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Asymptomatic bacteriuria or asymptomatic urinary infection are bacteria present in urine in the absence of clinical signs and symptoms of urinary infection in the hosts. The microbiological definition is having greater than or equal to 105cfu/ml of same organism(s) in a urine specimen. This study investigated the prevalence of asymptomatic bacteriuria in female students and to determine the antibiotic sensitivity pattern of bacterial isolates. A total of forty (40) female student urine samples were examined and analyzed for asymptomatic bacteriuria. The total number of positive cultures (with significant growth) 17 out of 40 samples analyzed representing 42.5% is presented in table 4 while 57.5% was with insignificant growth. Culture plates with bacteria count greater than or equal to 105cfu/ml were considered significant and thus indicative of UTI (Urinary tract infection). The bacterial isolates and their percentage prevalence of the organisms is as show in table 3. Escherichia coli was found to be the most prevalent (47.0%), followed by Staphylococcus aureus (23.5%) and Klebsiella Spp (11.7%). The least prevalent organisms were Proteus Spp and Streptococcus Spp with 11.7% and 5.8% respectively. Isolates were tested against antibiotics which included Ampicillin, Cotrimoxazole, Ciprofloxacin, Gentamicin, Tetracycline and Chloramphenicol by disc diffusion method. The occurrence of asymptomatic bacteriuria was 42.5% while the isolates were E. coil representing 47.0% of the isolates. Others were S. aureus 23.5%, Klebsiella Spp (11.7%); Proteus Spp (11.7%) and Streptococcus Spp (5.88%). A negative test for nitrite and leucocyte esterase was not used to rule out an infection as culture was demonstrated on such samples. Positive tests from the urine dipstick analysis however required further confirmation through urine culture. Ciprofloxacin was the most active antibiotic as it achieved a success rate of 87.5% against E. coil while Tetracycline and Ampicillin recorded the least. The incidence rate of 42.5% reported in this study should be of great concern because asymptomatic bacteriuria predisposes patients to UTI.



Title page                                                                                                                                i

Certification                                                                                                                            ii

Dedication                                                                                                                              iii

Acknowledgment                                                                                                                   iv

Table of Contents                                                                                                                   v-vi

List of Tables                                                                                                                          vii

Abstract                                                                                                                                  viii


1.0                          Introduction                                                                                                    1         

1.1                   Aim and Objectives                                                                                        2

1.2                   Literature Review                                                                                           3

1.2.1                An Overview of Urine                                                                                    3

1.2.2                Asymptomatic Bacteriuria                                                                              4             Etiology                                                                                                          4             Pathophysiology                                                                                             5             Classification                                                                                                  5             Epidemiology                                                                                                  6             Presentation                                                                                                    7

1.2.3                Asymptomatic Bacteriuria in Pregnancy                                                        7

1.2.4                Asymptomatic Bacteriuria in Diabetic Patients                                              9

1.2.5                Pathogenesis of ASB and UTIs                                                                      11

1.2.6                Bacterial Adherence and Virulence Factor for UTI                                       12

1.2.7                Diagnosis of ASB and UTIs                                                                           12             Urine Microscope                                                                                            13             Dipstick Test                                                                                                   13             Urine Culture                                                                                                  14

1.2.8                Common Antibiotics for ASB and Other UTIs                                             15


2.0                   Materials                                                                                                         17

2.1                   Study Population                                                                                            17

2.1.1                Collection of Samples                                                                                     17

2.2                   Methods                                                                                                          17

2.2.1                Sterilization of Media and Materials                                                              17

2.2.2                Microscopy                                                                                                     17

2.2.3                Isolation of Bacterial Species                                                                         18

2.2.4                Identification of Isolates                                                                                18             Gram Staining                                                                                                 18             Biochemical test                                                                                              19

2.2.5                Subculture and Purification                                                                            20

2.2.6                Antimicrobial Susceptibility Testing                                                               20


Results                                                                                                                                    22


Discussion, Recommendation and Conclusion                                                                       29

References                                                                                                                              33














              Urinalysis for Nitrite and Leucocyte Esterase.    



              Microscopic Examination



              Frequency of Isolation of Organisms



              Level of Bacteriuria.



