PREVALENCE OF URINARY TRACT INFECTION IN DIABETIC PATIENTS ATTENDING UMUAHIA HEALTH CARE FACILITIES

 ABSTRACT

Diabetes is a polygenic disease characterized by abnormally high glucose levels in the blood. There is evidence that patients with diabetes have an increased risk of Urinary Tract Infections (UTIs). UTI is the most common bacterial infection in diabetic patients. The study population included diabetic patients and non diabetic patients (attending five different Umuahia Health Care Facilities). Urine culture was carried out on the urine samples collected using MacConkey media. A total of four genera of bacteria were isolated namely; Escherichia coli, Staphylococcus aureus, Klebsiella spp and Pseudomonas spp. 70% of diabetics had positive urine cultures while 56% of non-diabetics had positive urine cultures. The most frequent bacteria isolated was Escherichia coli with a percentage value of 34.28%. The isolated micro-organisms were more sensitive to Gentamycin, Streptomycin and Ciproflox and more resistant to augmentin, ampicillin and ceporex. UTIs are frequent in diabetics, a great proportion of asymptomatic forms exist among diabetic patients therefore urine culture should be performed in all patients with diabetes.

TABLE OF CONTENTS

Certification i

Dedication ii

Acknowledgement iii

Table of Content iv

List of Tables vi

List of Figures                                                                                                                  vii

Abstract viii

CHAPTER ONE

1.0 INTRODUCTION 1

1.1 Objective of the study 3

1.3 Scope of study 4

CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Definition of urinary tract infection 5

2.2 Urinary tract infection in diabetic patients 5

2.2 Route of infection 6

2.3 Definitions 7

2.4 Factors contributing to urinary tract infection 9

2.4.1 Infections beginning in the urinary tract 10

2.5 Clinical features of urinary tract infection in diabetic patients 10

2.5.1 General features of UTI 11

2.5.2 Symptoms and signs of lower UTI 11

2.5.3 Symptoms of upper UTI 12

CHAPTER THREE

3.0 MATERIALS AND METHODS

3.1 Study area 13

3.2 Study population 13

3.3 Specimen collection 13

3.4 Isolation of micro-organisms 13

3.5 Characterization and identification of isolated micro-organisms 13

3.6 Gram stain 14

3.7 Biochemical tests 14

3.8 Antibiotic sensitivity test 17

3.9 Statistical analysis 18

CHAPTER FOUR

4.0 RESULTS 19

CHAPTER FIVE

5.0 DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 Discussion 29

5.2 Conclusion 30

5.3 Recommendation 30

REFERENCES

LIST OF TABLES

TABLE                   TITLE                                                                                          PAGE

1   Antibiotics for sensitivity test 17

2 Identification of isolates 21

3    Frequency of isolated organisms in diabetics compared to non-diabetics 22

4     Prevalence of organisms isolated from diabetics and non-diabetics 23

5    Antibiotic Sensitivity/Resistance Profile 26

7   Antibiotic Sensitivity/Resistance Profile 27

Table 8:    Antibiotic Sensitivity/Resistance Profile 28

LIST OF FIGURES

Fig. 1:    Bacteria Isolates Distribution of Diabetic and Non-Diabetic Subject 24

