PREVALENCE OF ASYMPTOMATIC URINARY TRACT INFECTION AMONGST STUDENTS OF MICHAEL OKPARA UNIVERSITY OF AGRICULTURE, UMUDIKE

ABSTRACT

This work was carried out to ascertain the prevalence of Asymptomatic Urinary Tract Infection amongst students of Michael Okpara University Of Agriculture, Umudike and the sensitivity pattern of the isolates from urine. Using Aseptic technique, midstream urine were collected from sixty (60) students, urinalysis was carried out on the urine samples and was then cultured on CLED and MacConkey agar using pour plate method. Growth was observed in 26 (87%) of the sample while there was no growth in 4 (13%) of the sample. Out of the 26 (87%) samples with growth, 14 (47%) had significant bacteria growth while 12 (40%) had no significant growth. Incidence of Asymptomatic bacteriuria was higher in females 8 (57%) than males 6 (38%). The organisms isolated were Escherichia coli, Klebsiella specie, Staphylococcus saprophyticus, Staphylococcus aureus, Enterococcus faecalis, Proteus specie, and Pseudomonas aeruginosa. All the Gram positive isolates were sensitive to Gentamycin and all resistance to Cefuroxime, Ceftazidime, Ceftriaxone, Cloxacillin. The Gram negative isolates were mostly sensitive to Nitrofurantoin, Gentamycin and Ofloxacin. Therefore, these drugs could be considered as the first line of drug for the treatment of Asymptomatic Urinary Tract Infection.

TABLE OF CONTENTS

Title page i

Certification ii

Dedication iii

Acknowledgement iv

Table of Contents v

List of Tables vii

List of Figures viii

Abstract ix

CHAPTER ONE

1.1 Introduction 1

1.2 Objectives of Study 3

CHAPTER TWO

2.0 Literature Review 4

2.1 Urinary Tract Infection 4

2.2 Epidemiology Of Urinary Tract Infection 5

2.3 Microorganisms Found In Urine And Their Aetiology 6

2.3.1 Bacteria 6

2.3.2 Viruses 6

2.3.3 Fungi 7

2.3.4 Protozoa 7

2.4 Clinical Manifestation Of Urinary Tract Infections 8

2.4.1 Asymptomatic Bacteriuria 8

2.4.2 Cystitis 8

2.4.3 Acute Pyelonephritis 9

2.5 Symptoms Of UTI 9

2.6 Routes Of Infection 9

2.7 Prevention And Control 10

CHAPTER THREE

3.0 Materials And Methods 12

3.1 Study Site 12

3.2 Sample Collection 12

3.2.1 Inclusion Criteria 12

3.2.2 Exclusion Criteria 12

3.3 Processing Of Samples 13

3.3.1 Urinalysis 13

3.3.2 Urine Microscopy 13

3.3.3 Culturing Of Urine Samples 13

3.4 Morphological And Biochemical Identification Of The Isolates 14

3.4.1 Gram Staining 14

3.4.2 Coagulase Test 15

3.4.3 Catalase Test 16

3.4.4 Urease Test 17

3.4.5 Indole Test 17

3.4.6 Motility Test 18

3.4.7 Citrate Utilization Test 18

3.4.8 Methyl Red Test 19

3.4.9 Voges Proskaeur Test 20

3.5 Antimicrobial Susceptibility Testing 21

CHAPTER FOUR

Result

CHAPTER FIVE

5.1 Discussion 30

5.2 Conclusion 32

5.3 Recommendation 32

References

Appendix

LIST OF TABLES

 Table        Title                   Page

  1.                    Age and  gender association with UTI                                      24

  2.                    Incidence of insignificant bacteriuria among the students            25

  3.                    Characterization and identification of isolates                            26

  4.                    Frequency of occurrence of bacterial isolates from the

                         Urine samples                                                                        27

  5(a)                 Susceptibility pattern of the isolates using Gram positive

                         Antibiotic disc                                                                       28

  5(b)                 Susceptibility pattern of the isolates using Gram negative

                         Antibiotic disc                                                                       29

CHAPTER ONE

1.1 INTRODUCTION

Microorganisms form a bulk of the earth’s biomass and their ability to adapt to newly found environment makes them beneficial or pathogenic (Singh et al, 2009). Many human diseases are as a result of infections caused by bacteria pathogens, either external or internal of the human host. One of such bacterial infection is the Urinary Tract Infection (UTI), involving the presence of bacteria in the Urinary Tract which is naturally sterile (Zorc et al, 2005). Urinary Tract Infection mostly occurs in patients with anatomically and functionally normal urinary tract and usually results from spontaneous ascent of bacteria from the Urethra to the bladder.

