PREVALENCE OF URINARY TRACT INFECTION AMONG FEMALE UNDERGRADUATES OF MICHAEL OKPARA UNIVERSITY OF AGRICULTURE, UMUDIKE

ABSTRACT

Urinary Tract Infection (UTI) is one of the major diseases that affect people of all age groups. It can be symptomatic or asymptomatic and the prevalence is higher in females. The study investigated the prevalence of the infection, implicated bacteria species and antibiogram  among  female undergraduate students of Michael Okpara University of Agriculture, Umudike. The study was carried out among 60 healthy female students living in the hostel and off campus. The samples were cultured on Blood agar and MacConkey agar. The Gram positive isolates were Enterococcus faecalis and Staphylococcus saprophyticus and the Gram negative isolates were Escherichia coli, Klebsiella species and  Proteus species. Bacteriuria was observed in 23(38.3%) of the samples while there was no significant growth in 22(36.7%) and no growth in 15(25%). Prevalence of significant bacteriuria was higher in female students living in the hostel 19(82.6%) than in female students living off campus 4(17.4%) and occurred highest under the age group of 22-24 (69.6%) followed by the age group 25-27 (17.4%). The Gram positive isolates Enterococcus faecalis was highly susceptible to Pefloxacin and Staphylococcus saprophyticus was highly susceptible to Gentamicin and Zinnacef. The Gram negative isolates were highly susceptible to Ciprofloxacin, Pefloxacin and Ofloxacin. The findings emphasize the need for personal hygiene among the female undergraduates and provision of basic infrastructure such as toilet facilities in the hostel.

TABLE OF CONTENTS

Title page…………………………………………………………………………………..i

Certification……………………………………………………………………………….ii

Dedication……………………………………………………………………...................iii

Acknowledgement………………………………………………………………………..iv

Table of Contents………………………………………………………………………....v

List of Tables…………………………………………………………………………….viii

Abstract…………………………………………………………………………………...ix

CHAPTER ONE

1.0                 Introduction………………………………………………………………...1

1.1                 Aim.………………………………………………………………………...3

1.2                 Objectives…………………………………………………………………. 3

CHAPTER TWO

2.1                  The urinary system and its infection…………………………………...…4

2.2                  Microorganisms found in urine and their etiology……………………….4

2.2.1               Bacteria………………………………………………………………...…5

2.2.2               Viruses………………………………………………………………....…5

2.2.3               Fungi…………………………………………………………………...…6

2.2.4               Protozoa…………………………………………………………………..6

2.3                  Entry of bacteria into the urinary tract…………………………………....7

2.4                  Routes of bacteria infection…………………………………………...….7

2.5                  Types of Urinary Tract Infection……..…………………………...……...8

2.5.1               Lower and upper Urinary Tract Infection………………………….……..8

2.5.2               Complicated and uncomplicated Urinary Tract Infection…………..…….8

2.6                  Pathogenesis……………………………………………………………....9

2.7                  Clinical features………………………………………………………….11

2.8                  Epidemiology of Urinary Tract Infection……………………………......12

2.9                  Risk factor of  Urinary Tract Infection………………………………......13

2.9.1               Anatomical and physiological factors………………………………...…13

2.9.2               Age ……………………………………………………………………...14

2.9.3               Sex and contraceptives…………………………………………………..14

2.9.4               Diabetes mellitus………………………………………………………...15

2.9.5               Urinary catherization…………………………………………………….15

2.10                Diagnosis………………………………………………………………...16

2.11                Treatment and prevention……………………………………………..…17

2.11.1             Treatment ………………………………………………………………..17

2.11.2             Prevention………………………………………………………………..18

2.12                Antibiotic sensitivity ………………………………………………....….19

 CHAPTER THREE

3.1                  Sample collection……………………………………………………..….21

3.2                  Media preparation………………………………………………………..21

3.3                  Bacteriology ……………………………………………………………..21

3.4                  Microscopy………………………………………………………...…….22

3.5                  Identification of the isolates…………………………………………......23

3.5.1               Gram staining ………………………………………………………...…23

3.5.2               Biochemical tests………………………………………………...……    23

3.5.2.1            Motility test………………………………………………………......….23

3.5.2.2            Indole test……………………………………………………………..…24

3.5.2.3            Urease test………………………………………………………….……24

3.5.2.4            Catalase test……………………………………………………..……….24

3.5.2.5            Coagulase test…………………………………………………………....25

3.5.2.6            Citrate utilization test…………………………………………………....25

3.5.2.7            Triple sugar iron agar test……………………………………………….26

3.6                  Antibiotic susceptibility testing…………………………………………26

CHAPTER   FOUR

4.1                  Results………………………………………………………….………..28

CHAPTER FIVE

5.1                  Discussion …………………………………………………….………...37

5.2                  Conclusion ……………………………………………………………...40

5.3                  Recommendation…………………………………………………..……40

References

Appendix

LIST OF TABLES

Tables                                                                                Pages

