URINARY TRACT INFECTION AMONG FEMALE STUDENTS IN A TERTIARY INSTITUTION

ABSTRACT

The aim of this study is to evaluate the urinary tract infection among female students of Michael Okpara University of Agriculture, Umudike. A total of hundred (100) mid stream urine samples were collected from female students in Michael Okpara University of Agriculture, Umudike in a sterile container and was taken immediately to the laboratory for bacteriological analysis. The mid stream urine samples were cultured on MacConkey and blood agar by streak method. This was incubated at 370C for 24hrs. Those that gave significant growth were identified by gram stain, motility and biochemical tests.  Age group 21-25 years had the highest prevalence rate (62.5%), followed by age group 26-30 years (25%), while ages 16-20 years recorded the least with (12.5)%. The results show that the most common uropathogen isolated from urine of infected subject is Escherichia coli and were responsible for the cases of urinary tract infection. This was followed by Proteus (5%), Pseudomonas aeruginosa (5%), Staphylococcus saprophyticus (4%), Staphylococcus aureus (4%) while Alpha Haemolytic streptococcus (1%) had the least frequency of occurrence. On the susceptibility to the selected antibiotics, an encouraging results were obtained with Ciprofloxacin, Gentamycin and Amoxycillin/clavullanic acid. The present study revealed a high prevalence rate of UTI among   female students of  Michael Okpara  University of Agriculture, Umudike.  However, it may be necessary to improve the level of sanitation in university the community. Since UTI may be symptomatic  or asymptomatic in most cases, it is therefore suggested that routine screening of patients with unexplained cases of fever be done and if UTI the appropriate antimicrobials administered after sensitivity tests have been carried out.

TABLE OF CONTENTS

Title page                                                                                                                                 i

Certification                                                                                                                            ii

Dedication                                                                                                                              iii

Acknowledgment                                                                                                                   iv

Table of content                                                                                                                      v

List of tables                                                                                                                           viii

List of figures                                                                                                                         ix

Abstract                                                                                                                                   x

CHAPTER ONE

1.1       Introduction                                                                                                                1

1.1       Aim and Objectives                                                                                                   4

1.2       Objectives                                                                                                                   4

CHAPTER TWO

2.0       Literature Review                                                                                                       5

2.1       Epidemiological of UTI                                                                                              5

2.2       Aetiology                                                                                                                    7

2.3       Bacterial UTI                                                                                                              7

2.4       Fungal and viral UTI                                                                                                  8

2.5       Modes of bacterial entry                                                                                             8

2.5.1    The ascending route                                                                                                    9

2.5.2    Haematogenous route                                                                                                 9

2.6       Pathogenesis of UTI                                                                                                   9

2.7       Clinical manifestations of urinary tract infections                                                     10

2.7.1    Asymptomatic bacteriuria                                                                                          10

2.7.2    Cystitis                                                                                                                        11

2.7.3    Acute pyclonephritis                                                                                                  11

2.8       Diagnosis of urinary tract infection                                                                            12

2.9       Laboratory detection of urinary tract infection                                                          12

2.10     Diagnosis of urinary tract infection                                                                            13

2.11     Laboratory detection of urinary tract infection                                                          13

2.11.1  Dipstick urinalysis                                                                                                      13

2.11.2  Microbiological culture                                                                                              15

2.12     Treatment                                                                                                                   16

2.13     Prevention of UTI                                                                                                       16

CHAPTER THREE

3.0       Materials and Methods                                                                                               18       

3.1       Sample collection                                                                                                       18

3.2       Media to be used and its preparation                                                                          18

3.3       Sterilization                                                                                                                18

3.4       Enumeration of bacteria from urine samples                                                             18

3.5       Identification and characteristics of isolates                                                              19

3.5.1    Gram staining                                                                                                             19

3.5.2    Motility test                                                                                                                19

3.6       Biochemical culture characteristics                                                                           20

3.6.1    Catalase test                                                                                                                20

3.6.2    Coagulase test                                                                                                             20

3.6.3    Citrate test                                                                                                                   20

3.6.4    Indole test                                                                                                                   20

3.6.5    Triple sugar iron test                                                                                                   21

3.6.6    Oxidase test                                                                                                                21

3.6.7    Urease test                                                                                                                  21

3.7       Antibiotics susceptibility testing                                                                                22

CHAPTER FOUR

4.0 Results                                                                                                                              23

CHAPTER FIVE

5.0 Discussion, Recommendation and Conclusion                                                                32

5.1       Discussion                                                                                                                   32

5.2       Conclusion                                                                                                                  34

5.3       Recommendation                                                                                                       35

References

LIST OF TABLES

Table                          Title                      Page

 1       Demographic data of respondent                                                                                  24

2        Microscopic examination of urine samples                                                                  25

3          Frequency of positive isolates from urine samples of female students

          in relation to age groups                                                                                                    26

