ABSTRACT
Urinary tract infections “UTIs” are one of the frequently encountered problems facing the family physician. The study is aimed at identification of bacteria isolates from urinary tract infection among pregnant women. A total of 50 clean midstream urine samples were collected and a general urine microscopic examination and culture were carried out. Susceptibility testing panels of the following antibiotics: Gentamycin, tetracycline amikacin, ampicillin, erythromycin, nalidixic acid, ciprofloxacin, cotrimazasole and cefuroxime were tested against the isolated organisms using disc diffusion method. The bacteriologic agents of UTI isolated from the patients showed that the most common uropathogen isolated from urine of infected subject is Escherichia coli which constituted 18.5% and followed by Staphylococcus aureus (18.5%), Proteus mirabilis (11%), Pseudomonas aeruginosa (11%) and Enterococcus faecalis (7.4%). The distribution of UTI among the ages of the antenatal patients showed that age group within the range of 27-32 years recorded the highest incidence of UTI, whereas those of them above 39 years showed the least incidence. Ciprofloxacin, Gentamicin and Erythromycin were the most active antibiotics, while the isolates were highly resistant to cotrimozasole, cefuroxime and nalidixic acid. The study reveals that UTI is a major health problem among pregnant women. Escherichia coli, Klebsiella pneumonia and Staphylococcus aureus were the predominant uropathogen that causes UTI. All the isolates were sensitive to Gentamicin and Ciprofloxacin. This calls for frequent and consistent evaluation of the prevalence, aetiologic agents and predisposing factors of urinary tract infections during pregnancy in developing countries.
TABLE OF CONTENTS
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
Lists of Tables viii
Abstract
ix
CHAPTER ONE
1.0
Introduction 1
1.1
Factors that predispose an individual to UTI include 2
1.2
Aim and Objectives 5
1.3
Objectives 5
CHAPTER TWO
2.0 Literature Review 6
2.1
Risk factors of UTI 7
2.2 Epidemiology of Urinary Tract Infection 9
2.3 Causative Organisms 10
2.3.1
Bacterial UTI 10
2.3.2 Fungal and Viral UTI 11
2.4 Modes of Bacterial Entry 12
2.4.1 The ascending route 12
2.4.2 Hematogenous route 12
2.5 Pathogenesis of Urinary Tract Infection 12
2.6 Diagnosis of Urinary Tract Infection 13
2.6.1Urinalysis 14
2.7 Treatment of Urinary Tract Infection 15
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 It’s Preparation 19
3.3 Sterilization 20
3.4 Enumeration of Bacteria From Urine Samples 20
3.5 Identification and
Characterization Of Isolates 20
3.5.1 Gram
Staining 21
3.5.3
Motility Test 21
3.6 Biochemical Cultural Characteristics 22
3.6.1
Catalase test 22
3.6.2
Coagulase Test 22
3.6.3
Citrate Test 22
3.6.4
Indole Test 23
3.6.5 Triple Sugar Iron Test 23
3.6.6 Oxidase Test 24
3.6.7 Urease Test 24
3.7 Antibiotic Susceptibility Testing 24
CHAPTER FOUR
4.0 Results 25
CHAPTER FIVE
5.0
Discussion, Conclusion and
Recommendation 30
5.1 Discussion
30
5.2 Conclusion 33
5.3 Recommendation 33 References
LIST OF TABLES
Table Title
Page
1
Morphology
and Biochemical identification of isolate 26
2 Incidence
of Urinary Tract Infection In Relation 27
To Age among the Antenatal Patients
3 Frequency
of Occurrence of Bacterial Isolates 28
4 Distribution
of Bacteria Susceptibility to Antibiotics
29
CHAPTER ONE
1.0
INTRODUCTION
Urinary
tract infections “UTIs” are one of the frequently encountered problems facing
the family physician. UTIs during pregnancy are among the commonest health problems
worldwide, especially in developing countries (John and Michael, 2000). Urinary
tract infections (UTI), which are caused by the presence and growth of microorganisms
in the urinary tract, are perhaps the single commonest bacterial infections of
mankind and in pregnancy; it may involve the lower urinary tract or the bladder.
UTI has been reported among 20% of the pregnant women and it is the most common
cause of admission in obstetrical wards (Theodor, 2007).
UTI
is defined as the presence of at least 100,000 organisms per milliliter of
urine in an asymptomatic patient, or as more than 100 organisms/ml. of urine
with accompanying pyuria (>5 WBCs/HPF) in a symptomatic patient.
Particularly in asymptomatic patients, a diagnosis of UTI should be supported
by a positive culture for a uropathogen (Emilie and Edward, 2011).
Several
physiological, anatomical and personal factors contribute to this problem
during pregnancy. For example, urethral dilatation, increased bladder volume
and decreased bladder tone with increased urinary stasis. Also physiologic
increases in plasma volume decreases urine concentration with up to 70% of
pregnant women develop glycosuria which encourages bacterial growth (Lucas and Cunningham,
1993). Urinary tract infection during pregnancy contributes
significantly to maternal and perinatal morbidity. Abortion, small birth size,
maternal anemia, hypertension, preterm labour, phlebitis, thrombosis and
chronic pyelonephritis are related to urinary tract infection during pregnancy
(Onuh et al., 2006).