             Biochemical, Macroscopy and Microscopic Characteristic of Isolated Bacteria



  Antimicrobial Susceptibility Rates of Bacterial Isolates against Antimicrobial Agents









1.0           INTRODUCTION

The term bacteriuria means the presence of bacteria in urine and it is taken to be significant when urine contains a bacterial count of 105cfu/ml in voided mid stream urine, aseptically collected from an individual without apparent symptom of urinary tract infection (Forbes et al, 2002., Ophori et al., 2010).  Asymptomatic bacteriuria is bacteriuria without the classical symptoms of urinary tract infection (fever, frequent urination; painful urination). The importance of asymptomatic bacteriuria is that it is a major risk factor for the development of UTI (Patterson and Andnole, 1997).

Bacterial infection of the urinary tract in human are the most frequent bacterial disease affecting out patients, hospitalized patients and apparently healthy populations (Piatti et al., 2008). The frequency and natural history of asymptomatic bacteriuria vary for different populations and is more common in females than in males by virtue of the shortened urethra.

Asymptomatic bacteruria can occur in both infants and adults but is seen more frequently in females than in males and is a major contain in UTI (Nurullaev, 2004). This is because under favorable conditions, asymptomatic bacteriuria progresses to symptomatic (clinical) UTI (Scholes et al., 2000; Harrington and Hooton, 2000). Factors such as shortness of urethra, estrogen deficiency, use of contraceptives, diabetes, sexual activity, easy contamination of urinary tract with fecal flora (Gupta et al., 2001), obstructing lesions, and genetic factors such as blood group secretor status, increase the likelihood of women contracting a UTI (Scholes et al., 2000).

The clinical significance of asymptomatic has been however controversial because the widespread use of the quantitative urine culture provided a reliable means for identification. This has led to question whether bacteriuria, in the absence of symptoms, leads to complications of urinary infection. Adverse outcomes, of concern have included the short-term complications of symptomatic lower tract infection and longer-term complications, such as genitourinary concern, renal failure, hypertension and death. Alternatively, asymptomatic bacteriuria may be beneficial. Colonization of the genitourinary tract by an virulent organism could prevent infection with more virulent organisms, through competition for nutrients, or receptor sites, by eliciting a cross host immune or inflammatory response or by other mechanisms.

Bacteria that colonize the urinary tract (which include organs that collect and store urine and release it from the body: kidneys, ureters, bladder and urethra) may ascend towards the bladder to cause cystitis, which is usually associated with the classic symptoms of UTI. UTI can proceed from the bladder, through the ureters, to the kidneys where it can cause pylonephritis, which may lead to irreversible kidney damage, renal failure and death (Scholes et al., 2005).

The most bacterial etiologic agents in asymptomatic bacteriuria are mostly members of the Enterobacteriaceae Klebsiella pneumonia, Eschericbia, Enterococcus faecalis, Streptococcus agalactiae; Staphylococcus and Streptococcus pyogenes (Ophori et al., 2010) with E. coli being the most common organism isolated from patients with asymptomatic bacteriuria (Geerlings et al., 2000). These bacteria are resistant to multiple antibiotics, and thus, they pose a serious threat to the safety and proper functionary of the patient. Untreated asymptomatic bacteriuria predisposes an individual to recurrent UTI, which may cause renal diseases. However, in most cases, asymptomatic bacteriuria does not cause any problem and treatment is not necessary.


This study is aimed at;

(a)   Investigating the prevalence of asymptomatic bacteriuria (ASB) in female students of MOUAU

(b)   Isolating and identifying the organisms responsible for the infection.

(c)   Studying the effects of commonly used antibiotics on the bacteria isolated i.e. antimicrobial susceptibility pattern of isolated bacteria.



Urine is an aqueous solution of greater than 95% water, with the remaining constituents in order of decreasing concentration as follows:- area 9.3g/l, chloride 1.87g/l, sodium 1.17g.l, potassium 0.75g/l, creatinine 0.670g/l and other  dissolved ions, inorganic and organic compounds (Colgan et al., 2006). Urine is a typically sterile bye-product of the body secreted by the kidneys through a process called urination and excreted through the urethra. Urine contains a variety of fluids; salts and waste products (Ngwai et al., 2010). Urine flows from the kidney through the Ureter, bladder and finally the urethra before leaving the body. The urine is usually sterile until it reaches the urethra, where epidermal cells living the urethra are colonized by facultative anaerobic Gram negative rods and cocci (Madigan and Brock, 2009). When these bacteria get into the bladder or kidney and multiply in the urine, they cause urinary tract infection (UTI). Sequel to elimination from the body, urine can acquire strong odours due to bacterial action and in particular, the release of ammonia from the breakdown of urea.

