COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
CHAPTERS: Chapter 1-5
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ABSTRACT
Urinary tract infections “UTIs” are one of the frequently encountered problems facing the family physician. The study is aimed at identification of bacteria isolates from urinary tract infection among pregnant women. A total of 50 clean midstream urine samples were collected and a general urine microscopic examination and culture were carried out. Susceptibility testing panels of the following antibiotics: Gentamycin, tetracycline amikacin, ampicillin, erythromycin, nalidixic acid, ciprofloxacin, cotrimazasole and cefuroxime were tested against the isolated organisms using disc diffusion method. The bacteriologic agents of UTI isolated from the patients showed that the most common uropathogen isolated from urine of infected subject is Escherichia coli which constituted 18.5% and followed by Staphylococcus aureus (18.5%), Proteus mirabilis (11%), Pseudomonas aeruginosa (11%) and Enterococcus faecalis (7.4%). The distribution of UTI among the ages of the antenatal patients showed that age group within the range of 27-32 years recorded the highest incidence of UTI, whereas those of them above 39 years showed the least incidence. Ciprofloxacin, Gentamicin and Erythromycin were the most active antibiotics, while the isolates were highly resistant to cotrimozasole, cefuroxime and nalidixic acid. The study reveals that UTI is a major health problem among pregnant women. Escherichia coli, Klebsiella pneumonia and Staphylococcus aureus were the predominant uropathogen that causes UTI. All the isolates were sensitive to Gentamicin and Ciprofloxacin. This calls for frequent and consistent evaluation of the prevalence, aetiologic agents and predisposing factors of urinary tract infections during pregnancy in developing countries.
CHAPTER ONE
- INTRODUCTION
Urinary tract infections “UTIs” are one of the frequently encountered problems facing the family physician. UTIs during pregnancy are among the commonest health problems worldwide, especially in developing countries (John and Michael, 2000). Urinary tract infections (UTI), which are caused by the presence and growth of microorganisms in the urinary tract, are perhaps the single commonest bacterial infections of mankind and in pregnancy; it may involve the lower urinary tract or the bladder. UTI has been reported among 20% of the pregnant women and it is the most common cause of admission in obstetrical wards (Theodor, 2007).
UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/ml. of urine with accompanying pyuria (>5 WBCs/HPF) in a symptomatic patient. Particularly in asymptomatic patients, a diagnosis of UTI should be supported by a positive culture for a uropathogen (Emilie and Edward, 2011).
Several physiological, anatomical and personal factors contribute to this problem during pregnancy. For example, urethral dilatation, increased bladder volume and decreased bladder tone with increased urinary stasis. Also physiologic increases in plasma volume decreases urine concentration with up to 70% of pregnant women develop glycosuria which encourages bacterial growth (Lucas and Cunningham, 1993). Urinary tract infection during pregnancy contributes significantly to maternal and perinatal morbidity. Abortion, small birth size, maternal anemia, hypertension, preterm labour, phlebitis, thrombosis and chronic pyelonephritis are related to urinary tract infection during pregnancy (Onuh et al., 2006).
The urinary tract includes the organs that collect and store urine and release it from the body which include: kidneys, ureters, bladder, urethra and accessory structures. Urine formed in the kidney is a sterile fluid that serves as a good culture medium for proliferation of bacteria (Omonigho et al., 2001). UTI is evident by the presence of 105 microorganisms or of a single strain of bacterium per ml in two consecutive midstream samples of urine (Berg, 2005; Davidson et al., 2009).
UTI could be described based on the part of the tract affected, for upper tract it is called Pyelonephritis and the lower part, cystitis (Stamm, 1998). As an anatomical unit, an infection of any part can generally spread to its other parts (Roberts, 1967). The commonest mode of infection is the ascending route, through which organisms of the bowel flora contaminated the urethra, ascends to the bladder and migrate to the kidney or prostrate. Haematogenous spread do occur particularly during neonatal period (Azubuike et al., 1999).
1.1 Factors that predispose an individual to UTI include:
(a) Stasis; a major cause of UTI during pregnancy.
(b) Obstruction of the flow of urine, which could be caused by stone.
(c) Presence of foreign body such as in-dwelling bladder catheter.
