TABLE OF CONTENTS

DECLARATION.. i

CERTIFICATION.. ii

APPROVAL PAGE.. iii

ACKNOWLEDGEMENT. iError! Bookmark not defined.

DEDICATION.. v

TABLE OF CONTENTS. vi

LIST OF TABLES. vii

ABSTRACT. x

CHAPTER ONE: INTRODUCTION.. 1

1.1 Background of the Study. 1

1.2 Statement of the Problem.. 2

1.3 Significance of The Study. 3

1.4 Aim.. 4

1.5 Objectives. 4

CHAPTER TWO.. 5

LITERATURE REVIEW... 5

2.0 Infections of the Urinary Tract 5

2.1 Prevalence of UTI. 5

2.2 Transmission of uropathogens. 6

2.3 Etiologic Agents of UTI. 7

2.4 Bacterial Virulence Factors. 9

2.5 Pathogenesis and Pathology. 10

2.6 Antimicrobial Susceptibility Pattern of Klebsiella pneumoniae. 11

2.7 Signs and Symptoms of Klebsiella pneumoniae Infection. 12

2.8 Epidemiology of Klebsiella pneumoniae. 12

2.9 Treatment of klebsiella pneumoniae infection. 13

2.10 Treatment of UTIs. 13

2.11 Antimicrobial Resistance. 15

2.12 Factors influencing resistance of antibiotics. 16

2.13 Mechanisms Of Action Of Antimicrobial Agents. 19

2.14 Susceptibility to antimicrobial agents. 20

2.15 Prevention of UTI and control 20

CHAPTER THREE.. 21

MATERIALS AND METHODS. 21

3.0 STUDY AREA.. 21

3.1 SAMPLE COLLECTION.. 21

3.2 LABORATORY ANALYSIS. 21

3.2 PREPARATION OF MEDIA.. 22

3.3 ISOLATION AND IDENTIFICATION OF MICROORGANISMS. 22

3.4 GRAM STAINING.. 22

3.5 BIOCHEMICAL TESTS. 23

3.5.1 Catalase test 23

3.5.2 Oxidase test 23

3.5.3 Coagulase test 23

3.5.4 indole test 24

3.5 .5   ANTIBIOTIC SUSCEPTIBILITY.. 24

CHAPTER FOUR.. 25

RESULT AND DISCUSSIONS. 25

4.1 RESULTS. 25

4.2 DISCUSSION.. 29

CHAPTER FIVE.. 32

SUMMARY, CONCLUSION AND RECOMMENDATION.. 32

5.1 Summary. 32

5.2 Conclusion. 33

5.3 Recomendations. 33

REFERENCES. 34

LIST OF TABLES

TABLE 4.1: Antibiotic Susceptibility Of Klebsiella Pneumoniae                            26

TABLE 4.2: Culture And Biochemical Characteristic Of The Isolate                      27

TABLE 4.3: Number And Percentages Of The Organism Isolated From Urine      28

TABLE 4.4: Drugs Of Choice For Klebsiella Pneumoniae Isolated From Urine.    29

LIST OF SYMBOLS AND ABBREVIATIONS

UTI                 :           Uniray Track Inpection

ANC               :           Anti Natal Care

ESBL              :           Estended Stectrum Beta Lactamase

ICU                 :           Intensive Care Unit

NDR               :           Multidrug Resistance

CLED             :           Cystine Labtus Electrolyte Deficiency

TMP/SMS       :           Trimethoprim/Sulfamfthoxazole

NA                  :           Nutrient Arga

MM                 :           Mili Meter

SPP                 :           Species

APUA                         :           Alliance for the Prudent Use of Antibiotics

GARP                         :           Global Antibiotic Resistance Partnership

CHC                :           Comprehensive Health Care

CLSI               :           Clinical and Laboratory Standards Institute

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Urinary tract infection (UTI) is the colonization of the urinary tract by pathogenic microorganisms. Infection is caused by fungi, bacteria and viruses. The infection has prolonged admissions in hospital, morbidity in general population and high financial cost implications to the patients (Ramakrishnan and Scheid, 2005, Prakash and Saxena, 2013). Majority of UTIs are caused by bacteria that are found in the bowel and live as normal flora and often result from faecal and perineal areas. These organisms are capable invading the tissues of the urinary tract and adjacent tissues causing lower urinary tract infections and upper tract infections (Shilpi et al., 2012; Kumar et al., 2013). UTI is a common condition that is found in very young children as well as older people (Tamber et al., 2006; Manikandan and Amsath 2013). In general population and hospital set up, UTI is a common infection although there arenew and more powerful antibiotics in use but bacterial resistance persists (Patel et al., 2012).

