PREVALENCE OF STAPHYLOCOCCUS SAPROPHYTICUS IN URINARY TRACT INFECTION AMONG FEMALES

ABSTRACT

This study was carried out to determine the prevalence of Staphylococcus saprophyticus (S. saprophyticus) among females of reproductive age in the University community. The overall prevalence of UTI recorded in this study was 41% out of 100 females whose urine samples were examined. Staphylococcus saprophyticus was the second most frequent cause of UTI in young females with a prevalence of 26.8%. Other bacteria isolated include Escherichia coli (46.3%), Pseudomonas aeruginosa (4.9%), Staphylococcus aureus (2.4%), Klebsiella species (7.3%), Streptococcus species (7.3%) and Proteus species (4.9%). Antibiotic susceptibility of S. saprophyticus showed 63.6% sensitivity to cloxacillin, 54.5% sensitivity to erythromycin, gentamycin and augmentin. This study has shown that S.saprophyticus is an important uropathogen in adolescents and young adult females.

TABLE OF CONTENTS

Title page    i

Declaration                                                                                                 ii

Certification                                                                                              iii

Dedication                                                                                                 iv

Acknowledgement                                                                                        v

List of Tables vi

Table of Contents                                                                                                        vii

Abstract                                                                                                        ix

CHAPTER ONE

INTRODUCTION                                                                                    1

1.1 Background of the Information                                                                                                 1

1.2 Statement of the Problem                                                 4

1.3 Scope of the Study   5

1.4 Aims and Objectives of the Study   6

1.4 Research questions.             6

1.6 Significance of Study   7

1.7 Limitations of the Study   7

CHAPTER TWO

REVIEW OF RELATED LITERATURE                                                                                           

2.1 Literature Review                                                                                                        8

2.2 Laboratory diagnosis.                                                                                                    9

2.3 Genome structure                                                                                                    10

2.4 Cell structure and metabolism                                                                                               11

2.5 Application to Biotechnology                                                                                          12

2.6 Urinary Tract Infection (UTI)   13

2.6.1 Pathogenesis                                                                                             14

2.6.2 Signs and symptoms                                                                                                  17

2.6.3 Diagnosis                                                                                                  17

2.6.4 Treatment                                                                                                 20

2.7 Nonpharmacologic Therapies                                                                                                  22

CHAPTER THREE

MATERIALS AND METHODS                                                                                                 

3.1 Materials                                                                                                   27

3.1.1 Specimen Collection                                                                                                 27

3.1.2 Bacteriological Examination                                                                                             27

3.1.3 Antibiotic Sensitivity Test     27

3.2 Phenotypic Identification of Staphylococcus Spp.     28

3.3 Phenotypic Identification of Coagulase – Negative Staphylococci                                                                                           29

CHAPTER FOUR

RESULTS AND DISCUSSION                                                                                             

4.1 Results 30

CHAPTER FIVE

SUMMARY AND CONCLUSION                                                                                          

5.1 Discussion                                                                                                 33

5.2 Summary                                                                                                  33

5.3 Conclusion                                                                                                34

REFERENCES

CHAPTER ONE

INTRODUCTION

1.1 Background of the Information

Urinary tract infections (UTIs) are common in females, accounting for over 6 million patient visits to physicians per year in the United States. Cystitis (bladder infection) represents the majority of these infections. For a long time, coagulase negative staphylococci have been considered of little or no significance as a cause of urinary tract infection (UTI). However, from the seventies, a particular sub-group of coagulase-negative staphylococci, S. saprophyticus, was shown to be an important cause of UTI, first in Europe then followed by studies in the United States of America and Canada1. They were mainly found in young women. In such works, it was reported that Staphylococcus saprophyticus was the second most common cause of UTI in young sexually active female out-patients without known pre-existing kidney disease or preceding manipulation of the urinary tract. Most cases present as acute cystitis. There is however, a paucity of information on this organism in this part of the world. This study seeks to determine the incidence of S. saprophyticus as a cause of UTI in two patient populations. Ethical clearance was obtained from The University of Nigeria Teaching Hospital (UNTH), Enugu ethical committee. Informed consent was also obtained from the out-patients.

