INCIDENCE OF ASYMPTOMATIC BACTERIURIA IN FEMALE STUDENTS OF MICHAEL OKPARA UNIVERSITY OF AGRICULTURE UMUDIKE

ABSTRACT

The study was aimed at assessing asymptomatic bacteriuria among female students of Michael Okpara University of Agriculture, Umudike, Abia State. Randomly sampled clean catch midstream urine specimens were collected from 110 apparently healthy asymptomatic undergraduate female students of MOUAU between ages of 16 to 30 years. The urine specimen was cultured on Cysteine Lactose Electrolyte Deficient Agar (CLED), which is the gold standard for detecting asymptomatic bacteriuria and incubated overnight at 370C. This reveals that out of the 110 urine specimen culture, forty two (42) urine specimen showed Scanty, whitish circular growth on the media, two (2) urine specimen showed Yellowish circular growth, fourteen (14) urine specimen showed Large circular, yellowish cluster growth, twelve (12) urine specimen showed Moderate growth circular, yellowish, two (2) urine specimen showed Whitish, circular, crossed straight and forty six (46) urine specimen showed no sign of growth on the culture media.The results showed that the total prevalence rate of bacteriuria was Coagulase Negative Staphylocccus 21(32.82%) was most common uropathogen isolated followed by Escherichia coli 5(7.81%), Staphylococcus aurues 15(23.43%), Proteus species 2(3.12%), Enterococcus spp 10(15.62%), Group B Streptococcus 2(3.12%), Citrobacter spp 5(7.81%), and Klebsiella spp 3(4.68%) respectively while Pseudomonas spp 1(1.56%) had the lowest. Coagulase Negative Staphylococcus was the most common bacteria for asymptomatic bacteriuria in female university undergraduates in this study. The incidence of the bacteriuria in a healthy population is of significant public health concern as they may be incubating pathogenic microorganism which may cause disease they may be incubating pathogenic Microorganism which may cause disease when they interact with the opposite sex. Thus, education and awareness on the need for proper personal hygiene should be encouraged.

TABLE OF CONTENTS

Title Page                                                                                                                                i

Certification                                                                                                                           iii

Dedication                                                                                                                              iv

Acknowledgement                                                                                                                  v

Table of Contents                                                                                                                   vi

List of Tables                                                                                                                          vii

Abstract                                                                                                                                  ix

CHAPTER ONE: INTRODUCTION                                                                                   1

1.1       Aims and Objectives                                                                                                  3

CHAPTER TWO: LITERATURE REVIEW                                                                      5

2.1       Asymptomatic Bacteriuria                                                                                         5

2.2       Prevalence of Asymptomatic Bacteriuria                                                                  6

2.3       The Role of Asymptomatic Bacteriuria Prior to Surgery                                           7

2.4       The Role of Asymptomatic Bacteriuria in Women Affected by Recurrent

            Urinary Tract Infections                                                                                             8

2.5       Screening for Asymptomatic Bacteriuria                                                                   9

2.6       Asymptomatic Bacteriuria amongst Female Students of Rivers State

            University of Science and Technology, Port Harcourt                                              10

2.7       Asymptomatic Bacteriuria among Female Students of a Tertiary

            Institution in Southeast Nigeria                                                                                  11

2.8       Microorganisms Associated with Asymptomatic Bacteriuria                                    13

CHAPTER THREE: MATERIALS AND METHODS                                                      15

3.1       Study Area                                                                                                                  15

3.2       Study Population                                                                                                        15

3.3       Sample Collection                                                                                                      15

3.4       Microbial Analysis                                                                                                     16

3.5       Urine Microscopy                                                                                                       16

3.6       Media Used                                                                                                                 16

3.7       Sample Preparation and Isolation of Microorganisms                                               17

3.7.1    Isolation of Microorganisms                                                                                      17

CHAPTER FOUR: RESULTS                                                                                             18

CHPATER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION          21

5.1       Discussion                                                                                                                   21

5.2       Conclusion                                                                                                                  23

5.3       Recommendation                                                                                                       23

            References

LIST OF TABLES

CHAPTER ONE

1.0       INTRODUCTION

The term 'bacteriuria' refers to the presence of bacteria in urine. It may results from contamination during or after collection of urine or it may indicate the presence of bacteria in the bladder. Asymptomatic bacteriuria (AB) or urinary tract infection is defined as isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen from an individual without symptoms or signs of urinary tract infection. Asymptomatic bacteriuria is common with varying prevalence by age, sex, sexual activity and the presence of genito-urinary abnormalities. Women with asymptomatic bacteriuria are more likely to experience symptomatic urinary tract infection than those without asymptomatic bacteriuria. Escherichia coli is the most frequent microorganism isolated from subjects with asymptomatic bacteriuria (Nicolle, 2014). E. coli remains the single most common microorganism isolated from women, but other organisms, such as Proteus mirabilis, are more common in men (Nicolle, 2014).