Occasionally, the bacteria progresses to the kidney and blood stream. However, since asymptomatic colonization of the urinary tract can occur, other features such as the presence of inflammatory markers or follow up cultures are needed to correctly diagnose a person with urinary tract infection.

Urinary Tract Infection (UTI) represents one of the most common diseases encountered in medical practice today and occurring from the Neonate to the geriatric age group (Kunin, 1994). Despite the widespread availability of antibiotics, UTI remains the most common bacteria infection in human body (Tambekar et al, 2006). 150 million individuals have been reported to be affected by UTI annually worldwide. Urinary Tract Infection occurs as a result of the microbial colonization of Urine and the invasion of any structure of the Urinary Tract by microbial organisms such as Bacteria, Viruses, Fungi and Parasites (Stamm, 1999).

The resulting disease conditions from UTI include cystitis and Pyelonephritis which is known to be non-age discriminatory as it affects both older persons and infants. Moreover, Pyuria as evidenced y the inflammation of the genitourinary tract is common in subjects with Asymptomatic bacteriuria (Nicolle et al, 2005). The infection of the Urethra and Ureter are referred to as Urethritis and Ureteritis respectively where as crystitis and Phyelonephritis corresponds to bladder and kidney infections. Cystitis is a common type of infection whereas the infection associated with the renal damage is an issue of serious concern. Therefore, the infection of bladder and Urethra are referred to as the infection of the lower urinary tract whereas the kidney and Ureter infection is an indication of upper urinary tract infection.

Urine is generally considered to be sterile and is believed to be Germ Free, any source of possible infection occurs through Urethra which initiates the incidence of the infection. Urinary Tract Infection are caused by the presence of bacteria in Urine, although fungi and viruses could be involved (Siiri et al, 2009). The predominant pathogen responsible for Urinary Tract Infection is Escherichia coli which constitute up to 75 – 90% and is followed by Staphylococcus saprophyticus which accounts for 5– 15% of Urinary Tract Infection (Michael et al, 2007). In addition to the above mentioned bacterial species, Klebsiella, Proteus, Pseudomonas and Enterobacter are associated with UTI. Pathogens like Escherichia coliand Staphylococcus saprophyticus are associated with population acquired acute uncomplicated infection where as Klebsiella, Enterococcus, Proteus specie, Enterobacter are known to confer uncomplicated cystitis and phylonephritis that are sporadic (Mars, 2002).

Asymptomatic UTI occurs when Urinary Tract pathogens enter into the bladder without causing apparent symptoms. Typically the pathogens are usually eliminated by host defence factors when they persist onlyfor a short time in human host. However, when such pathogen stay in the urinary system for a long time, symptomatic Urinary Tract Infection result (Nicolle, 2003).

The presence of bacteria in Urine is known as bacteriuria, Asymptomaticbacteriuria is a Urinary Tract Infection that occurs in both males and females where bacteria are present in urine with the absence of clinical signs or symptoms in the host. Asymptomatic bacteriuria is defined by the presence of at least 10⁵ colony forming units (CFU) of organisms per milliliter in cultures of urine specimens in the absence of symptoms of infection referable to the Urinary Tract (Smith, 1994).

Urinalysis is an important part of the initial examination of the patient and the results provides a valuable picture of the patients general health pattern. Generally, Urinalysis will indicate the state of kidneys and the urinary tract, chemical test for the presence of protein or blood, together with physical properties and microscopic examination for casts, cells and certain crystals are very helpful in assessing and treating renal and Urinary tract disease. Information about metabolic and systemic (non renal) abnormalities test for glucose, ketone bodies, bilirubin and Urobilinogen are useful parameters in the diagnosis of metabolic and systematic disorders (Bulakh, 2003).

Asymptomatic bacteriuria occurred reliably more frequently in females as compared with males and it is a major Criterion of Urinary Tract Infection (Nurullaev, 2004). Therefore, it is necessary to investigate the incidence of Asymptomaticbacteriuria in both apparently healthy male and female undergraduate students of Michael Okpara University of Agriculture,Umudike.                            

1.2 OBJECTIVES OF THE STUDY

General Objectives

To ascertain the prevalence of asymptomatic Urinary Tract Infection among students of Michael Okpara University of Agriculture, Umudike, Abia state.

Specific Objectives

1. To determine the organisms involved in the infection.

2. To determine the Age and Gender Association with Urinary Tract Infection.

3. To ascertain the antibiotic susceptibility pattern of bacteria isolated from the urine   samples.

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