S. saprophyticus can also cause UTI in males of all ages; the organism has been isolated in young boys, male homosexuals, and elderly men with indwelling urinary catheters. It also can cause urethritis, epididimitis, prostatitis, and nephrolithiasis in men, and is relatively rare in hospitalized men. In contrast, S. saprophyticus appears to be unusual in Israel. In a study performed 20 years ago, we did not find any cases of S. saprophyticus infection among 198 young women with acute UTI. In addition, only 103 (0.3%) of 35,580 and 88 (0.6%) of 15,206 urine cultures performed at 2 microbiological laboratories in Northern Israel that were positive for a pathogen yielded S. saprophyticus (unpublished data). There is one puzzling report of the recovery of coagulase-negative staphylococci in 15.6% of young Israeli women with UTI who have been recently sexually active. Unfortunately, the bacterial isolates were not further identified. These significant differences in incidence could be attributed to different techniques of sampling, delivery, culture, and interpretation of cultures used by different authors. Although S. saprophyticus mainly infects young women, other coagulase-negative staphylococci are usually isolated from hospitalized elderly patients with urinary indwelling catheters or other manipulations of the urinary tract. The main reason for this difference is the capacity of S. saprophyticus to adhere to the uroepithelial cells, and other coagulase-negative staphylococci have the ability to colonize indwelling catheters. Coagulase-negative staphylococci were considered to be urinary contaminants prior to the 1960s. In 1962, Torres Pereira reported the isolation of coagulase-negative staphylococci possessing antigen 51 from the urine of women with acute UTI. In subsequent years, additional reports supported this concept. The organism was found to belong to micrococcus subgroup 3. It was later reclassified as S. saprophyticus. Urease production is another important characteristic, and renal and ureteral stones were found to be associated with S. saprophyticus infection. The virulence factors of S. saprophyticus include adherence to urothelial cells by means of a surface-associated protein, lipoteichoic acid; a hemagglutinin that binds to fibronectin, a hemolysin; and production of extracellular slime. The hemagglutinin appears to be more important than adherence factors in enabling colonization of kidney tissue in rats. Hedman et al. described epidemiological and clinical aspects of 270 randomly selected episodes of UTI caused by S. saprophyticus matched with 276 episodes of UTI caused by other organisms, according to the sex and age of each subject and the temporal occurrence of each episode.

S. saprophyticus is second only to E. coli as the most frequent causative organism of uncomplicated UTI in women. The more severe complications include acute pyelonephritis, septicemia, nephrolithiasis, and endocarditis. The vast majority of infections occur in young sexually active women. Wallmark et al. isolated S. saprophyticus from the urine of 173 of 787 (22%) consecutive female patients found to have bacteriuria. The highest rate of S. saprophyticus infection was 42.3%, among women aged 16–25 years included in the study. Gupta et al. reported a prevalence of 8% among 665 young women with UTI. In a study conducted in Australia, S. saprophyticus was isolated from 15.2% of the women aged 13–40 years with UTI. There are also several case reports of infections in young girls.

Another factor that should be considered when data from different sources are analyzed is that most laboratories base the identification of S. saprophyticus on novobiocin resistance. Other staphylococci can show resistance. In addition, different laboratories use different identification methods (e.g., colony appearance on chromogenic agar and automated phenotypic methods, among others), making data collected from different sources incomparable. In future epidemiological studies, well-defined methods of comparison should be used. Latham et al. noted that rectal, vaginal, and urethral colonization of S. saprophyticus was associated with UTI caused by this organism. Rupp et al. determined that the prevalence of colonization of S. saprophyticus of the urogenital tract among healthy women was 6.9%; the most common site of colonization was the rectum (40%). The urine sediment of a patient with UTI caused by S. saprophyticus has a characteristic microscopic appearance; methods of chemical screening for bacteriuria do not always succeed in diagnosing UTI caused by S. saprophyticus. Even when such an infection occurs in the bladder, comparatively low numbers of colony-forming units (⩽105 cfu/mL) are found in the bladder and voided urine. The American Society of Microbiology's Manual of Clinical Microbiology recommends a cut-off value of between 102 and 105 cfu/mL for the diagnosis of significant bacteriuria, but there is not a worldwide consensus for these values. Colonization is more frequent during the summer and fall. Hovelius et al. showed that women with S. saprophyticus colonization were more likely to have had a symptomatic UTI during the previous 12 months, to have recently had a menstrual period, and to have had sexual intercourse concurrent with vaginal candidiasis than were women without colonization. None of the women developed symptomatic UTI during the next 6 months. Further support for the existence of a rectal reservoir was the isolation of the same plasmid-identified clone from both urine and stool samples. Related terms include pyelonephritis, which refers to upper urinary tract infection; bacteriuria, which describes bacteria in the urine; and candiduria, which describes yeast in the urine.

