ABSTRACT
The aim of this study is to evaluate the urinary tract infection among female students of Michael Okpara University of Agriculture, Umudike. A total of fifty (50) urine samples were collected from female students in Michael Okpara University of Agriculture, Umudike in a sterile container and was transported to the laboratory for microbial analysis. The mid stream urine samples were cultured on MacConkey and blood agar by streak method. This was incubated at 370C for 24hrs. those that gave significant growth 105 cfu/ml were identified by gram stain, motility and biochemical tests. The pure isolates of bacterial pathogens was transferred to Nutrient agar slants and stored in the refrigerator at 40C. The distribution of urinary tract infections among the age group ranged between 22-24years recorded the highest incidence of (42.1%) while 28-30years recorded the least (5.26%). Microscopic examination of the samples showed the presence of pus cells, epithelia cells, calcium oxalate crystals and yeast cells. The results show that the most common uropathogen isolated from urine of infected subject is E.coli which constituted 60% followed by Klebsiella spp (15%), Proteus spp (15%) while Non Haemolytic streptococcus and Pseudomonas aeruginosa had the least occurrence of (5%) each. On the susceptibility to the selected antibiotics, a significant results was obtained with Ciprofloxacin, Gentamicin and Amoxycillin-clavulanate. The success of Ciprofloxacin could be due to its broad spectrum activities. Other drugs have varying and fair activities on the different isolates. Urine is generally considered to be sterile. Any source of possible infection occurs through urethra which initiates the incidence of infection. The present study revealed a high prevalence rate of UTI among female students of Michael Okpara University of Agriculture, Umudike. Majority of the students are youths, and therefore should be adequately informed and educated on the need of personal and environmental hygiene. The government should ensure that proper toilet facilities are available. I recommend that Urine culture must be done at the first antenatal visit, and repeated cultures should be obtained at different trimesters, because the urine of treated patients may not remain sterile for the entire pregnancy.
TABLE OF CONTENTS
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
Lists of Tables vii
List of Figures ix
Abstract
x
CHAPTER ONE
1.0
Introduction 1
1.1
Aim and Objectives 3
CHAPTER TWO
2.0
Literature Review 4
2.1
Urinary Tract Infection 7
2.2 Epidemiology of Urinary Tract Infection 9
2.3 Causative Organisms 11
2.3.1 Bacterial UTI 11
2.3.2 Fungal and Viral UTI 12
2.4 Modes of Bacterial Entry 12
2.4.1 The ascending route 12
2.4.2 Hematogenous route 13
2.5 Pathogenesis of Urinary Tract Infection 13
2.6 Diagnosis of Urinary Tract Infection 13
2.6.1Urinalysis 14
2.7 Treatment of Urinary Tract Infection
16
2.7.1
Antibiotics Used In the Treatment of Urinary Tract Infection Include 17
CHAPTER THREE
3.0 Materials and Methods 19
3.1
Sample Collection 19
3.2
Media to Be Used and its Preparation 19
3.3 Sterilization 19
3.4 Enumeration of Bacteria from Urine Samples 20
3.5 Identification and
Characterization of Isolates 20
3.5.1 Gram
Staining 20
3.5.3
Motility Test 21
3.6 Biochemical Cultural Characteristics 21
3.6.1
Catalase test 21
3.6.2 Coagulase
Test 21
3.6.3
Citrate Test 21
3.6.4
Indole Test 22
3.6.5 Triple Sugar Iron Test 22
3.6.6 Oxidase Test 23
3.6.7 Urease Test 23
3.7 Antibiotic Susceptibility Testing 23
CHAPTER FOUR
4.0 Results 25
CHAPTER FIVE
5.0
Discussion, Conclusion and Recommendation 33
5.1 Discussion
33
5.2 Conclusion 34
5.3 Recommendation 35
References
LIST OF TABLES
Table Title Page
1 Demographic data of respondents
26
2 Morphological and
Biochemical Characterization of isolates 27
3 Frequency of occurrences of isolates 28
4
Antibiotic
Susceptibility Pattern of Isolate 29
5 Demographic
Data of Respondents 30
LIST OF FIGURES
Figure Title Page
1
Percentage prevalence of
UTI among the sampled population 31
2
Distribution of symptoms
among the sampled population 32
CHAPTER ONE
1.0 INTRODUCTION
Urinary
tract infection (UTI) is the infection of any part of the urinary tract which
consists of the kidney, ureter bladder, and urethra. Any part of these
structures can become infected. However, the infection of the bladder (cystitis)
and the urethra (pyelonephritis) are the most common. Most UTIs are caused by
bacteria that can live in the digestive tract, the vagina or around the
urethra. Bacteria can enter the sterile urinary system through the urethra or
more rarely through the blood stream (Feitosa
et al., 2009).