CHAPTER ONE

1.0 INTRODUCTION

The prevalence of diabetes mellitus has increased over the past decades, and it is now approaching epidemic proportions (International Diabetes Federation, 2012). Worldwide, 371 million people have diabetes and it is estimated that by 2030 this number will reach 552 million. Changes in lifestyle, aging of the population and the increasing prevalence of obesity are responsible for this dramatic situation (Ribera et al., 2006). Diabetes is one of the top ten causes of death in the world and this fact is due especially to its complications. With  the  growing  number  of diabetic  patients,  the  prevalence  of urinary tract infections has  also  increased. Hyperglycemia  and  hypertension  are  the major  risk  factors  for  initiation  of  chronic kidney  disease but  other  factors,  such  as repeated  episodes  of  acute  kidney  injury (infections,  drugs,  or  nephrotoxins)  can  also contribute to its progression (WHO, 2006). In diabetic patients, it is generally accepted that infections are frequent causes of morbidity and mortality.  Immunologic defects  contribute  to  the  increased  risk  for infection:  impaired  neutrophil  function,  low levels  of  prostaglandin  E,  thromboxane B2,leukotriene  B4,  decreased  T  cell-mediatedimmune  response,  etc. (Geerlings, 2008). Other conditions  such  as  incomplete  bladder emptying  due  to  autonomic  neuropathy  and high  glucose  concentration  in  the  urine  allow urinary  colonization  by  microorganisms (Chin-Hong, 2006). The presence of bacteria in urine is bacteriuria.There  is  evidence  that  patients  with diabetes  have  an  increased  risk  of asymptomatic  bacteriuria  and  urinary  tract infections (UTIs) with UTIs being the most common  bacterial  infections  in  diabetic patients (Bonadioet al., 2006). The increased prevalence of asymptomatic bacteriuria (ASB) and symptomatic UTI in diabetic patient may be the result of difference in host responses between diabetic and non-diabetic patients or to a difference in infecting bacterium itself (Greelings, 2006).Patients with diabetes have a 10-fold increased risk of UTI when compared to non-diabetics (Goswaniet al,2001) and diabetics have a longer hospitalization than non-diabetics (Moreno et al, 1999). Diabetics are more prone to UTIs and to upper UTI (Geerlings, 2008). The reason for this predisposition is not completely understood, but the most important is likely to be bladder dysfunction caused by diabetic neuropathy. In diabetic women, there is higher incidence of bacteriuria and of asymptomatic kidney infection. UTIs are more common in women than men. Females are more commonly affected with UTI than males and are about thirty times more common among females than males (Geerlings, 2008). UTIs occur in females throughout life and tend to increase with age (Razet al.,1992). Silent infections occur about 1% for each ten years of life. They can suddenly become symptomatic and produce considerable discomfort particularly among women prone to repeated infections and during the last three months of pregnancy (Stamm,1982). About half of adult women report that they have had a UTI at some time during their life.

Diabetics as a whole suffer more UTIs than non-diabetics(Foxman, 2002). A study by Janifer, Geethalakshmi, Satyavani K, and Viswanathan(2009) found that the prevalence of lower urinary tract infection was significantly higher in female patients than in male type 2 diabetic patients. Evidence from various epidemiological studies showed that UTI is more common in women with diabetes than those without diabetes (Janiferet al., 2009). Urinary tract infection appears to be multifactorial in patients with diabetes and various diabetes related risk factors have been proposed. The study by Janiferet al., (2015) on prevalence of urinary tract infection in patients with diabetes found that age, longer duration of diabetes, and poor glycemic control were significantly associated with urinary tract infection. Shkurti (2015) also confirmed that diabetes predisposes patients to the risk of urinary tract infections due to the changes in bladder function and in circulation. UTIs are more frequent and are likely to have a more complicated course in patients with (DM).

Bacteriological studies  usually reveal the involvement of gram negative enteric organism that commonly cause urinary tract infections, such as E. coli, Klebsiella spp, and Proteus spp. (Shkurti, 2015). Studies have shown that urinary tract infections due to Enterococci are quite common, particularly in patients who have received antibiotic treatment (Janiferet al., 2009)

This increase is confined largely to those patients with long- standing diseases and neuropathic bladder dysfunction. Young diabeticsare not at risk of UTIs (Souhami and Moxham,1994). Moreover  it is  important  to recognize and to treat UTIs in diabetic patients because  of  their  possibly  severe complications,  including  bacteremia,  renal abscess,  renal  papillary  necrosis.

The most common organisms causing UTIare Escherichia coli (E. coli), Proteus, Klebsiella spp, Staphylococcus aureus, Pseudomonas spp (American Diabetic Association, 2012).These organisms originate mainly from endogenous colonic flora. Pyuria itself is a poor indication of infection (Acharyet al.,1980). In diabetic patients, screening for UTI is very important to enable it to be properly treated and to prevent the development of possible complications.

1.1 OBJECTIVE OF THE STUDY

a) To assess the prevalence of urinary tract infection among diabetic patients attending Umuahia health care facilities.

b) To isolate and characterize the micro-organisms responsible for UTI in diabetic patients.

c) To compare the frequency of UTI in diabetic and non-diabetic patients attending Umuahia health care facilities.

d) To identify the antibiotic sensitivity pattern of the various micro-organisms isolated.

1.3 SCOPE OF STUDY

The study was carried out using urine samples collected from diabetic patients and non-diabetic patients in five Umuahia health care facilities.

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