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

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 fifty (50) urine samples were collected from female students in Michael Okpara University of Agriculture, Umudike in a sterile container and was transported to the laboratory for microbial 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 105 cfu/ml were identified by gram stain, motility and biochemical tests. The pure isolates of bacterial pathogens was transferred to Nutrient agar slants and stored in the refrigerator at 40C. The distribution of urinary tract infections among the age group ranged  between 22-24years recorded the highest incidence of (42.1%) while 28-30years recorded the least (5.26%). Microscopic examination of the samples showed the presence of pus cells, epithelia cells, calcium oxalate crystals and yeast cells. The results show that the most common uropathogen isolated from urine of infected subject is E.coli which constituted 60% followed by Klebsiella spp (15%), Proteus spp (15%) while Non Haemolytic streptococcus and Pseudomonas aeruginosa had the least occurrence of (5%) each. On the susceptibility to the selected antibiotics, a significant results was obtained with Ciprofloxacin, Gentamicin and Amoxycillin-clavulanate. The success of Ciprofloxacin could be due to its broad spectrum activities. Other drugs have varying and fair activities on the different isolates. Urine is generally considered to be sterile. Any source of possible infection occurs through urethra which initiates the incidence of infection. The present study revealed a high prevalence rate of UTI among   female students of  Michael Okpara  University of Agriculture, Umudike. Majority of the students are youths, and therefore should be adequately informed and educated on the need of personal and environmental hygiene. The government should ensure that proper toilet facilities are available. I recommend that Urine culture must be done at the first antenatal visit, and repeated cultures should be obtained at different trimesters, because the urine of treated patients may not remain sterile for the entire pregnancy.

TABLE OF CONTENTS

Title Page                                                                                                                                i

Certification                                                                                                                            ii

Dedication                                                                                                                               iii

Acknowledgements                                                                                                                iv

Table of Contents                                                                                                                   v

Lists of Tables                                                                                                                        vii

List of Figures                                                                                                                         ix

Abstract                                                                                                                                   x

CHAPTER ONE

1.0 Introduction                                                                                                                      1

1.1 Aim and Objectives                                                                                                          3

CHAPTER TWO

2.0 Literature Review                                                                                                              4

2.1 Urinary Tract Infection                                                                                                      7

2.2 Epidemiology of Urinary Tract Infection                                                                          9

2.3 Causative Organisms                                                                                                        11

2.3.1 Bacterial UTI                                                                                                                 11

2.3.2 Fungal and Viral UTI                                                                                                    12

2.4 Modes of Bacterial Entry                                                                                                 12

2.4.1 The ascending route                                                                                                       12

2.4.2 Hematogenous route                                                                                                      13

2.5 Pathogenesis of Urinary Tract Infection                                                                          13

2.6 Diagnosis of Urinary Tract Infection                                                                               13

2.6.1Urinalysis                                                                                                                         14

2.7 Treatment of Urinary Tract Infection                                                                               16

2.7.1 Antibiotics Used In the Treatment of Urinary Tract Infection Include                         17

CHAPTER THREE

3.0   Materials and Methods                                                                                                   19

3.1 Sample Collection                                                                                                            19

3.2 Media to Be Used and its Preparation                                                                              19

3.3 Sterilization                                                                                                                      19

3.4 Enumeration of Bacteria from Urine Samples                                                                 20

3.5 Identification and Characterization of Isolates                                                                 20

3.5.1 Gram Staining                                                                                                                20

3.5.3 Motility Test                                                                                                                  21

3.6  Biochemical Cultural Characteristics                                                                              21

 3.6.1  Catalase test                                                                                                                 21

3.6.2      Coagulase Test                                                                                                            21

3.6.3 Citrate Test                                                                                                                    21

3.6.4 Indole Test                                                                                                                     22

3.6.5  Triple Sugar Iron Test                                                                                                  22

3.6.6 Oxidase Test                                                                                                                  23

3.6.7 Urease Test                                                                                                                    23

3.7 Antibiotic Susceptibility Testing                                                                                      23

CHAPTER FOUR

4.0       Results                                                                                                                        25       

CHAPTER FIVE

5.0       Discussion, Conclusion and Recommendation                                                          33       

5.1       Discussion                                                                                                                   33

5.2       Conclusion                                                                                                                  34

5.3       Recommendation                                                                                                       35

References                                                                                                                 

LIST OF TABLES

Table                                                              Title                                                    Page

1                     Demographic data of respondents                                                      26

2                      Morphological and Biochemical Characterization of isolates            27

3                       Frequency of occurrences of isolates                                                28

4                      Antibiotic Susceptibility Pattern of Isolate                                        29

5                      Demographic Data of Respondents                                                    30

LIST OF FIGURES

Figure    Title                                                               Page

1                                   Percentage prevalence of UTI among the sampled population                        31

2                                   Distribution of symptoms among the sampled population                        32

CHAPTER ONE

1.0 INTRODUCTION

Urinary tract infection (UTI) is the infection of any part of the urinary tract which consists of the kidney, ureter bladder, and urethra. Any part of these structures can become infected. However, the infection of the bladder (cystitis) and the urethra (pyelonephritis) are the most common. Most UTIs are caused by bacteria that can live in the digestive tract, the vagina or around the urethra. Bacteria can enter the sterile urinary system through the urethra or more rarely through the blood stream (Feitosa et al., 2009).