The
bacteria usually implicated in UTI patients include E. coli, Staphylococcus
aureus, Klebsiella aerogenes, Pseudomonas aeroginosa, Proteus spp,
Streptococcus facalis and Enterobacter spp (Oladeinde et al.,
2015; Okonko et al., 2010; Al-Haddad,
2005). The prevalence and degree of occurrence of one or two of these
microorganisms over others are dependent on the environment (Omonigbo et al., 2001). Gram-negative bacteria have been found to be
most frequent in UTI cases (Omonigbo et
al., 2001; Ebie et al., 2001). UTI are known for their
resistance and exhibit the property of antimicrobial tolerance (Foxman and
Brown, 2003).
Stewart et al.,(1993) reported the isolation of an
unusual multiple resistance Corynebacterium from urine of a comatose patient.
The pathogen was reported to be
resistance to Sulphurfurazole, Trimethroprion, Nalidixic acid, Cefazolin,
Floxacin, Norfloxacin, Vancomycin and Fusidin (Omonigbo et al., 2001). In healthy females, the prevalence of bacteriuria increases
with age from 1% in females within 5-14 years of age to more than 20% in
females at least 80 years of age (Colgan
et al., 2006). This is higher among individuals in lower socioeconomic
classes and those with past history of UTI (Turpin et al., 2007). Sickle cell trait, diabetes mellitus and grand
multiparity have been reported to cause two-fold increase in the rate of bacteriuria
(Enayat et al., 2008). There is also
increase in the risk of developing UTI due to sexual activity, catheterization,
contraceptive usage, urethral structure, kidney stone, etc (Emiru et al., 2013; Aboderin et al., 2009; Ramzan et al., 2004).
Urinary
tract infection(UTI) is the most common infection experienced by humans after
respiratory and gastro-intestinal infections and also the most common cause of
both community-acquired and hospital acquired (nosocomial) infections for
patients admitted to the hospitals (Najar
et al.,2009). UTI can be asymptomatic or symptomatic characterized by a
wide range of symptoms from mild voiding irritation to bacteraemia, sepsis or
even death (Ranjbar et al., 2009).
Infection
of the urinary tract could manifest differently depending on the site of the
infection and length of time involved (Takhar, 2011). Those that affect the
lower urinary tract are called cystitis(i.e. involving the bladder alone with
symptoms including painful urination, burning sensation, frequent urination or
urge to urinate or both while those that affect upper urinary tract are referred
to as pyelonephritis(i.e. involve the kidneys and other organs (Sarah,2010).
The symptoms of the upper urinary tract infection include fever and flank pain
during urination in addition to those of the lower urinary tract (Sarah 2010).
Urinary
tract infection occurs more frequently in females than males due to the
shortness and width 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 during pregnancy (Ebie et al., 2001). The moist environment of the female’s perineum
favours microbial growth and predisposes the female bladder to bacterial contamination
(Ebie et al., 2001). In addition,
urine of females was found to have more suitable pH and osmotic pressure for
the growth of Escherichia coli than urine from males (Obiogbolu et al.,
2004).
Most
UTIs are caused by gram negative bacteria like Escherichia coli and Klebsiella
spp (Omonigho et al., 2001; Ebie et al.,2001).
Other bacterial pathogens frequently isolated include gram positive bacteria
such as Staph. aureus, Staph. epidermidis and Enterococcus spp
formerly called Strept. Faecalis as well as Proteus mirabilis, Pseudomonas
aeruginosa, coagulase negative staphylococci, Acinectobacter spp
and Serratia spp (Ebie et al.,2001).
Knowledge
of the local bacterial aetiology and susceptibility pattern is required to
trace any change that might have occurred with time so that updated recommendation
for optimal empirical therapy of UTI can be made (Ebie et al.,2001). A
number of studies have been done on the prevalence and antimicrobial resistance
patterns of UTIs (Okonko et al., 2010).
1.1 AIM AND OBJECTIVES
The
aim of this study is to assess the urinary tract infection among female
students of Michael Okpara University of Agriculture, Umudike.
The
objectives are:
1. To
isolate and identify bacterial pathogens associated with urinary tract
infection.
2. To
determine the percentage occurrence of isolates from urine samples.
3. To
determine the antimicrobial susceptibility profile of microorganisms associated
with urinary tract infection.
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