ANTIMICROBIAL SUSCEPTIBILITY OF GRAM NEGATIVE BACTERIA ISOLATED FROM URINE SAMPLE

ABSTRACT

Gram negative bacteria are the most prevalent cause of urinary tract infection when compared to gram positive bacteria. The gram negative organisms commonly implicated are E. coli, Klebsilla spp, Staphylococcus aureus, protens spp., Psendomonas asmginosa and other gram negative bacteria. Urinary tract infection is most common among females than males and this could be explained by the short urethra of the females which make them prone to urinary tract infection. Mid stream urine samples were collected from UTI patients around MOUAU. Each specimen was cultured using standard bacteriological methods identification of gram negative organisms were made and antibiotic sensitivity testing of the gram negative isolates was carried out. A total of 30 gram negative isolates were used in the study out of which 10 (33.3%) were E. coli, 9(30%) Protens spp  6(20%) pseudomonad aeruginosa and 5(16.7%) klebsiella spp. Nitrofurantoin was the most effective antibiotic against the isolates while the isolates were highly resistant to cefixime and augmentin. E. coli was the most isolated gram negative organism isolated in thus study. Education on the importance of proper treatment of UTI to the general public cannot be over emphasized.

TABLE OF CONTENTS

Cover page                                                                                                                                                                                                                                                                                                      i

Title page                                                                                                                                                                                                                                                                                                        ii

Certification                                                                                                                                                                                                                                                                                                   iii

Dedication                                                                                                                                                                                                                                                                                                      iv

Acknowledgement                                                                                                                                                                                                                                                                                          v

Table of contents                                                                                                                                                                                                                                                                                            vi

List of tables                                                                                                                                                                                                                                                                                                   viii

List of figures                                                                                                                                                                                                                                                                                                 ix

Abstract                                                                                                                                                                                                                                                                                                          x

CHAPTER ONE

1.1       Introduction                                                                                                                1

CHAPTER TWO

LITERATURE REVIEW

2.1       Antimicrobial Agents                                                                                                 3

2.2       Penicillin                                                                                                                    3

2.2.1  Tetracycline                                                                                                      4

2.2.2     Chloramphenicol                                                                                                                                                                                                                                                                               4

2.3    Antibiotic Resistance                                                                                                                                                                                                                                                                             5

2.4     Mode of Action of Antibiotics                                                                                                                                                                                                                                                             6

2.5    Gram Negative Bacteria                                                                                                                                                                                                                                                                        8

2.5.1. Escherichia coli                                                                                                                                                                                                                                                                                    8

2.5.2.    Klebsiella Specie                                                                                                                                                                                                                                                                               8

2.5.3      Proteus Species                                                                                                                                                                                                                                                                                 9

2.5.4. Pseudomonas Species.                                                                                                                                                                                                                                                                          9

2.6.     Urinary Tract Infections                                                                                                                                                                                                                                                                      9

2.6.1.   Types of Urinary Tract Infections                                                                              10

CHAPTER THREE

MATERIALS AND METHODS

3.1       Sample Collections                                                                                                     11

3.2       Sterilization of Materials                                                                                            11

3.3       Isolation of bacteria from urine Samples                                                                                                                                           11

3.4       Grem Stain Test                                                                                                                                                                                  11

3.4.1    Biochemical tests                                                                                                        12

3.4.2    Catalase test                                                                                                                12

3.4.3    Peptone Water Sugar Test                                                                                                                                                                  12

3.4.4    Antibiotic Sensitivity Testing                                                                                     13

CHAPTER FOUR

4.0       Results                                                                                                                        14

CHAPTER FIVE

5.0           Discussions                                                                                                                             19

5.1           Conclusion                                                                                                                  20

REFERENCE

APPENDIX  1

APPENDIX  2

LIST OF TABLES

Table 1: Identification of the gram negative bacterial isolates from urine samples of UTI patients                                                                                                           15    

Table 2: Antimicrobial susceptibility of the gram negative bacteria isolates from urine samples of UTI patients.                                                                                     16

LIST OF FIGURES

Figure 1: The distribution of the various gram negative isolates from urine

                  samples of UTI     patients used in the study                                                                                                                                                                                                          17

Figure 2: The average percentage susceptibility of the isolates to the different

               antimicrobial   agents                                                                                         18

CHAPTER ONE

1.1       INTRODUCTION

Gram negative bacteria important hospital pathogens, particularly for critical patients and appropriate antimicrobial treatment is often critical to decreasing mobility and mortality among  hospitalized patients having infections. Gram negative bacteria are non- sporing bacilli which grow readily on ordinary  laboratory media under both aerobic and anaerobic conditions. Most of them ferment glucose and a variety of other of sugars. (stewart et al; 1979).

Bacteria are the primary organisms that cause urinary tract infections. Urinary tract infections are conditions where one or more structures in the urinary tract become infected after bacteria overcome and it is also a bacteria inflammation in the urinary tract (Stamm and Hootoni, 1993).

Urinary tract infection are more than 100 organisms per militer of urine in a symptomatic patient or less than 100,000 organisms per milliliter of urine in an asymptomtic patient  (Haris et al., 1983). Escherichia coli accounts for the majority of UTIs in young women but other gram negative rods of different genera such as proteus species and enterobacter which also cause particularly in hospitalized patients and P. aeruginosa on anaerobic gram negative rod is particularly troublesome . Urinary tract pathogen because of its resistance to antimicrobials medicine makes it different to tract successfully (Nester et al., 1998). A high proportion of hospital acquired UTIs are associated with indwelling caltheters.

This device subverts several host defenses to allow bacteria entry in the urinary tract (Warren, 1997). Any situation in which the urine does not naturally flow increase the chance of infection. In this, circumstances, urine accumulates and distends the elastic bladder. Even a few bacteria can multiply to high levels, during this time causing infection.

Urine provide abundant nutrient for many species of bacteria (Nester et al., 1998). Most cases of UTIs in the hospitals are initially treated empirically based on the frequency of potential pathogens, local antimicrobial resistance rate and illness severity. The use of inappropriate empirical therapy was found to be a predication of mortality in patients who had bacterieaemia originating from a urinary tract source (Bishara et al., 1997). Antibodies are used for control of bacterial infections in humans. Generally, gram negative bacteria are sensitive to many antimicrobial agents but strains from different patients and carriers differ in the patterns and degree of the sensitivity to different drugs. In recent times , many strains have developed resistance to some antibiotics, notably penicillin and its derivatives (Adekeye, 1979).

However, very little research has been carried out on the antimicrobial susceptibility of gram negative bacteria isolated from urine samples. This work was therefore undertaken to determine prevalence of gram negative bacteria to provide the antimicrobial agent useful on the best choice of urinary tract infections treatment.

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