Prevalence And Antimicrobial Susceptibility Of Gram Negative Bacteria In The Urine Of Varitas University Students

Description

ABSTRACT

Urinary tract infection (UTI) remains to be one of the most common infectious diseases diagnosed in developing countries. And a widespread use of antibiotics against uropathogens has led to the emergence of antibiotic resistant species. A laboratory based cross-sectional survey was conducted in Varitas University Microbiology Laboratory to determine the prevalence and antibiotic susceptibility of uropathogens. In order to access the prevalence and sensitivity pattern of urinary pathogens, 60 midstream urine samples from students of Varitas University were investigated using cultural methods. Samples were examined microscopically and cultured in blood agar and Macckonkey agar. Disk diffusion method was used for antibiotic testing. Of the 60 urine samples 48 yielded significant growth with a prevalence rate of 80%. It was observed that females were more infected than the males with a prevalence rate of 56.70% and 43.30% respectively under the ages of 18-25yrs. Escherichia coli was the most predominant. The isolates were very sensitive to Gentamycin, Nitrofurantoin and Ofloxacin which were the (most sensitive) and the most resistant were Tetracycline, Cortrimozol, Cephalexin and Ampicillin. Therefore, Nitrofurantoin, Gentamycin, Ofloxacin were strongly recommended for the treatment of UTI as indicated in the study.

ABBREVIATIONS

BUG	BiOLOG Universal Growth medium
DM	Diabetes mellitus
MUSC	Microbial Urethral Stent Colonization
TMP-SMX	Trimethprime-Sulfamethoxazole
UTI	Urinary Tract Infection

 

TABLE OF CONTENTS

COVER PAGE

TITLE PAGE

APPROVAL PAGE

DEDICATION

ACKNOWELDGEMENT

ABSTRACT

CHAPTER ONE

• INTRODUCTION
• BACKGROUND OF THE PROJECT
• PROBLEM STATEMENT
• AIMS AND OBJECTIVES
• SIGNIFICANCE OF THE PROJECT
• SCOPE OF THE PROJECT
• RESEARCH QUESTIONS
• DEFINITION OF TERMS

 

CHAPTER TWO

2.0      LITERATURE REVIEW

• REVIEW OF THE STUDY
• RISK FACTORS OF UTI
• SYMPTOMS OF UTI
• URINARY TRACT INFECTIONS REVIEW
• CAUSES OF URINARY TRACT INFECTIONS (UTIS)

CHAPTER THREE

3.0      METHODOLOGY

• INTRODUCTION
• ETHICAL APPROVAL
• STUDY AREA
• STUDY SAMPLES AND THE SITE
• LABORATORY TECHNIQUES
• ANTIBIOTIC SUSCEPTIBILITY ASSAY OF BACTERIAL ISOLATES
• BACTERIAL INOCULUMS

CHAPTER FOUR

• RESULTS AND DISCUSSION
• RESULT
• DISCUSSION

CHAPTER FIVE

• CONCLUSION
• REFERENCES

CHAPTER ONE

1.0                                               INTRODUCTION

1.1                                 BACKGROUND OF THE STUDY

Gram negative bacteria are bacteria that do not retain their crystal violet dye in the gram staining protocol. They are differentiated by their cell wall structure. The following characteristics are displayed by gram negative bacteria as follows Cytoplasmic membrane Thin peptidoglycan layer(much thinner than gram positive) Outer membrane containing lipopolysaccharide outside the peptidoglycan layer Porin exists in the outer membrane, which acts like pores There is a space between the layer of peptidoglycan and the secondary cell membrane, called the periplasmic space If present, flagella have four (4) supporting rings instead of two No techoic acid or lipopolysaccharide Some examples of gram negative bacteria include; Escherichia coli, Salmonella species, Pseudomonas species, Klebsiella species, Proteus species, Helicobacter species, Mosoxella species, Cyanobacteria species, Spirochetes species.

They also constitute a serious problem in urinary tract infections in many parts of the world. Appropriate antimicrobial treatments are often critical to decreasing morbidity and mortality among hospitalized patients having the infections caused by the pathogens. Gram negative bacteria are non-spore forming bacilli that grow rapidly on ordinary laboratory media under both aerobic and anaerobic conditions. It has been estimated that symptomatic urinary tract infects (UTI) occurs in as many as 7million visits to emergency units and 100,000 hospitalised annually. UTI has been the most common hospital acquired infections, accounting for as many as 35% of nosocomial infection. It is the second most common cause of bacteraemia in hospitalised patients (Nacem, 2000). UTI is known to occur in all populations but has a particular impact on females of all ages and males at two extremes of life, immuno-compromised patients and anyone with function or structural abnormalities of the urinary and excretory system.

UTI is known to be the microbial invasion of any of the tissues of the urinary tract reaching from the renal cortex to the urethrameatus (Nicolle, 2000). It is also known to be the presence in two consecutive urine samples of greater than 100rods (105 ) organisms per ml of a single bacterial strain in the urinary tract. UTI can be categorized in ascending or descending. Infections which are confined to the urethral or the bladder are ascending and referred to as uretitis or cystitis respectively. On the other hand, the pathogens spread from one or other infected body site to the kidney down along the ureter to the bladder. Such descending UTI cause severe kidney infection, a condition called pyelonephritis (Parsons, 1958). This is potentially more serious; infections to the urethra are called urethritis and to the prostrate gland are called prostitis. This classification is the presence or absence of symptoms, reoccurrence or absence or presence of complicating factors which are host factors facilitating establishment and maintenance of bacteraemia or worsening the prognosis of UTI`s engaging the kidney.