4          Morphology and biochemical identification of isolate                                              27

5          Frequency of bacterial isolates from female students                                                28       

6          Distribution of bacteria susceptibility to antibiotics                                                  29

LIST OF FIGURES

Figures                                     Title                    Page

1                      Distribution of symptoms among the sampled population                                    30

 2                     Percentage prevalence of UTI among the sampled population                   31

CHAPTER ONE

1.0   INTRODUCTION

Urinary tract infection (UTI) is defined as the bacterial invasion of the urinary tract. Microorganisms form a bulk of the earth’s biomass and ability to adapt to newly found environment makes them beneficial or pathogenic (Singh et al., 2009). Urinary tract infection are the most common of all bacterial infections that occur at any time in the life of an individual, both in the community and hospital settings. Although everyone is prone to UTI, it is age and sex specific. There are specific subgroups that are at greater risk of contracting UTI. These subgroups include infants, pregnant women, the elderly, and patients with spinal cord injuries and/or catheters (Biering-Sørensen et al., 2001;Ruben et al., 1995; Winberg et al., 1974). Almost 95% of the cases of urinary tract infections are caused by bacteria that multiply at the opening of the bladder. Much less often, bacteria spread to the kidney from the blood stream (Hooton and Stamm, 2007). It is primarily caused by Escherichia coli (E.coli), accounting for 75% of bacterial UTI cases.  Pseudomonas aeruginosa and Enterococcus faecalis have been reported as causative agents by studies in Ghana, Nigeria and other parts of the world (Antwi et al., 2008;  Boye et al., 2012; Gyansa-Lutterodt et al., 2014).

 UTI occurs as a result of significant microbial growth in the urinary tract, especially between the urethra and the kidneys. Thus, the classification of UTI is based on the site of infection. Infection of the bladder is known as cystitis, and infection of the kidneys is called pyelonephritis. It can also be classified clinically as either complicated or uncomplicated depending on the extent of infection (Bennett et al., 2014). Complicated urinary tract infection is known to occur in men and women at any point of their lives and usually has the tendency to produce severe outcomes resulting in death in serious situations. They are highly intricate and are difficult to treat. Complicated urinary tract infections can lead to structural abnormalities that blight the capability of the urinary tract to flush out the urine hence bacteria are provided with better scope for growth (Fihn, 2003). On the contrary, uncomplicated UTI are due to a bacterial infection, most often E. coli. They affect women much more than men. Cystitis is the most common urinary tract infection which occur in the lower part of the urinary tract (bladder and urethra) and nearly always in women. In most cases the infection is brief and acute, only the surface of the bladder is infected. Deeper layer of the bladder may be harmed if the infection becomes persistent or chronic or if the urinary tract infection is structurally abnormal. Pyelonephritis spread to the upper tract (ureters and kidney) (Foster, 2008).

Globally, UTI is a major public health burden leading to increased morbidity and the associated high healthcare cost (Hooton et al., 1995; Orenstein and Wong, 1999). It is   the second most common infection among patients visiting primary healthcare facilities. In United states, where comprehensive data is available, it is estimated that UTI accounts for seven million hospital visits per year, with millions of those infections leading to visits at the emergency department (Foxman, 2002). The associated cost of health care is enormous accounting for $659 million in direct cost for treating and $936 million in indirect cost, totaling to $1.6 billion annually (Foxman, 2002). Worldwide, it is evident that UTI is more common among young girls, except in neonatal period where boys predominate (Foxman, 2002). Furthermore, it is estimated that about 20% of all women develop UTI during their lifetime (Fihn, 2003). A number of studies have been conducted in the sub-region that suggested a range of prevalence of UTIs in some selected populations. Reports have indicated that most of these studies were done on febrile and malnourished infants and children below age 12 years, with study sites being primarily hospitals and other health facilities (Wolff and Maclennan). In addition, a few studies were done on male and females adults, including pregnant women. In Kenyatta National Hospital, a cross sectional study on antenatal women presenting with lower abdominal pains showed a prevalence of 26.7% bacterial urinary tract infection (Nabbugodi, 2009).

A demonstrative study conducted at a large Ghanaian hospital in Accra showed that 93% of isolates from urine samples were bacteria species and 7% were yeast (Odonk et al., 2011).Antibiotics play an important role in minimizing morbidity and mortality associated with infectious diseases. The most common antibiotics used for the treatment of UTI are cefuroxime, amoxicillin/clavulanic acid, trimethoprim/sulpmethoxazole and fluoroquinolones. However, the efficacy of these treatment is affect by bacterial resistant to many of the antibiotics leading to treatment failure, spread of resistant bacterial strains, increased morbidity and ultimately high cost of treatment. The extensive and inappropriate use of antimicrobial agents has invariably resulted in the development of antibiotic resistance which, in recent years, has become a major public health problem worldwide (Gupta et al., 2001; MordiandErah, 2006). Furthermore, antibiotic resistance is compounded by the unorthodox treatment of patients with suspected UTI with antibiotics without a valid microbial culture and sensitivity laboratory results. One way to avert this problem is detailed knowledge on the prevalence of bacteria causing UTI and their antibiotic susceptibility pattern. Thus, this study investigated the prevalence and antibiotic susceptibility pattern of Uropathogenic bacteria isolated from urine samples of female students with suspected UTI, in MOUAU.

1.1      Aim and Objectives

The aim of this study is to determine the prevalence and antibiotic susceptibility pattern of Uropathogenic bacteria in urine samples of patients with suspected UTI in MOUAU.

1.5       Specific objectives.

1.     To determine the spectrum of bacteria causing UTI  amongst the subjects

2.     To determine the prevalence of bacteria causing UTI amongst female students with suspected UTI in MOUAU

3.     To determine the antibiotic susceptibility of bacteria isolated from urine samples of female students with suspected UTI.

4.     To determine the association between the isolated bacteria species and demographic characteristics of study participants.

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