ABSTRACT
In order to access the prevalence and sensitivity pattern of urinary pathogens, 60 midstream urine samples from students of Caritas 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.
TABLE OF CONTENT
Title page
Certification
Dedication
Acknowledgement
Abstract
Tables of contents
List of tables
CHAPATER ONE
1.0 INTRODUCTION
1.1 Aims and objectives of the study
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Microorganisms found in urine and their etiology
2.1.1 Bacteria
2.1.2 Viruses
2.1.3 Fungi
2.1.4 Protozoa
2.2.1 Entry of bacteria into the urinary tract
2.2.2 Routes of bacteria infection
2.2.3 Symptoms of UTI
2.2.4 Diagnosis
2.2.5 Treatment
2.2.5.1 Aims of treatment of UTI
2.2.5.2 Future strategies in treatment of bacteria/UTI
2.2.6 Prevention and control
2.3.0 Antimicrobial resistance
2.3.1 Mechanisms of drug resistance
2.3.1.1 Drug- inactivating enzyme
2.3.1.2 Alteration in the target molecule
2.3.1.3 Decrease uptake of the drugs
2.3.1.4 Increased elimination of the drugs
2.3.2 Conditions influencing the effectiveness of drugs
2.3.2.1 Population size
2.3.2.2 Population composition
2.3.2.3 Concentration and intensity of antimicrobial agent
2.3.2.4 Duration of exposure
2.3.2.5 Temperature
2.3.3 Actions of antimicrobial drugs
2.3.3.1 Inhibition of cell synthesis
2.3.3.2 Inhibition of cell membrane
2.3.3.3 Inhibition of nucleic acid synthesis
2.3.3.4 Inhibition of essential metabolites
CHAPTER THREE
3.0 MATERIALS AND METHODS
3.1 Sample collection
3.1.2 Antimicrobial susceptibility test
3.1.3 Urinalysis test
3.2 Gram staining
3.3 Biochemical test
3.3.1 Catalase test
3.3.2 Coagulase test
3.3.3 Motility test
3.3.4 Methyl test
3.3.5 Urease test
3.3.6 Indole test
3.3.7 Citrate utilization test
CHAPTER FOUR
4.0 RESULT
CHAPTER FIVE
5.1 DISCUSSION
5.2 Conclusion
5.3 Recommendation
References
Appendix I
Appendix II
CHAPTER ONE
· .Net
CHAPTER ONE
INTRODUCTION
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
1.1 Aims and objectives
To find out the prevalence of gram negative organisms in the urinary
tract among caritas 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.