(d) A decrease in general body resistance such as observed in malnourished individuals, use of immunosuppressive drugs and disease conditions e.g. diabetes (Olowu, 1996).
The pathological lesions of UTI include urethritis (inflammation of the urethra), cystitis (inflammation of the bladder) etc. infection of the urinary tract puts other parts at risk of infection. It has been recognized for sometime that asymptomatic bacteriuria is common in pregnancy thus women are at increased risk of UTIs.
Nicholson (1989) reported that except for a short period immediately after birth (infant period), females far exceed males in the prevalence of asymptomatic bacteriuria (Weatheral et al., 1988; Omonigho et al., 2001).
Females are more susceptible to colonization with enteric bacteria due to shortness of their urethra. The close proximity of the urethral orifice to the rectum, which is in direct contact with perineal microbes, also makes the females to be more susceptible. In males, the sterility of the proximal two-thirds of the urethra, its longer length and the bactericidal effect of prostatic secretion constitute an excellent immunological defense against bacterial infection (Omonigho et al., 2001).
Also, the anatomical relationship of the female urethra to the vagina makes it liable to trauma during sexual intercourse as well as bacteria being massaged up the urethra into the bladder during pregnancy or childbirth; the moist environment of the females perineum favours microbial growth and predisposes females to bladder contamination (Ebie et al., 2001).
Other factors including improper cleaning of the perineum, the use of napkins and sanitary towel together with pregnancy and sexual intercourse contribute to the higher incidence of UTIs in various women. 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, 2004).
Increase in the concentration of amino acids and lactose during pregnancy are believed to encourage the growth of E. coli in urine (Weatheral et al., 1988). In boys, UTI is a disease of infancy while in girls; a disease of school age with 3 – 5% of girls having asymptomatic bacteruria (Azubuike et al., 1999).
Clinical manifestation of UTI varies but the symptoms range from dysuria, lower abdominal pain, pyrexia of unknown origin and foul smelling urine (Davidson et al., 1989). UTI may generally be diagnosed from the symptoms and laboratory examination of the urine. Criteria for the diagnosis of UTI vary greatly depending on the patients and context. There is considerable evidence of practice variation in the use of diagnostic tests, interpretation of signs or symptoms (Jamieson et al., 2006).
According to Alexander et al., (2006) standard quantitative urine culture should be performed routinely at first antenatal visit. The presence of bacteriuria in urine should be confirmed with a second urine culture. Dipstick testing should not be used to screen for bacterial UTI at first or subsequent antenatal visits. Dipsticks to test only for proteinuria and the presence of glucose in the urine should be used for screening at the first and subsequent antenatal visits as a more cost-effective alternative to multi-reagent dipsticks that detect the presence of nitrite, leucocyte esterase and blood in addition to protein and glucose (Alexander et al., 2006).
The prevalent organisms that are usually isolated from UTIs patients are E. coli, Staphylococcus aureus, Klebsiella aerogenes, Pseudomonas aeruginosa, Proteus spp. Streptococcus faecalis and Enterobacter spp. The prevalence and degree of occurrence of one or two of these organisms over others are dependent on the environment (Omonigho et al., 2001). Gram-negative bacteria
have been found most frequently in UTIs cases by several authors with E. coli and Klebisella spp. being the most predominant organisms (Omonigho et al., 2001; Ebie et al., 2001). Other bacterial pathogens frequently isolated include S. aureus, S. epidermidis and S. faecalis (Eghafona et al., 1988; Omonigho et al., 2001). Stewart et al., (1993) recently reported the isolation of an unusual multiple resistant Corynebacterium from the urine of a comatose patient. The pathogen was reported to be resistant to sulphurfurazole, trimethroprion, nalidixic acid, cefazolin, ofloxacin, ofloxacin, norfloxacin, vancomycin and fusidin (Omonigho et al., 2001).
1.2 AIMS AND OBJECTIVES
The aim of this study is to evaluate the bacteria isolates in urinary tract infection among pregnant women.
1.3 OBJECTIVES
- To isolate and identify bacterial pathogens associated with urinary tract infection.
- To determine the percentage occurrence of isolates from urine samples.
- To determine the antimicrobial susceptibility profile of bacteria associated with urinary tract.
- To determine the Incidence of urinary tract infection in relation to age.