Some diseases alter the quantity and consistency of urine (e.g.) diabetes introducing sugar into urine (Watts et al., 1993).

Urine varies in appearance depending principally upon the body’s level of hydration, as well as other factors. Normal urine is transparent ranging from colorless to amber but is usually Pale yellow (Colgan et al., 2006). The colorless urine indicates over-hydration. Average urine production in adult human is about 1-2l/day, depending on state of hydration, activity level, environmental factors, weight and the individual’s health. Producing too much urine requires medical attention. Polyuria is a condition of excessive production of urine (> 2.5l/day; Oliguria < 100ml per day). Turbid or cloudy urine may be a symptom of bacteria infection.


Asymptomatic bacteriuria in young women is common but rarely persists. It is a strong predictor of subsequent symptomatic urinary tract infection. Asymptomatic bacteriuria occurs frequently and is a major cause of UTI.

This is because under favorable conditions, asymptomatic presents with symptoms of UTI (Scholes et al., 2000).

UTI is defined as the presence and multiplication of significant numbers of microorganisms in one or more structures of the urinary tract (Bladder, urethra, kidneys) with the organism invading the surrounding tissue (Stanm,2002., Scholes et al., 2000). Bacteria in the urine especially gram-negative rods usually indicate a UTI. UTIs are among the most common bacterial infections acquired in the community and in hospital. They are generally self-limiting but have a propensity to recur (Salvatore et al., 2011, Foxman, 1990). UTI affects all age groups and is among the leading cause of morbidity in persons of all age specific sub- populations at increased risk of UTIs include pregnant women (Okonko et al., 2010), the elderly, patients with spiral cord injuries and/ or catheters (Nicolle,2001), patients with diabetes or sclerosis, patients with AIDs/HIV patients with underlying urologic abnormalities. The risk of incidence increases with age co-existent disease and increasing duration of catheterization. ETIOLOGY

UTI is caused by the ascent of bacteria up the urethra. The organisms that cause UTI are common normal rectal and perinea bacterial flora and include Escherichia coli, Klebsiella,

Staphylococcus and Streptococcus (Ophori et al., 2010). E coli remains the predominant Uropathogen (80%) isolated in acute community acquired uncomplicated infections followed by Staphylococcus saprophytic, Klebsiella, Enterobacter and proteins species. These bacteria have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract (Johnson, 1991; Mabbett el al., 2009). The pathogens tradition associated with UTI are changing many of their features, particularly because of antimicrobial resistance (Wold et al., 1992). The etiology of UTI is also affected by underlying host factors that complicate UTI such as age, diabetes, spiral cord injury or catheterization.   PATHOPHYSIOLOGY

The urinary tract, from the kidneys to the urethral meatus is normally sterile and resistant to bacterial colonization (Olowu and Oyetunji, 2003), despite frequent contamination of the distal urethra with colonic bacteria. Mechanisms that maintain the tract’s sterility include urine acidity, emptying of the bladder at micturition urination, ureteroversical and urethral sphincters and various immunologic and mucosal barriers.

            About 95% of UTIs occur when bacteria ascent the urethra to the bladder and, in the case of acute uncomplicated pyelonephritis, ascend the ureter to the kidney (Olaitan, 2006) the remained of UTIs are hematogenous. Systemic infections can result from UTIs particularly in the elderly.   CLASSIFICATION

Bacterial UTIs can involve the urethra, kidneys and bladder. A UTI may involve only the lower urinary tract (bladder), in which case it is known as cystitis (Colgan and Williams, 2011) or bladder infection. Alternatively, it may involve the upper urinary tract (kidneys) in which case it is called pyelonephitis (Lane and Takhar, 2011). It can also affect the urethra when organisms gain access to it, acutely or urethra in which case it is known as urethritis. A UTI is said to be complicated when the patient has diabetes, is pregnant or immune compromised. Otherwise if a women is healthy and pre-menopausal, it is considered uncomplicated (Colgan and Williams, 2011). A complicated UTI is lying factors that predispose to ascending bacterial infection. Such predisposing factors include urinary instrumentation (E.g. Catheterization), anatomic abnormalities, poor bladder emptying etc uncomplicated UTI occurs without underlying abnormalities impairment of urine flow.  EPIDEMIOLOGY

 UTIs are the most frequent bacterial infection in women. They occur more frequently between the ages of 16 and 35 years with 10%of women getting an infection yearly and 60% an infection at some point in their lives.

