozoa                                                                                                                      6

2.2       Routes of bacterial infection                                                                                      6

2.2.1    The  ascending route                                                                                                   6

2.2.2    Hematogenous route                                                                                                   6

2.3       Symptomatic and Asymptomatic bacteriuria                                                             7

2.4       Diagnosis of UTI                                                                                                        8

2.5      Treatment of UTI                                                                                                         9

2.6       Prevention                                                                                                                   10

2.7       Antimicrobial resistance                                                                                             11

2.7.1    Conditions affecting the effectiveness of antimicrobial agents                               11

2.8       Actions of antimicrobial drugs                                                                                   12

2.8.1    Inhibitors of cell wall synthesis                                                                                  13

2.8.2    Inhibition of protein synthesis                                                                                    14

2.8.3    Inhibition of cell membrane                                                                                       15

2.8.4    Inhibition of nucleic acid synthesis                                                                            16

CHAPTER THREE 

3.0       MATERIALS AND METHODS                                                                              17

3.1       Sample collection                                                                                                       17       

3.2       Sterilization of media and materials                                                                           17

3.3       Inoculation of urine samples and isolation of bacteria isolates.                               18

3.4       Identification of isolates                                                                                             18

3.5       Antimicrobial sensitivity testing                                                                                18

3.6       Biochemical tests                                                                                                        19

3.6.1    Catalase test                                                                                                                19

3.6.2    Oxidase test                                                                                                                19

3.6.3    Coagulase test                                                                                                             19

3.6.4    Citrate test                                                                                                                   20

3.6.5    Indole test                                                                                                                   20

3.6.6    Motility test                                                                                                                20

3.6.7    Methyl Red Test                                                                                                         21

3.7.8    Voges-proskauer Test                                                                                                 21

CHAPTER FOUR                                                                              

4.0       RESULT                                                                                                                    22

CHAPTER FIVE                                                                                

5.0       DISCUSSION, CONCLUSION AND RECOMMENDATIONS                                    28

5.1       Discussion                                                                                                                   28

5.2       Conclusion                                                                                                                  29

5.3       Recommendations                                                                                                      30

References                                                                                                                              31

LIST OF TABLES

Tables      Title                                                                Pages

1                      Identification and characterization of bacterial isolates from urine samples of MOUAU students.    23

2                      Distribution and Percentage of occurrence of bacteria isolated from urine samples of MOUAU students according to sex and locations.    24

3                      Frequency of bacterial isolates from urine samples of MOUAU students according to sex.      25

4                      Antimicrobial susceptibility of Gram negative bacteria isolated from Urine samples of MOUAU students.     26

5                      Antimicrobial susceptibility of Gram positive bacteria isolated from Urine samples of MOUAU students.    27

CHAPTER ONE

1.0       INTRODUCTION

Urine is a liquid by product of the body secreted by the kidney through a process called urination and excreted through urethra (Akobi et al.,2014). Bacteriuria is identified when urine specimens have at least 10⁵ cfu/ml of a uropathogen isolated in the absence of signs or symptoms of urinary infection. The host immune response is less vigorous with bacteriuria than with symptomatic infection (Nicolle, 2014). Urinary Tract Infection (UTI) is defined as the microbial invasion of any of the tissues of the urinary tract extending from the renal cortex to the urethral meatus. The urinary tract includes the organs that collect and store urine and releases it from the body, and these organs are the kidneys, ureters, bladder, urethra and accessory structures (Ogbukagu et al., 2016). UTI can also be defined as the condition in which actively-multiplying bacteria persist in the urine at any point from kidney to the urethral meatus. It is the presence of a significant level of bacteria in urine typically 10⁴ to 10⁶ colony forming units (CFU/ml). UTIs may be with symptoms, that is, symptomatic or without symptom, that is, asymptomatic (Oluwole and Adeyemi. 2016).

Asymptomatic bacteriuria, also referred to as Bacteriuria or asymptomatic urinary infection, is a common finding in healthy women, and in both men and women with abnormalities of the genitourinary tract.

However, although not in all cases, there is propensity for bacteriuria to become symptomatic if left untreated. Escherichia coli has been reported as the most prominent bacteria associated with bacteriuria but an increased percent of Proteus, Klebsiella, Enterococcus, and Pseudomonas has also been identified (Oluwole and Adeyemi. 2016).

 Infection of the urinary tract system however, occurs when too much bacteria especially those that inhabit the gastrointestinal tract and the skin enter the vagina through the anus and thrive inside the urinary system (kidney, urethra, bladder and urethras) and consequently reproduce rapidly due to available nutrients. Infection of the urinary tract could manifest differently depending on the site of the infection and length of time involved, those that affect the lower urinary tract are called the cystitis- involving the bladder alone with symptoms including painful urination, burning sensation, either frequent or urge to urinate (or both), while those that affect upper urinary tract are the pyelonephritis involving the kidney and other organs. The symptoms of the upper urinary tract include; fever and flank pain during urination in addition to those of the lower urinary tract (Ogomaka et al.,2014). Numerous reports have suggested that UTI can occur in both males and females of any age, with bacterial counts as low as 100 colony forming units (CFU) per milliliter in urine. Females are however believed to be more affected than males. This is due to the short and wider female urethra and its proximity to the anus. The female urethra is also adjacent to the genital and intestinal tracts. Bacteria from the rectum can easily travel up the urethra and quickly gain access to the bladder and cause infections (Amaeze et al.,2013).

 The choice of medication and length of treatment depend on the patient’s history and the type of bacteria causing the infection. Indiscriminate and extensive use of antibiotics, however, results in the development of resistant strains which in recent years have become major health problem to medical practitioners and to the public at large. Hence it becomes necessary that to effectively treat and control infections such as UTIs by health care provider, a good knowledge of the antibiotic sensitivity pattern of the causative organisms should be ascertained before drug administration (Ogomaka et al.,2014)

Drug resistance among bacteria causing UTI has increased since the introduction of UTI chemotherapy, the etiological agent and their susceptibility patterns of UTIs vary in regional and

geographical location, besides, the etiology and drug resistance change through time. Knowledge of the local bacterial etiology and susceptibility patterns is required to trace any change that might have occurred in time so that updated recommendation for optimal empirical therapy of UTI can be made (Onuoha and Fatokun, 2014). Antibiotics are used for prophylaxis of recurrent UTIs but can lead to emergence of drug-resistant bacteria. Knowledge about the type of pathogens responsible for UTIs and their susceptibility patterns may help the clinicians to choose the right empirical treatment (Ogbukagu et al.,2016).

1.1       AIMS AND OBJECTIVES

To find out the prevalence and antimicrobial susceptibility of bacteria in urine samples of students of Michael Okpara University of Agriculture Umudike, Umuahia, Abia State.

1.1.1      specific objectives

·       To isolate bacteria from urine samples.

·       To identify the isolates.

·       To determine the occurrence of the isolates.

·       To determine the sensitivity pattern of the isolates.

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