Urinary Tract Infection among Symptomatic Outpatients Visiting a Tertiary Hospital Based in Midwestern Nigeria

Abstract

Microbial pathogens implicated in urinary tract infection and their antibiotic susceptibility patterns as prevalent in UTI symptomatic outpatients resident in Benin City, Nigeria was the focus of this study. One hundred (100) midstream urine samples were collected into sterile plastic universal bottles from outpatients who visited the University of Benin Teaching Hospital, Nigeria and who were tentatively diagnosed as manifesting symptoms of UTI. Patients were referred to the Medical Microbiology department by the consulting doctors. Significant bacterial counts and neutrophil (pus cells) counts were carried out on samples by standard methods. Positive samples for both counts were inoculated aseptically on sterile MacConkey agar, Cystine Lactose Electrolyte Deficient (CLED) agar and Sabouraud Dextrose agar plates and incubated appropriately. Microbial isolates were identified and antibiotic sensitivity testing was carried out on isolates by standard methods. Thirty nine (39.0%) and 61 (61.0%) samples recorded significant microbial growth and no growth respectively. Gram negative bacilli constituted 86.1% (of which enterobacteriaceae made up 49.9%) while gram positive cocci made up 13.9%. Strains of uropathogens isolated were Alcaligenes spp (19.4%), Klebsiella aerogenes (16.7%), Escherichia coli (13.9%), Staphylococcus aureus (13.9%), Candida albicans (11.1%), Proteus mirabilis (8.3%), Pseudomonas aeruginosa (5.5%), Enterobacter spp (5.5%) and Providencia spp (5.5%). Occurrence of UTI in male and female patients were 58.3% and 41.7% respectively of which UTI occurred highest in the 25-46, 15-54 and 27-54 age groups in that decreasing order. Alcaligenes spp occurred most in very old female patients. Candida albicans (the only fungal uropathogen) occurred in an 8day old male patient. Other isolates occurred in much older patients. A significantly high microscopic neutrophil count or pyuria was recorded from deposits of UTI positive patients (i.e. < 5/HPF). Eighteen (representing 50.5%) and 15 (47.8%) of total microbial strains isolated were sensitive to nitrofurantoin and ceftriaxone respectively. Antibiotic susceptibility profile also showed 13(41.6%), 13(41.6%), 13(41.6%) for ciprofloxacin, cefuroxime and ofloxacin respectively suggesting moderate sensitivity of the fluoroquinolones and second/third generation cephalosporins. Gentamicin, ampicillin and augmentin recorded over 70.0% resistance level each. A total of nineteen bacterial strains made of E. coli, Enterobacter spp, Proteus mirabilis, Providencia spp, Staph. aureus and Pseudomonas aeruginosa were multi drug resistant as they resisted 3, 3, 4, 4, 5 and 8 antibiotics respectively.

Incidence of Urinary Tract Infections (UTI) amongst Patients Attending Primary Health Centres in Anambra State

“…This is contrary to the findings of [1] [2], who found Klebsiella species to be more prevalent than E. coli in UTIs. However, the result compares favourably with the findings of other workers [2] [8] [11] [30]- [34] who found E. coli more predominant over Klebsiella species.…”

“…[19] recorded a much lower rate of 11.9% while [20], had a high rate of 25.6%. However, it is important to note that much higher prevalence rates have been reported by some authors [1] [9] [21]- [24], with a range of 39.0% -71.6%.…”

“…The reason for the no bacterial growth among a good number of the patients may be due to the fact that some of the patients have been on antibiotic therapy before reporting to the hospital or laboratory. These antibiotics may have inhibited bacterial growth [1].…”

“…Urinary Tract Infection (UTI) is defined as the microbial invasion of any of the tissues of the urinary tract extending from the renal cortex to the urethral meatus [1]. The urinary tract includes the organs that collect and store urine and release it from the body, and these organs are the kidneys, ureters, bladder, urethra and accessory structures [2].…”

Carriage of Class 1 and 2 Integrons in Quinolone, Extended-Spectrum-β-Lactamase-Producing and Multi Drug Resistant E.coli and K.pneumoniae: High Burden of Antibiotic Resistance

“…Several reports are available on the mechanism of quinolone resistance in either E.coli or K.pneumoniae or even both or quinolone resistance in ESBL producing bacteria; however, no report is available on the actual resistance of nalidixic acid and ciprofloxacin in these two isolates [29][30][31][32][33][34][35] , except few published studies on urinary isolates, [36][37][38][39][40] whereby low prevalence has been reported as compared to our study. Study performed in our neighboring country reported 17% and 38% of E. coli isolates obtained from uncomplicated and complicated UTI respectively, were found resistant to ciprofloxacin.…”