Recurrences are common, with nearly half of the women getting a second infection within a year (Stapleton, 1999) UTIs occur four times more frequently in female than males because of their anatomic predisposition (i.e short urethra).This holds true at most ages except in elderly populations where the UTI rates in males approaches that of females of the same age (McMurdo and Gillespie; 2000). The rate of asymptomatic bacteriuria increase with age from 2-7% in women of child bearing age to as high as 50% in elderly women (Dielubanza and Schaefer, 2011). The increased risk of UTI in women using antibiotic or spermicidal probably occur because of alternations in vaginal flora that allow overgrowth of E. coli (Stecher and Hardt, 2008).

In young sexually active women, sexual activity is the cause of 75-90% of bladder infections, with the risk of infection related to the frequency of sex (Hooton et al., 2000). Antibiotic use changes the vaginal flora and promotes colonization of the genital tract with E. coli, resulting in subsequent increased risk of UTI.

The organism isolated in patients with asymptomatic bacteriuria will be influenced by patient variables healthy persons will likely have E. coli, whereas a nursing horn resident with a catheter is more likely to have multiple drug resistant polymicrobic flora (e.g. Pseudomonas aerogenosa) (Mims et al., 1990).  PRESENTATION:

            A UTI can present with a range of symptoms the presenting symptoms will vary with the age and sere of the patient and also with the severity and site of the infection but may include:- urinary frequency, Dysuria, Hematuria, Urinary Inconsistency, Rigors, Nausea, Vorniting, Suprapubic or loin pain, and painful frequent passing of only small amounts of urine (Nicolle, 2003). In all form of UTI (Cystitis, Urethritis, pyelonephritis), the urine may be cloudy, urination tends to be painful of the urethra is inflamed. If the bladder is inflamed, urination is both painful and frequent. If the infection reaches the kidney, symptoms are more severe.


This is a major risk factor for the development of UTI in pregnancy due to physiological changes (Ophori et al., 2010). Increased UTI in pregnant women has led to high morbidity and mortality with the subsequent increase in Nosocomial infection (Vazque and Sobel, 1995). Although the incidence of bacteriuria in pregnant women is similar to that in that non-pregnant women, the incidence of acute pyelonephritis in pregnant women with bacteriuria is significantly increased (Schnarr and Smaill, 2008). While asymptomatic bacteriuria in no non-pregnant women is generally benign, pregnant women with bacteriuria have an increased susceptibility to Pyelonephritis (Dafnis and Sabatini, 1992). The prevalence of asymptomatic bacteria range from 6.1% to 10.9% the rate of asymptomatic bacteriuria in pregnant women is comparable to non-pregnant women, indicating that pregnant alone does not necessarily incline to the development of asymptomatic bacteriuria. Nicolle (2003) reported that the frequency of bacteriuria increases by about 1% during pregnancy.

There are a number of conditions associated with an increased prevalence of asymptomatic bacteriuria in pregnancy- low socio economic status, sickle cell traits diabetes previous medical history of UTI and grand multiparty (Ophori et al., 2010).

            Pregnancy is a unique state with anatomic and physiologic urinary tract changes. It causes numerous hormonal and mechanical changes in the body. It also gives rise to several. Physiological changes resulting in immune suppression. In a study by Brian and Pamela (2003), it was shown that T and B lymphocytes count do not change in pregnancy but their function is suppressed. This explains the increased incidence of infection in pregnant women.

UTIs are one of such infections and are more concerning in pregnancy due to the increased risk of kidney infection (Ezeome et al., 2006). In pregnancy, beginning in the sixth week, with peak incidence during the 22nd to 24th week, the high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux (Schnarr and Smaill, 2008), where urine flows back up the ureters and towards the kidneys. The pressure effect of a much bigger, the increasing smooth muscle relaxing effect of pregnancy hormone, and the pressure on the blood from the descending presenting part, ma all lead to stasis of urine, which will encourage bacteria multiplication (Oli et al., 2010).

