COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
CHAPTERS: Chapter 1-5
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INTRODUCTION
Urinary tract infection (UTI) is the colonization of the urinary tract by pathogenic microorganisms. Infection is caused by fungi, bacteria and viruses. The infection has prolonged admissions in hospital, morbidity in general population and high financial cost implications to the patients (Ramakrishnan and Scheid, 2005, Prakash and Saxena, 2020). Majority of UTIs are caused by bacteria that are found in the bowel and live as normal flora and often result from faecal and perineal areas. These organisms are capable invading the tissues of the urinary tract and adjacent tissues causing lower urinary tract infections and upper tract infections (Shilpi et al., 2012; Kumar et al., 2020). UTI is a common condition that is found in very young children as well as older people (Tamber et al., 2006; Manikandan and Amsath 2020). In general population and hospital set up, UTI is a common infection although there are new and more powerful antibiotics in use but bacterial resistance persists (Patel et al., 2012). The spectrum of causative agents and their antimicrobial resistance pattern has been dynamic worldwide (Annapurna and Lakshmi, 2020).
Urinary tract infection may lead to life threatening complications and death (Gupta et al., 2001). Urine culture is the most effective diagnosis of UTI and treatment (Onuoha and Fatokun, 2014). Lower UTI (cystitis) and upper UTI (pyelonephritis) are the two clinical entities mostly found in patients with symptomatic UTI. Lesions caused by UTI are severe and contribute to morbidity in the population resulting in loss of renal function, which leads to long-term illness (Lane and Mobley, 2007).
Urine pass through the urethra allows the entry of uropathogens into the urinary tract initiating an inflammatory response, colonize urine in the urethra and if not washed out during urination culminating into a bacterial infection. Due to their anatomical orientation: that is the short distance between the anus and vagina women are at a higher risk of getting UTIs (Foxman, 2010). A second re-infection occurs in about 50 % of all women with a first UTI within six months (Ehinmidu, 2003). Bacteria establish infection in the urinary tract only after overcoming possible elimination by normal flora during micturation and innate host defense mechanism in the bladder
(Gupta et al., 2001).
Only about 2-5 % of documented UTIs are acquired hematogenously and usually result from bacteremia caused by relatively virulent organisms such Salmonella spp. and Staphylococcus aureus (Karlowsky et al., 2002). Common symptoms of UTIs include burning sensation during urination, loss of bladder control, increased frequency of urination especially in small amounts, low back pain, cloudy and bloody or foul-smelling urine (Onifade et al., 2011).
Multidrug resistance should be monitored worldwide and surveillance systems should be used to determine the aetiology for UTIs (Kimando et al., 2010). There is a worldwide setback in management of many bacterial infectious diseases due to antibiotic resistance. It is estimated that globally 26 % of deaths are due to infectious diseases such as UTIs of which 98 % occur in low income countries. Nigeria is among the low-income countries thus bears impact of urinary tract infections (Wamalwa, 2020).
Being the second most common infectious disease in the community and hospitalized patients, UTI has globally affected over 150 million people per year which costs global economy more than 6 billion US dollars (Alemu et al., 2012; Onuoha and Fatokun, 2014). Worldwide, infectious diseases cause a significant amount of financial burden and morbidity (Kolawole et al., 2009; Tiruneh et al., 2014). In the USA, about 7 million patients who visit the clinicians are diagnosed with UTI while more than 100,000 are hospitalized annually. In community and hospital acquired bacterial infections there has been a growing concern worldwide due to UTIs caused by multidrug resistant uropathogens (Radyowijati and Haak, 2003; Alemu et al., 2012). There is pressure resulting from intensive and indiscriminate use of antibiotics in treatment leading to a rapid spread of antimicrobial agent resistance genes to uropathogens. A global concern is on the rise over rapid dissemination of drugresistant bacteria creating serious complications on the treatment of infectious diseases. A major concern to clinicians is the increase in the number of resistant and multi-resistant strains of bacteria and the decline in the number of new antibiotics available for treatment of UTIs (Annapurna and Lakshmi, 2020).
The prevalence of UTI in Uganda was reported as 10 % (Mwaka et al., 2011) while in Nigeria it was 24 % (Kebira et al., 2009) and in Lagos National Hospital, Lagos was 26.7 % (Nabbugodi et al., 2015). In Nigeria, like any other developing country, antibiotics are sold as half doses by quacks mainly due to limited resources and most clinicians prefer empirical treatment of infections hence minimal microbiological samples are taken for culture and sensitivity. Nigeria is at risk of developing bacterial resistance due to self-prescription and defaulting on medication. Patients who suspect that they have UTI often get over the counter drugs without getting culture and sensitivity tests which lead to antibiotic resistant and may end up being a threat. In addition, there is over the counter treatment and widespread self-medication by the patients leading to development of multidrug resistance (Wamalwa, 2020).
In Lagos State University Teaching Hospital, there is lack of resources such as skilled manpower and laboratory facilities to efficiently carry out culture and sensitivity (Kariuki et al., 2012). This often leads to overuse of antibiotics thus causing antibiotic resistance. Therefore there was need to establish the prevalence and susceptibility pattern of uropathogens in this study area. Susceptibility testing of antibiotics is of great important to reduce reoccurrence of infections of UTIs and reduce treatment failure. Therefore it important to isolate and identify uropathogens, common microorganisms causing UTIs and evaluate their susceptibility patterns of the isolates causing UTIs among patients visiting this study area. To date, there are few or no studies carried out describing the uropathogens and their susceptibility pattern among female students (patients) in Lagos State University Teaching Hospital.
This study aimed at describing the major pathogens causing UTI among patients, the prevalence of UTI and establish susceptibility pattern of antimicrobial resistance in Lagos state. The data will be used in guiding on the most effective drugs of choice on treatment of UTIs and identifying the most prevalent uropathogen. On the light of this, the following study was carried out.
1.3 Justification of the study
Routine culture and sensitivity is not carried out for UTI patients in hospitals of developing countries therefore antimicrobial agents are administered before laboratory results of urine culture are available (Kariuki et al., 2012). This phenomenon creates multidrug resistance (Kariuki et al., 2012; Annapurna and Lakshmi, 2020). The estimation of local etiology and susceptibility profile could support the most effective empirical treatment. Therefore, investigating epidemiology of UTIs (prevalence, risk factors, bacterial isolates and antibiotic sensitivity) is fundamental for care givers and health planners to guide the expected interventions. Thus, the aim of this study was to determine bacterial etiologic agent of uropathogens and evaluate their in vitro susceptibility pattern to commonly used antimicrobial agents (Momoh et al., 2011). This is due to lack of awareness, low hygiene and poverty. Uses of expired drugs in circulation are on increase. There is need to update on the increasing rate of antibiotic resistance among uropathogens in Lagos State University Teaching Hospital and other hospitals and determine their antibiotic susceptibility patterns regularly.
- What is the prevalence of UTIs among patients visiting Lagos State University Teaching Hospital?
- What is the most common uropathogen that causes UTI among female students (patients) in Lagos State University Teaching Hospital?
- What are the susceptibility patterns of UTI bacterial isolates to commonly used antibiotics among female students (patients) in Lagos State University Teaching Hospital?
- i) Prevalence of UTI among patients visiting Lagos State University Teaching Hospital is not known ii) Bacterial isolates from patients visiting Lagos State University Teaching Hospital are not susceptible to antibiotics.
iii) Levels and spectrum of antimicrobial resistance is of isolates obtained from Lagos State University Teaching Hospital is not known.