Table 1: Age distribution of the female students used for the study          30                                              

Table 1: Samples obtained from the study population                                       31

Table 3: Identification of the isolates                                             32

Table 4: Frequency of the isolated organisms among the female undergraduates used for the study               33 

Table 5: Prevalence of Urinary Tract Infection among the female students of Michael Okpara University of Agriculture, Umudike with age group                     34

Table 6: Antibiotic sensitivity of the Gram positive isolates from urine culture                   35

Table 7: Antibiotic sensitivity of the Gram negative isolates from urine culture                  36

CHAPTER ONE

1.0  INTRODUCTION

A Urinary Tract Infection (UTI) is a microbial infection of the urethra, bladder, ureter, or kidney. UTIs are serious health problems affecting millions of people each year. They are the second most common type of infections in the body, accounting for about, 8.3 million visits to the hospital each year (UDHHS, 2004). Despite the widespread availability of antibiotics, UTI remains the most common bacterial infection in the human population (Tambekar et al., 2006).

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 microorganisms from the urinary bladder.UTI is a common disorder that occurs in approximately 25% of young women and 5% of all women during their life time. Majority of women have recurrent 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 bacteremia, sepsis or even death. Infection of the urinary tract could manifest differently depending on the site of the infection and the length of time involved (Takhar, 2011). Those that affect the lower urinary tract called cystitis involve the bladder alone with symptoms which include painful urination, burning sensation, frequent urination, or urge to urinate or both. Those that affect the upper urinary tract referred to as pyelonephritis involve the kidneys and other organs, the symptoms include fever, and flank pain during urination in addition to those of the lower urinary tract .

It is caused by a variety of Gram negative and Gram positive bacteria that can live in the digestive tract, vagina or around the urethra. Infection occurs when bacteria enters into the normally sterile urinary system and multiply there. The Gram positive bacteria includes Staphylococcus spp., Streptococcus spp., and Enterococcus spp. The Gram negative bacteria includes a large number of aerobic bacilli which includes Escherichia spp., Klebsiella spp., Enterobacter spp.,Proteus spp., Pseudomonas spp., Salmonella spp. Among these 80-90% of UTI is caused by Escherichia coli. The most frequently isolated ones include Staphylococcus aureus, Klebsiella aerogenes, Proteus mirabilis, Pseudomonas aeruginosa  and  Enterococcus faecalis . Prevalence and occurrence of one or two of these over the other are dependent on the environment (Hill et al., 2001).

In all suspected cases of UTI, culture of the urine is the first step in diagnosis. Urine culture is traditionally the gold standard for diagnosing UTI and though a culture showing no growth essentially rules out UTI caused by the most common organisms, sensitivity and specificity will vary depending on the threshold colony count used and whether a specimen is obtained by catheterization or other methods (Gibson and Toscano, 2012). Urine microscopy looks for the presence of red blood cells, pus cells, bacteria, parasites, and other components.

Drug resistance among bacteria causing UTI has increased since the introduction of UTI chemotherapy. The increased prevalence of drug resistant bacteria has made susceptibility testing particularly important. Antibiotic sensitivity can be tested with these cultures, making them useful in the selection of antibiotic treatment.

UTIs can be prevented by having adequate fluid intake, especially water, not resisting the urge to urinate, taking showers not bath, practicing good hygiene ,cleaning genital area prior to and after sexual intercourse, voiding before and after sexual intercourse and wiping from anterior to posterior. In those with frequent urinary tract infections who use spermicide or a diaphragm as a method of contraception, use of alternative method is advised.

1.1        AIM

This work aims at studying the prevalence of UTI among female undergraduates of Michael Okpara University of Agriculture, Umudike.

1.2        OBJECTIVES

-       To isolate and characterize the organisms that are implicated in these infections.

-       To determine the prevalence rate of UTI among female undergraduates

-       To investigate the prevalence of parasites

-       To carryout antimicrobial susceptibility pattern of the isolates

-       To compare the rate between females living in the school hostel and those  living off campus    

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