In addition, differences in urine PH and Pregnancy induced Glycosuria and aminoaciduria provide an excellent culture medium for bacterial growth in areas of urinary stases (Schnarr and Smaill, 2008). These changes along with the already short urethra and difficulty with hygiene due to the distended pregnant belly increase the frequency of UTI in pregnant females.

A limited and predictable spectrum of organisms causes UTI in pregnant otherwise healthy females. E. coli is the primary urinary tract pathogen accounting for 75%-90% cases others are Staphylococcus saprophyticus, Klebsiella pneumonia, Proteus mirabilis and Group B Streptococci.

UTIs are one of the most common medical complications of pregnancy. This is because untreated upper UTI in pregnancy carries well documented risk of morbidity and rarely mortality to the pregnant women (Okonko et al., 2010). Untreated bacteriuria in pregnancy either asymptomatic or symptomatic is associated with a 50% increase in the risk of low birth weight and a significant increase in the risk of premature delivery, pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures) (Nicolle, 2003), hypertension and anemia (Kiningham, 1993). Some of the fetal complications of acute pyelonephitis in pregnancy include premature labour, intra-uterine growth restriction and possibly intra-uterine fetal death (Addo et al., 2002). Some possible material complications include chronic pyelonephritis and septicemias (Oli et al., 2010). However, screening of pregnant women for asymptomatic bacteriuria and associated UTI minimize these UTI associated complication. Certain antibiotic are unsuitable for use in pregnancy (e.g. tetracycline) due to their potential toxicity.


            Diabetes mellitus has a number of long-term efforts on the Genito-urinary system. This effect predisposes to bacterial urinary tract infection in the patient with diabetes (Ophori et al., 2010). Diabetes mellitus is a major health problem in Nigeria. Following the 1985 World Health Organization (WHO) criteria, diabetes mellitus is defined an a fasting glucose concentration of at least 7.8mmcl/l (140ml/l) or a two hour glucose concentration of at least 11.1mmg/L(200mg1/L) (Wahl et al., 1998).

            Asymptomatic bacteriuria occurs three (3) times more often among women with diabetes than among otherwise healthy women; asymptomatic bacteruria is associated with an increased risk of symptomatic infection (Geerlings et al., 2001). The presence of asymptomatic bacteruira in diabetic women is however not associated with a faster decrease in renal function (Meiland et al.,2006) or a greater risk of diabetes complications or mortality (Geerlings et al; 2001). Risk factor of asymptomatic bacteriuria in diabetic women include sexual intercourse, degree of metabolic control, age duration of diabetes, insulin use and some diabetes complications. In a study of Zhanel et al., 1991, involving women with diabetes, there was an association between asymptomatic bacteriuria and long-term complications of diabetes such as retinopathy, nephropathy and neuropathy. The bladder dysfunction due to diabetic neuropathy could play a role in the prevalence of asymptomatic bacteriuria among women with diabetes (Nicolle, 2001). Women with diabetes and asymptomatic bacteriuria has a much higher chance to develop pyelonephritis some individuals present with a distressing picture showing definite progression of pyelonephritis characterized by evidence of systemic infection, local extension of the infection, septicemia, and severe impairment of metabolic control, which may become too difficult to manage. Because of these reasons, diabetes has long been considered to be as predisposing factor for UTI.

            UTI is classically assumed to be a clinically relevant problem for persons with diabetes (Baldwin and Root, 1993). The increased prevalence (7% to 13%) of bacteriuria in diabetic women is largely attributable to autonomic neuropathy leading to on paired bladder emptying (Schnarr and Smaill, 2008).

            Many possible explanations have been proposed to account for the greater prevalence of bacteriuria in diabetic persons. These include:-

Ø  Increased adherence of uropathogens to bladder epithelial cells.

Ø  The effects of glucosuria of the growth of uropathogens in diabetic persons (Geerlings et al; 2001).

            E. coli has been reported to adhere more tightly invitro to the vaginal and buccal cells of women with recurrent UTIs than those of healthy persons. High levels of glucose in the urine of persons with diabetes might cause uropathogens to furnish. Geerlings et al; 2001 found that moderate and severe glucosuria (glucose concentrations between 100 and 1000mg1/L) enhanced bacterial growth inviro. These glucose concentrations are seen in the urine of out patients with diabetes ranges from 0to 6.0mg1/L.