The bacteria usually implicated in UTI patients include E. coli, Staphylococcus aureus, Klebsiella aerogenes, Pseudomonas aeroginosa, Proteus spp, Streptococcus facalis and Enterobacter spp (Oladeinde et al., 2015; Okonko et al., 2010; Al-Haddad, 2005). The prevalence and degree of occurrence of one or two of these microorganisms over others are dependent on the environment (Omonigbo et al., 2001).  Gram-negative bacteria have been found to be most frequent in UTI cases (Omonigbo et al., 2001; Ebie et al., 2001). UTI are known for their resistance and exhibit the property of antimicrobial tolerance (Foxman and Brown, 2003).

Stewart et al.,(1993) reported the isolation of an unusual multiple resistance Corynebacterium from urine of a comatose patient. The  pathogen was reported to be resistance to Sulphurfurazole, Trimethroprion, Nalidixic acid, Cefazolin, Floxacin, Norfloxacin, Vancomycin and Fusidin (Omonigbo et al., 2001). In healthy females, the prevalence of bacteriuria increases with age from 1% in females within 5-14 years of age to more than 20% in females at least 80 years of age (Colgan et al., 2006). This is higher among individuals in lower socioeconomic classes and those with past history of UTI (Turpin et al., 2007). Sickle cell trait, diabetes mellitus and grand multiparity have been reported to cause two-fold increase in the rate of bacteriuria (Enayat et al., 2008). There is also increase in the risk of developing UTI due to sexual activity, catheterization, contraceptive usage, urethral structure, kidney stone, etc (Emiru et al., 2013; Aboderin et al., 2009; Ramzan et al., 2004).

Urinary tract infection(UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections and also the most common cause of both community-acquired and hospital acquired (nosocomial) infections for patients admitted to the hospitals (Najar et al.,2009). UTI can be asymptomatic or symptomatic characterized by a wide range of symptoms from mild voiding irritation to bacteraemia, sepsis or even death (Ranjbar et al., 2009).

Infection of the urinary tract could manifest differently depending on the site of the infection and length of time involved (Takhar, 2011). Those that affect the lower urinary tract are called cystitis(i.e. involving the bladder alone with symptoms including painful urination, burning sensation, frequent urination or urge to urinate or both while those that affect upper urinary tract are referred to as pyelonephritis(i.e. involve the kidneys and other organs (Sarah,2010). The symptoms of the upper urinary tract infection include fever and flank pain during urination in addition to those of the lower urinary tract (Sarah 2010).

Urinary tract infection occurs more frequently in females than males due to the shortness and width 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 during pregnancy (Ebie et al., 2001). The moist environment of the female’s perineum favours microbial growth and predisposes the female bladder to bacterial contamination (Ebie et al., 2001). In addition, urine of females was found to have more suitable pH and osmotic pressure for the growth of Escherichia coli than urine from males (Obiogbolu et al., 2004).

Most UTIs are caused by gram negative bacteria like Escherichia coli and Klebsiella spp (Omonigho et al., 2001; Ebie et al.,2001). Other bacterial pathogens frequently isolated include gram positive bacteria such as Staph. aureus, Staph. epidermidis and Enterococcus spp formerly called Strept. Faecalis as well as Proteus mirabilis, Pseudomonas aeruginosa, coagulase negative staphylococci, Acinectobacter spp and Serratia spp (Ebie et al.,2001).

Knowledge of the local bacterial aetiology and susceptibility pattern is required to trace any change that might have occurred with time so that updated recommendation for optimal empirical therapy of UTI can be made (Ebie et al.,2001). A number of studies have been done on the prevalence and antimicrobial resistance patterns of UTIs (Okonko et al., 2010).

1.1 AIM AND OBJECTIVES

The aim of this study is to assess the urinary tract infection among female students of Michael Okpara University of Agriculture, Umudike.

The objectives are:

1.     To isolate and identify bacterial pathogens associated with urinary tract infection.

2.     To determine the percentage occurrence of isolates from urine samples.

3.     To determine the antimicrobial susceptibility profile of microorganisms associated with urinary tract infection.

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