The spectrum of causative agents and their antimicrobial resistance pattern has been dynamic worldwide (Annapurna and Lakshmi, 2013). Urinary tract infection may lead to life threatening complications and death (Gupta et al., 2001). Urine culture is the most effective diagnosis of UTI and treatment (Onuoha and Fatokun, 2014). Lower UTI (cystitis) and upper UTI (pyelonephritis) are the two clinical entities mostly found in patients with symptomatic UTI. Lesions caused by UTI are severe and contribute to morbidity in the population resulting in loss of renal function, which leads to long-term illness (Lane and Mobley, 2007)Urine pass through the urethra allows the entry of uropathogens into the urinary tract initiating an inflammatory response, colonize urine in the urethra and if not washed out during urination culminating into a bacterial infection. Due to their anatomical orientation: that is the short distance between the anus and vagina women are at ahigher risk of getting UTIs (Foxman, 2010). A second re-infection occurs in about 50 % of all women with a first UTI within six months (Ehinmidu, 2003). Bacteria establish infection in the urinary tract only after overcoming possible elimination by normal flora during micturation and innate host defense mechanism in the bladder (Gupta et al., 2001)

Only about 2-5 % of documented UTIs are acquired hematogenously and usually result from bacteremia caused by relatively virulent organisms such Salmonella spp. and Staphylococcus aureus (Karlowsky et al., 2002). Common symptoms of UTIs include burning sensation during urination, loss of bladder control, increased

frequency of urination especially in small amounts, low back pain, cloudy and bloody or foul-smelling urine (Onifade et al., 2011).Multidrug resistance should be monitored worldwide and surveillance systems should be used to determine the aetiology for UTIs (Kimando et al., 2010). There is a worldwide setback in management of many bacterial infectious diseases due to antibiotic resistance. It is estimated that globally 26 % of deaths are due to infectious diseases such as UTIs of which 98 % occur in low income countries.

1.2 Statement of the Problem

Being the most second infectious disease in the community and hospitalized patients, UTI has globally affected over 150 million people per year which costs global economy more than 6 billion US dollars (Alemu et al., 2012; Onuoha and Fatokun, 2014). Worldwide, infectious diseases cause a significant amount of financial burden and morbidity (Kolawole et al., 2009; Tiruneh et al., 2014). In the USA, about 7 million patients who visit the clinicians are diagnosed with UTI while more than 100,000 are hospitalized annually. In community and hospital acquired bacterial infections there has been a growing concern worldwide due to UTIs caused by multidrug resistant uropathogens (Radyowijati and Haak, 2003; Alemu et al.,2012). There is pressure resulting from intensive and indiscriminate use of antibiotics in treatment leading to a rapid spread of antimicrobial agent resistance genes to uropathogens. A global concern is on the rise over rapid dissemination of drug-resistant bacteria creating serious complications on the treatment of infectious diseases. A major concern to clinicians is the increase in the number of resistant and multi-resistant strains of bacteria and the decline in the number of new antibiotics available for treatment of UTIs (Annapurna and Lakshmi, 2013). This study aimed at describing the major pathogens causing UTI among patients, the prevalence of UTI and establish susceptibility pattern of antimicrobial resistance. The data will be used in guiding on the most effective drugs of choice on treatment of UTIs and identifying the most prevalent uropathogen. On the light of this, the following study was carried out.

1.3 Significance of The Study

UTIs are prevalent during pregnancy, and the increasing resistance of pathogens like K. pneumoniae to commonly used antibiotics complicates treatment options. As antibiotic resistance continues to rise globally, identifying local resistance patterns can inform healthcare providers and policymakers about the most effective treatment regimens. This is particularly important in regions where empirical treatments may not align with current resistance trends, potentially leading to treatment failures.

Additionally, the findings of this study can contribute to public health strategies aimed at reducing the incidence of UTIs and associated complications in pregnant women. By providing data on susceptibility profiles, the research supports the need for regular screening and targeted antibiotic stewardship programs to combat the threat of antibiotic-resistant infections in vulnerable populations.

1.4 Aim

To determine the antibiotic susceptibility profiles of Bacterial Isolates from among pregnant women attending ANC in General Hospital Dutse.

1.5 Objectives

i) To determine the most common bacterial isolate that causes UTIs among pregnant women attending ANC in the study area.

ii) To determine the antimicrobial susceptibility patterns of the identified bacterial isolates of UTIs among pregnant women attending ANC in the study area

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