            Symptomatic urinary infection may be more severe in diabetic than non- diabetic patients.

The severity of symptomatic infection and frequent observation of bacteriuria in diabetic women has led to some recommendations for treatment of asymptomatic bacteriuria                             However, a long-term prospective study of the nature history of asymptomatic bacteria is harmful                      These studies suggest that asymptomatic bacteriuria (ASB) in diabetic women does not glucose control or promote development of long-term complications of diabetes. Antimicrobial treatment of bacteriuria does not decrease the frequency or severity of, symptomatic urinary infection.


The normal genitourinary tract is sterile, apart from the distal urethra. Uropathogenic organism especially uropathogenic E. coli (UPE) have a variety of virulence tracts that enable them to successfully the normally sterile urinary tract (Zhang and Foxman, 2005) these tracts include a number of adhesions, iron sequestration systems and toxins that distinguish them from normal bowel flora E. coli; ASB occurs following ascension of bacteria up the urethra into the bladder, sometimes with subsequent ascension to the kidneys. After gaining entry to the bladder, E. coli are able to attach to the bladder will and form a biofilm that resists the body’s immune response (Salvatore et al., 2011). These organisms then persist in the urinary tracts without eliciting a host response sufficient to produce symptom or cause indication (Scharr and Smaill, 2008), variables such as host genetic disposition, incomplete bladder emptying or the presence of a foreign body may all facilitate persistence, expression of organism virulence factor is, then, one variable that determine symptoms or persistence. A local urinary host response is often present despite the absence of symptoms. Pyruria is the most common. Other local inflammatory or immune markers such as cytokines and urinary immunoglobulin may also be present.


Bacterial adhesion onto mucosal or urothelial cells is an important phenomenom determining bacterial virulence. Infection in the urinary tract is relented in part to the ability of, urethra, bladder and renal interstitum (Mulvey, 2002). Adhesion property of the bacteria is an important factor that mediate the ability of a bacterial species to colonize the vaginal surface uropathogenic Enterobacteriaceae are electronegative and too small to overcome repulsion by the net negative charge of epithelial cells. As a result bacterial adhesion cannot occur in the absence of fimbriae or other (non-fimbriae) surface adhesion systems. These systems have favorable electrical charge and also promote adhesion through hydrophobicity fimbriae allow irreversible attachment to the uroepithelial cell membrane through adhesions (Oelschlaeger et al., 2002). The virulence factors of E. coli are mainly responsible for promoting progression of the organism from the fecal reservoir into the bladder and occasionally the kidney.


            Asymptomatic bacteriuria is a microbiologic diagnosis determined with a urine specimen that has been collected in a manner to minimize contamination and transported to the laboratory in a timely fashion to limit bacterial growth. Thus the presence of a significant quantity of bacteria in a urine specimen properly collected from a person without symptoms or a sign of a UTI characterizes ASB (Rubin et al; 1992). A clean- catch urine sample in which urine is collected in midstream (a technique where the first 5ml of urine is not captured but the next 5 to 10ml is collected in a sterile container) to prevent contamination with organisms present at the opening of the urethra is necessary for laboratory analysis. Analysis may involve simple dictation for the presence of bacteria or it may involve culture and identification of the specific organism that is causing infection. It may be useful to confirm the diagnosis through urinalysis, looking for the presence of urinary nutrient, white blood cells (leucocytes) or leucocytes esterase another test, urine microscopy, looks for the presence of red blood cells, white blood cells or bacteria. The other test urine culture, is deemed positive of it shows a bacterial colony count greater than or equal to 105cfu/ml of a typical urinary pathogen (Hooton et al; 2000). URINE MICROSCOPY

Microscopic examination of urine is useful but not definitive as it reveals the presence of pus, bacteria and other substance in urine. Pyuria (pus in urine) is evidence of inflammation in the genitourinary tract and is common in subjects with asymptomatic bacteriuria               

Phyuria is present with ASB in 32% of young women. Pyuria is defined as 8WBcs/ML of uncentrifuged urine, which corresponds to 2-5 WBCs/high power field in spun sediment. The presence of bacteria in the absence of pyuria, is usually due to contamination during sampling. Gross hematuria is uncommon. Pyuria also accompanies other inflammatory conditions of the genitourinary tract and is thus, by itself, not sufficient to diagnose bacteriuria.  DIPSTICK TEST

Also are commonly used. The stick has 9-pads each impregnated with different chemicals. The leukocyte esterase and nitrite tests (two of the components of the stick) are used in primary care settings to evaluate urinary symptoms. A positive nitrite test on a freshly collected sample is highly specific for UTI, but the test is not very sensitive. The leukocyte esterase test is very specific for the presence of >10WBCS/ml and is fairly sensitive.