The frequency of asymptomatic bacteriuria varies among different populations, depending on factors such as age, sex, area of residence and underlying disorders, pregnancy, obstruction of urinary flow and underlying diseases, (Ojiegbe and Nworie, 2010; Frank-Peterside and Wokoma, 2010). Stamm and Hooton, (2013) defined asymptomatic disease as that which may involve only the lower tract or both the lower and upper urinary tract. Infections are “uncomplicated” when they occur in a normal urinary tract with no structural, functional or underlying host illness to account for the infection, or “complicated” when an underlying abnormality is thought to have enabled the infection to occur (Krieger, 2012).

Bacteria can enter the sterile urinary system through the urethra or more rarely through the blood stream. The bacteria usually implicated in Urinary tract infection patients include E. coli, Staphylococcus aureus, Klebsiella aerogenes, Pseudomonas aeroginosa, Proteus spp, Streptococcus facalis and Enterobacter spp. The prevalence and degree of occurrence of one or two of these others are dependent on the environment (Omonigbo et al., 2011). Gram-negative bacteria have been found to be most frequent in Urinary tract infection cases (Omonigbo et al., 2011).

Asymptomatic bacteriuria occurs more frequently in females as compared with males and it is a major criterion of urinary tract infection (Nurullaev, 2014). Asymptomatic bacteriuria may remain asymptomatic for many years exposing such group of females to high risk of bacteremia, sepsis, pyelonephritis and risk of fertility disorders later in adult life (Weissenbacher and Reisenberger, 2013; Sheffield and Cunningham, 2015). Several reports have indicated that females are more predisposed to asymptomatic bacteriuria than their male counterparts and this has been related in part to the anatomy of the female genitourinary system as well as hormonal, and some behavioural factors (Griebling, 2015; Boye et al., 2012; Shakya et al., 2014; Sharma and Paul, 2012; Yeshitela et al., 2012)

As a result, females bear most of the asymptomatic bacteriuria-related disease complications such as pyelonephritis and renal scarring (Raz, 2013). Many epidemiological studies from different geographical settings as well as in different female risk groups have associated sexual activity, number of sexual partners, post-coital voiding, use of diaphragm, use of deodorant sanitary napkins, use of spermicide-coated condoms, drinking caffeinated beverages, and carbonated soft drinks to the risk of asymptomatic bacteriuria and its attendant disease complications. (Vincent et al., 2013; Foxman and Chi, 2010; Fihn et al., 2016; Foxman and Chi, 2010; Foxman et al., 2015)

It has been reported that drinking cranberry juice tends to protect women against Asymptomatic Bacteriuria (Foxman et al., 2015). Many studies have provided varying reports regarding asymptomatic bacteriuria prevalence, and antimicrobial resistance (AMR) patterns among most-at-risk (MAR) groups (Diamond et al., 2011), while other reports are divided on the most implicated uropathogen in asymptomatic bacteriuria.

Clinical (symptomatic) or subclinical (asymptomatic) disease that may involve just the lower tract or both the lower and upper tracts infection may involve single sites, such as urethra-urethritis, prostrate-prostitis, bladder, cystitis, kidney-pyelonephritis but the whole system is always at a risk of invasion by bacteria once any part is infected (Atlas, 2016).

In Nigeria, Elo-Ilo et al., (2013), carried out a cross-sectional survey to determine the prevalence of asymptomatic bacteriuria in pre-school children in Nnewi, South-East Nigeria. The prevalence of asymptomatic bacteriuria was significantly higher in females, being 15 times that of their male counterparts 4%. Oner et al., (2014) reported a prevalence of 3.3%. Eyong et al., (2011) studied pre-school children in Calabar, Nigeria and found a prevalence of 5.6%. Similarly, an asymptomatic bacteriuria prevalence of 7.3% was reported by Jombo et al., (2010) in a study of pre-school children in Calabar, Nigeria. Also in Nigeria, reports of higher asymptomatic bacteriuria rates include 10.3% and 15% by Wogu et al., 2011; Iduoriyekemwen et al., (2013) both in Benin City, while Alo et al., (2012) reported 48% prevalence of asymptomatic bacteriuria in rural primary school children in Ebonyi State.

1.2       AIMS AND OBJECTIVES

The aim of this study is to determine incidence of asymptomatic bacteriuria among female undergraduate students of Michael Okpara University of Agriculture, Umudike, while the specific objectives were;

1.     To isolate and identify the bacterial agents responsible for asymptomatic bacteriuria among the female students population of Michael Okpara University of Agriculture, Umudike.

2.     To determine the antibiotic susceptibility profile  of isolated bacteria to selected antibiotics

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