ABSTRACT
Extended
spectrum
Lactamase (ESBL)
producing Enterobacteriaceae have
become widespread in hospitals and are increasing in community settings where
they cause a variety of infections. 40 clinical isolates from federal medical
centre, Umuahia patients was investigated. The isolates were made of 22 Escherichia coli and 18 Klebsiella pneumoniae. Antimicrobial
susceptibility was determined by disc diffusion method. ESBL producers were
determined by the double disc method using ceftazdime and cefuroxime. Out of
the 40 isolates, ESBL producers are made of 15 (68.2%) E. coli and 12 (66.7%) K.
pneumonia. ESBL producing isolates were found be in higher proportions from
in patients 12 (30%) than out patients. ESBL producing isolates were also found
to be more among the female patients 30 (75%) than the male patients 10 (25%).
However, nitrofuration and ciprofloxacin was found to have excellent
performance against the urinary isolates tested and therefore is recommended
for the treatment of infections caused
by Escherichia coli and Klebsiella pneumonia.
TABLE OF CONTENTS
CHAPTER
ONE
1.0
INTRODUCTION
1.1 Aim of the Study
1.2 Objective of the Study
CHAPTER
TWO
2.0 LITERATURE
REVIEW
2.1 Characteristics Of Escherichia Coli
2.2 Characteristics Of Klebsiella Pneumoniae
2.3 Entry Of Bacteria Into The Urinary Tract
2.4 Types Of Urinary Tract Infection
2.4.1 Lower And
Upper Urinary Tract Infections
2.4.2 Complicated And
Uncomplicated Urinary Tract Infections
2.5 The Epidimology Of Urinary Tract Infection
2.6 Risk Factors To Urinary Tract Infection
2.6.1 Anatomical And
Physiological Factors
2.6.2 Age
2.6.3 Urinary Catheterization
2.6.4 Sex And Contraception
2.6.5 Diabetes Mellitus
2.7 Diagnosis
2.8 Treatment And Prevention
2.8.1 Treatment
2.8.2 Prevention
2.9 Antibiotic Susceptibility
CHAPTER
THREE
MATERIALS
AND METHODS
3.0 Collection Of Clinical Isolates
3.1 Media For Isolation
3.2 Media
Preparation
3.3 Material Sterility
3.4 Urine Culture
3.4 Test Organism
3.5 Gram Staining
3.6 Biochemical Tests
3.6.1 Indole Test
3.6.2 Oxidase Test
3.6.3 Citrate Test
3.6.4 Motility Test
3.7 Antimicrobial
Susceptibility Testing
References
CHAPTER
ONE
1.0 INTRODUCTION
Urinary
tract infection (UTI) is a bacterial infection that affects any part of the
urinary tract, such as urethra, bladder and kidney.
Symptoms
which include frequent urination and painful urination, and cloudy urine. The
main causal agent is Escherichia coli.
Although urine contains a variety of fluids, salts, and waste products. It does
not usually have bacteria in it. When bacteria get into the bladder or kidney
and multiply in the urine, they may cause a UTI.
UTIs are caused by the presence of bacteria in
the urine, although fungi and viruses could be involved, and are 14 times more
common among women than men. This is because of the shortness and width (5cm)
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 (Ebie et al., 2001).
In
males, the length of the urethra (20cm) provides a distance barrier that
excludes micro-organism from urinary bladder. UTI is a common disorder that
occurs in approximately in 25% of young women and 5% of all women during their
life time. Majority of women have the current infection within one year (Siiri
et al., 2009)
UTI
can be asymptomatic or symptomatic and it is characterized by a wide range of
symptoms from mild voiding irritation to bacteramia, sepsis or even death
(Ranjbare et al., 2009). Infection of the urinary tract could manifest
differently depending on the site of the infection and the length of time
involved (Takahar, 2011). Those that affect the lower urinary tract called
cystitis involve the bladder alone with the symptoms which include frequent
urination, painful urination, and burning sensation. Those that affect the
upper urinary tract referred to as pylelonephritis involve the kidneys and
other organs. The symptoms include fever and flank pain during urination in
addition to those of the lower urinary tract (Sarah, 2010). If UTI is not
diagnosed early and treated adequately, it may result into chronic illness and
long term renal damage (Adeji and Opokiv, 2004).
In
all suspected cases of UTI, culture of the urine is the first step in
diagnosis. Urine culture is traditional the gold standard for diagnosing UTI. Sensitivity
and specificity will vary depending on the threshold colon used and whether a
specimen is obtained by catheterization or other methods (Gibson and Toscano,
2012).
Extended
spectrum Beta-lactamses (ESBLs) were first describe in 1983. The Beta-lactamses
produced by bacteria are known to protect against the lethal effect of peniculins, cephalosporoins and monobactams on their cell wall
synthesis. ESBLs have found most commonly in uropathogens like k.pneumoniae
and E. coli other enterobacteria and
non-fermenting Gram negative rods also produce ESBLS bit to a lesser extent
(Goussard and couruclin, 1999; Bush and Jacoby, 2010).
Extended
spectrum beta-lactamases (ESBLs) are among the important cause of multi-drug
resistant infections throughout the world (Livermore et al, 2007). Bacteria carrying such enzymes have long been
recognized as the incidence of such health care associated infections and the
incidence of such organisms also appear to be increasing in the community, typically
as source of urinary tract infections (Pitout et al., 2005).
The ESBL producing bacteria are
increasingly causing urinary tract infections both in hospitalized and out
patients. This is making the therapy of UTI difficult and promoting greater use
of expensive broad spectrum antibiotics, such as carbapenems (Mekki et al., 2010).
Detection
of ESBLs using conventional antimicrobial susceptibility methods and delay in
the detection and reporting of ESBL production by Gram negative baclli are
associated with prolonged hospital stay, increase morbidity, mortality and health
care costs (Mehrgan and Rahbar, 2008).
Infections
due to ESBL product organisms such as Escherichia
coli, Klebsiella, Pseudomonas,
Citrobacter, Enterobacter, Salmonella, Proteus, and Shigella species can pose major heat, to life and often difficult
and expensive to heat, and can delay discharge from hospital (Lee et al;2006).
Drug
resistance among bacteria causing UTI has increased since the introduction of
UTI chemotherapy. The increased prevalence of drug resistance bacteria has made
susceptibility testing particularly vital. Antibiotic sensitivity can be tested
with these cultures, making them useful in the selection of antibiotic
treatment.
Basic
infection control measures can help to prevent such spread but these steps may
be undermined in high pressure care settings by rapid bed turn over in
hospitals, or between care settings, overcrowding, adequate fluid intake,
water, practicing good hygiene, cleaning genital area and overstretching of
medical wards within hospitals (P.rout et
al., 2005).
1.1 Aim of the Study
This
study was done to detect ESBL producing E.
coli and K. pneumoniae in urinary tract infection (UTI) patients in Federal
Medical Center, Umuahia (FMC) Nigeria.
1.2 Objective of the
Study
1. To
isolates and identify the two organisms (E.
coli and K. pneumoniae) that are implicated in these infections.
2. To
determine the rate of ESBLs producing E.
coli and K. Pneumonae among UTI
patient in Federal Medical Center Umuahia.
3. To
carryout antimicrobial susceptibility pattern of the isolates.
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