            Limitations of the dipstick nitrite test in diagnosing bacteriuria include:- infection with non-nitrite producing pathogens; delays between obtaining and testing the sample; and insufficient time from the collection for nitrites to appear at detectable levels. Combining the leucocytes esterase and nitrite tests results in higher specificity than using either test alone (Hooton, et al; 2000).

Urinalysis with microscopic examination for bacteria is thus a useful test for the identification of bacteriuria. URINE CULTURE

Although urine cultures are expensive, require laboratory expertise and take 24-48 hours for results to become available, quantitative culture remains the gold standard for diagnosis of UTI.

            Quantitative analysis of bacteria in urine culture was developed several decades ago (Hooton et al; 2000) to establish reliable criteria for discriminating between infection and contamination in asymptomatic persons, with the expectation that asymptomatic infection might be associated with pyelonephitis, hypertension, renal disease and complications  of pregnancy (Zhanel and Harding, 1990). In studies of ASB, counts of at least 105 colony-forming unit per milliliter usually predicated persistently high levels of bacteriuria whereas counts of less 105cfu/ml usually meant persistently low levels of bacteriuria, (Hooton et al; 2000). Diagnosis of ASB and UTI include the use of blood agar and either MacConkey agar or a similar selective medium for routine urine culture. Therefore, the presence of at least 105cfu/ml of the same urinary tract pathogen in urine specimens has been widely adopted as the criterion identifying potentially important bacteria in asymptomatic women.


            Asymptomatic bacteriuria is common. Populations with structural or functional abnormalities of the genitourinary tract may have an exceedingly high prevalence of bacteriuria (Schnarr and Smaill, 2008); but even healthy individuals frequently have positive urine cultures. ASB is seldom associated with adverse outcomes. Pregnant women (Okonko et al., 2010) and individuals who are to undergo traumatic genitourinary interventions are at risk for complications of bacteriuria and benefit from treatments, for other populations, including most bacteriuria individuals, negative outcomes attributable to ASB have been progression to UTI.

Antibiotics are the mainstay treatment for all forms of urinary tract infections. The choice of antibiotic and length of treatment depend on the patient’s history and the urine test that identify the causative bacterial. The sensitivity test is especially useful in helping select the most effective medication. It has been argued however, that the positive effect of antibiotic therapy is mediated by an alternate mechanism such as modification of vaginal flora, rather than eradication of bacteriuria.

Nitrofurantoin, however, which does not alter vaginal flora, is effective in, preventing pyelonephitis in pregnancy. It is effective against E. coli; Enterococcus, Klebsiella and S aureus. It is however not combined with quinolone antibiotic because of its adverse effect.

UTI are often treated with different broad- spectrum antibiotics even when one with a narrow spectrum of activity may be appropriate. This is because of concerns about infection with resistant organisms. Fluoroguinolones are preferred as initial agents for empiric therapy of UTI in areas where resistance is likely to be of concern (Ngwai et al., 2010). This is because they have high bacteriological and clinical cure rates, as well as low rates of resistances among most common Uropathogens. Ciprofloxacin is one of the broad-spectrum fluroquilnone frequently used to treat

urinary infections because of its excellent activity against majority of urinary tract bacteria and particularly E. coli (Warren et al; 1999). Ciprofloxacin has a success rate of 90% in eradicating bacteriuria.

Other common antibiotics for asymptomatic and symptomatic lower urinary tract infections include:- Cephalexin, Co-trimoxazole, Gentamycin, Ampicillin, Streptomycin and Tetracycline. Tetracycline is however not an appropriate agents to use in pregnancy because it leads to discoloration of the teeth if taken after five months gestation (Schnarr and Smaill, 2008).



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