The
urinary tract includes the organs that collect and store urine and release it
from the body which include: kidneys, ureters, bladder, urethra and accessory
structures. Urine formed in the kidney is a sterile fluid that serves as a good
culture medium for proliferation of bacteria (Omonigho et al., 2001). UTI is evident
by the presence of 105 microorganisms or of a single strain of
bacterium per ml in two consecutive midstream samples of urine (Berg, 2005;
Davidson et al., 2009).
UTI
could be described based on the part of the tract affected, for upper tract it
is called Pyelonephritis and the lower part, cystitis (Stamm, 1998). As an
anatomical unit, an infection of any part can generally spread to its other
parts (Roberts, 1967). The commonest mode of infection is the ascending route,
through which organisms of the bowel flora contaminated the urethra, ascends to
the bladder and migrate to the kidney or prostrate. Haematogenous spread do
occur particularly during neonatal period (Azubuike et al., 1999).
1.1 Factors that
predispose an individual to UTI include:
(a)
Stasis; a major cause of UTI during pregnancy.
(b)
Obstruction of the flow of urine, which could be caused by stone.
(c)
Presence of foreign body such as in-dwelling bladder catheter.
(d)
A decrease in general body resistance such as observed in malnourished individuals,
use of immunosuppressive drugs and disease conditions e.g. diabetes (Olowu,
1996).
The
pathological lesions of UTI include urethritis (inflammation of the urethra),
cystitis (inflammation of the bladder) etc. infection of the urinary tract puts
other parts at risk of infection. It has been recognized for sometime that
asymptomatic bacteriuria is common in pregnancy thus women are at increased
risk of UTIs.
Nicholson
(1989) reported that except for a short period immediately after birth (infant period),
females far exceed males in the prevalence of asymptomatic bacteriuria
(Weatheral et al., 1988; Omonigho et al., 2001).
Females
are more susceptible to colonization with enteric bacteria due to shortness of
their urethra. The close proximity of the urethral orifice to the rectum, which
is in direct contact with perineal microbes, also makes the females to be more
susceptible. In males, the sterility of the proximal two-thirds of the urethra,
its longer length and the bactericidal effect of prostatic secretion constitute
an excellent immunological defense against bacterial infection (Omonigho et al., 2001).
Also,
the anatomical relationship of the female urethra to the vagina makes it liable
to trauma during sexual intercourse as well as bacteria being massaged up the urethra
into the bladder during pregnancy or childbirth; the moist environment of the
females perineum favours microbial growth and predisposes females to bladder contamination
(Ebie et al., 2001).
Other
factors including improper cleaning of the perineum, the use of napkins and
sanitary towel together with pregnancy and sexual intercourse contribute to the
higher incidence of UTIs in various women. 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, 2004).
Increase
in the concentration of amino acids and lactose during pregnancy are believed
to encourage the growth of E. coli in urine (Weatheral et al., 1988). In boys, UTI is a disease
of infancy while in girls; a disease of school age with 3 - 5% of girls having
asymptomatic bacteruria (Azubuike et al.,
1999).
Clinical
manifestation of UTI varies but the symptoms range from dysuria, lower
abdominal pain, pyrexia of unknown origin and foul smelling urine (Davidson et al., 1989). UTI may generally be
diagnosed from the symptoms and laboratory examination of the urine. Criteria
for the diagnosis of UTI vary greatly depending on the patients and context.
There is considerable evidence of practice variation in the use of diagnostic
tests, interpretation of signs or symptoms (Jamieson et al., 2006).
According
to Alexander et al., (2006) standard
quantitative urine culture should be performed routinely at first antenatal
visit. The presence of bacteriuria in urine should be confirmed with a second
urine culture. Dipstick testing should not be used to screen for bacterial UTI
at first or subsequent antenatal visits. Dipsticks to test only for proteinuria
and the presence of glucose in the urine should be used for screening at the
first and subsequent antenatal visits as a more cost-effective alternative to multi-reagent
dipsticks that detect the presence of nitrite, leucocyte esterase and blood in
addition to protein and glucose (Alexander et
al., 2006).
The
prevalent organisms that are usually isolated from UTIs patients are E. coli,
Staphylococcus aureus, Klebsiella aerogenes, Pseudomonas aeruginosa, Proteus
spp. Streptococcus faecalis and Enterobacter spp. The prevalence
and degree of occurrence of one or two of these organisms over others are
dependent on the environment (Omonigho et
al., 2001). Gram-negative bacteria
have
been found most frequently in UTIs cases by several authors with E. coli and
Klebisella spp. being the most predominant organisms (Omonigho et al., 2001; Ebie et al., 2001). Other bacterial pathogens frequently isolated
include S. aureus, S. epidermidis and S. faecalis (Eghafona
et al., 1988; Omonigho et al., 2001). Stewart et al., (1993) recently reported the
isolation of an unusual multiple resistant Corynebacterium from the
urine of a comatose patient. The pathogen was reported to be resistant to
sulphurfurazole, trimethroprion, nalidixic acid, cefazolin, ofloxacin, ofloxacin,
norfloxacin, vancomycin and fusidin (Omonigho et al., 2001).
1.2 AIMS AND OBJECTIVES
The
aim of this study is to evaluate the bacteria isolates in urinary tract
infection among pregnant women.
1.3 OBJECTIVES
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 bacteria associated with
urinary tract.
4. To
determine the Incidence of urinary tract infection in relation to age.
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