1.2 Statement of the Problem

Staphylococcus saprophyticus is a leading cause of cystitis in young women. S. saprophyticus shares many clinical features of urinary tract infection caused by Escherichia coli, but differs in pathogenesis, seasonal variation, and geographic distribution. This review summarizes what is known and what still needs to be learned about this microorganism. Staphylococcus saprophyticus is uniquely associated with uncomplicated urinary tract infection (UTI) in humans. It has special urotropic and ecologic features that are distinctly different from other staphylococci and from Escherichia coli. This article will consider the epidemiology, ecology, pathogenesis, and clinical features of infections caused by this microorganism. Much more needs to be learned about the epidemiology and natural history of UTI caused by S. saprophyticus as well as the role of S. saprophyticus in human and animal health and disease. A series of research questions are offered to address these issues. And due to the large population of females in MOUAU and most at times the congestion in the hostels and other places, the effect of S. Saprophyticus is common. And therefore this study tends to study this problem and possibly proffer a solution to it.

1.3 Scope of the Study

The study was done to analyze the activity of S. Saprophyticus as one of the causes of Urinary tract infection in females. The study covered mainly the females in MOUAU and their exposure to Urinary tract infections caused by S. Saprophyticus. The remarkable selective susceptibility of young women to colonization by S. saprophyticus is further emphasized by a study by Schneider and Riley. They isolated the microorganism from the genital tracts of 4.6% of women aged 13–40 years, but not from older women or men.  These observations are in accord with numerous clinical reports that UTI caused by S. saprophyticus is associated with recent sexual intercourse and occurs more often during late summer and fall. The microorganisms colonize the human gastrointestinal tract, particularly during the gastroenteritis season in the summer and fall, and this is probably the reason for this seasonal variation in the incidence of UTI caused by S. saprophyticus. However, there was no seasonal variation in Western Australia and Israel. There is a strong association between the use of condoms coated with nonoxynol 9 and the occurrence of UTI, which suggests that vaginal spermicides interfere with the normal vaginal flora and promote colonization by S. saprophyticus.

Other associations include outdoor swimming prior to colonization and occupations related to meat processing and meat products. S. saprophyticus has been isolated from 7.1% of rectal swab specimens taken from carcasses of cattle and from 7.3% of rectal swab specimens taken from pigs. The seasonal variation in the prevalence of colonization by S. saprophyticus in cattle and pigs was similar to that of UTIs in humans. The microorganism was found to contaminate 16.4% of various food samples in Sweden, with a high prevalence of 34% in samples of raw beef and pork. Nevertheless, S. saprophyticus UTI can occur in women who are vegetarians. S. saprophyticus is susceptible to antibiotics usually prescribed for patients with UTI, with the exception of nalidixic acid. However, recurrence of UTI due to S. saprophyticus is common. In addition, single-dose therapy with quinolones is less effective than a 3-day course.

1.4 Aims and Objectives of the Study

The major aim of this study is to investigate the prevalence of Staphyloccocus Saprophyticus in urinary tract infection of females. Other specific objectives include:

v  To examine the rate of S. Saprophyticus as a causative agent of urinary tract infection in females of MOUAU

v  To examine the effects of Urinary Tract infection in females.

v  To examine the ways of contacting S. Saprophyticus in urinary tracts of females.

v  To provide possible solutions to the problems of urinary tract infections.

1.4 Research questions.

The following questions were used to get results for this work:

1.     Can the microorganism be transmitted by human-to-human contact by casual or contact or by a more intimate contact?

2.     How long does the carrier state last before it develops to UTI and what triggers it?

3.     How many microorganisms need to be ingested to produce gastrointestinal colonization?

4.     Can more thorough cooking or irradiation of meat products reduce the incidence of infection?

5.     Can genital colonization occur independently of gastrointestinal colonization?

6.     What is the role of vaginal pH and commensal microbes?

1.6       SIGNIFICANCE OF STUDY

This study will provide knowledge mainly on S. Saprophyticus found in Urinary tracts the females and how it affects their health. It will help to assess the various characteristics of S. Saprophyticus, how it affects females and how it can be prevented.

This study will enlighten students on proper use of toilets as well as protective measures for possible contaminations from S. Saprophyticus that may be unsafe for the health. It will help to direct students of the need for good hygiene and sanitation in the care of their environment and their health.

The result from this study will be helpful to medical personnel to counsel and direct patients and students on the effects of S. Saprophyticus contamination and ways to avoid them.

1.7 LIMITATIONS OF THE STUDY

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