Majority of pathogens are gram negative species with predominance of members of Enterobacteriace (Neu, 1992). Escherichia coli accounts for majority of urinary tract infections in young women but other gram negative rods of different genera such as proteus species and pseudomonas aeruginosa an aerobic gram negative rod is also troublesome. As a urinary tract pathogens because of its resistance to antimicrobial medicine make it difficult to treat successfully (Nester et al. 1998). Antibiotics are used for the control of bacterial infections in human. Generally, gram negative bacteria are sensitive to many antimicrobial agents but strains from different patients and carriers differ in the pattern and degrees of sensitivity to different drugs. Increasing antimicrobials resistance in bacterial pathogen is a worldwide concern. The prevalence of antimicrobial resistance among urinary tract infectious agents is also increasing (Mathai et al. 2001 : Karaloswsky et al. 2001) and its treatment has become more complicated due to increasing resistance and empirical therapy leading to treatment failures of most associated with gram negative bacteria (Blondeau et al. 1999). The present study investigated the pattern of gram negative uropathogens and their antimicrobial resistance pattern among the clinical isolates to the commercially available antibiotics that are often prescribed in urinary tract infectious cases.

1.2                                   PROBLEM STATEMENT

Urinary tract infections (UTIs) are the most common infections in humans that can affect any part of the urinary system including kidneys, ureters, bladder, or urethra. It is estimated that approximately 150 million cases occur yearly globally eachyear [1]. Clinically, UTI is categorized as uncomplicated or complicated cases. Uncomplicated UTIs occur in healthy individuals and usually can be cured within 3 days of treatment. These infections are more common causing cystitis (lower UTI) and pyelonephritis (upper UTI) [2,3]. Numerous risk factors can increase the likelihood of developing a UTI, including female gender, sexual intercourse, poor personal hygiene, diabetes, obesity, vaginal infections and heavy use of antibiotics [4]. In contrast, complicated UTIs are found in an individual with factors that compromise the urinary tract or immune system, such as immunosuppression, renal failure, renal transplantation, pregnancy, problems of emptying the bladder completely, kidney stones and the presence of foreign bodies particularly indwelling catheters [5]. Additionally, this type of UTI requires longer periods of antibiotic treatment [6].

The leading pathogens of UTIs are caused mainly by Gram-negative bacteria including uropathogenic Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Proteus mirabilis and Pseudomonas aeruginosa (P. aeruginosa). Gram-positive bacteria like S. aureus, Staphylococcus saprophyticus (S. sap- rophyticus), Enterococcus faecalis (E. faecalis) and Streptococcus agalactiae (S. agalactiae), and yeasts like Candida spp. are also an important cause of UTIs [1].

Recently, The Center for Disease Control and Prevention (CDC) declared that the human race is now in the post-antibiotic era [7]. The World Health Organization (WHO) also warned that the antibiotic resistance crisis is becoming serious all around the world [7].

For this reason, we conducted  this  investigation in order to determine the prevalence of bacterial pathogens causing UTIs Gram-negative bacteria and their antibiotic susceptibility profiles of urine of Varitas University Students.

1.3                                                       AIMS AND OBJECTIVES 

To find out the prevalence of gram negative organisms in the urinary tract among Varitas university students. To investigate their antibiotic sensitivity pattern to enable formulation of drugs for urinary tract infection in our community. To determine the age and sex prevalence. To determine the prevalence of bacterial strains and their antimicrobial susceptibility in urine. To find the pathogenic bacteria commonly responsible with UTI and susceptibility patterns this will help the clinicians to choose the right empirical treatment.

1.4                             SIGNIFICANCE OF THE STUDY

This work exposes us the knowledge of Gram-negative bacteria as the leading pathogens of urinary tract infections (UTIs).

This study is useful in increasing awareness about the importance of maintaining clean environment in order be free from uninary track infection.

1.5                                                   SCOPE OF THE STUDY

This study discusses about Urinary tract infection (UTI) which is one of the most common bacterial illnesses associated with leading cause of morbidity and health care expenditures in persons of all ages (Kunin CM, 1994). A variety of organisms entering the urinary tract establish bacteriuria often at levels more than or equal to 10⁵ colony forming units of bacteria/ml of urine. It can affect both individual patients as well as in patients staying in hospital for long period especially in adult patients when they are some kind of incubations such as catherization and venous shunt. Several studies reported that hospital acquired UTI is about 33% (Gupta et al., 2001). Majority of pathogens are gram-negative species, with predominance of members of Enterobacteriaceae (Neu, 1992). Increasing antimicrobial resistance in bacterial pathogens is a worldwide concern. The prevalence of antimicrobial resistance among UTI agents is also increasing (Mathai et al., 2001; Karlowsky et al., 2001) and  its treatment has become more complicated due to increasing resistance and empirical therapy leading to treatment failures mostly associated with gram-negative bacteria (Blondeau et al., 1999). The present study investigated the pattern of gram-negative uropathogens and their antimicrobial resistance pattern among the clinical isolates to thirteen commercially available antibiotics that are often prescribed in UTI cases.

1.6                                                  RESEARCH QUESTIONS

At the end of this work, student involved shall be able to give answers to the following questions:

1. What is the meaning of urinary tract infection?
2. How does urinary tract infection affect human being?

• What are the symptoms of urinary tract infection?

1.7                                                  DEFINITION OF TERMS

i. urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra.

ii. Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder.

iii. Urination results in urine being excreted from the body through the urethra.