TRANSMISSION
Community – acquired urinary tract infection
The prevalent microorganism implicated in this form of uncomplicated urinary tract infection (UTI) is Escherichia coli which is designated uropathogenic E. coli (UPEC). Other bacteria involved include Klebsiella spp., other enterobacteriaceae, Staphylococcus saprophyticus as well as Enterococci. In urinary tract infections with higher complications, particularly in recurrent infections the rate of infection caused by Pseudomonas, Klebsiella, Proteus, Enterobacter spp increases (Oladeinde, et al., 2011).
2.2.4 Hospital- acquired urinary tract infection
This takes almost 40% of all nosocomial infections. The morbidity and mortality rate drains the hospital resources. Patients fixed on indwelling catheters, patients undergoing manipulations of the urological region, long-stay older male patients, and patients with regressing diseases have a high risk of developing urinary tract infections. Hospital acquired pathogens resulting in urinary tract infection have a higher tendency of becoming resistant to antibiotics compared to simple urinary tract infections ( Kalsi et al., 2009). Kalsi et al., (2009) stated that catheters impregnated with antibiotics may reduce the incidence of nosocomial urinary tract infection.
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2.3 RISK FACTORS
The risk factors that culminates urinary tract infections include intercourse, gender, genetics and the use of urinary catheters.
2.3.1 Intercourse
In sexually active young women, the major cause of 75 ' 90% of cystitis is with honeymoon cystitis in early marriage. Frequency of intercourse does not dispose post-menopausal women to the development of urinary tract infection. The use of some contraceptive methods increases the risk of urinary tract infection (Nicolle, 2009).
2.3.2 Gender
It is known that the structure of the female urinary tract makes them prone to infection compared to men because of the closeness of the urethra to the anus in females and the lack of bacteriostatic properties of prostatic secretions. Urinary tract infection in older people is almost equal especially in men because of enlarged prostate. The gland obstructs the urethra as it develops causing difficulty in micturition and higher incidence of microbial invasion of the urethra due to less urine flushing the urethra (Nicolle, 2009).
2.2.3 Urinary catheters
80% of urinary tract infections occurring in the hospital are due to catheters and most cases of the infection involved are usually asymptomatic. The longer a catheter is in place, the higher the risk of an infection. Catheters should be used only when necessary. An aseptic method of insertion and maintenance of closed drainage of catheter should utilized (Nicolle, 2009).
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Chapter 3
MATERIALS AND METHODS
3.1 Study Area
The research was carried out in the city of Ipet, Rivers State, Nigeria. It lies along the Bonny River (an eastern distributary of the Niger) and it is 66km upstream from the Gulf of Guinea. Founded in 1912 in an area traditionally inhabited by the Ijaw people, it serves as a port named after Lewis Harcourt the colonial secretary.
Rivers state has long been an important merchant state and is today the center of Nigeria's oil industry. Some of its exports include petroleum, coal, tin, palm products, cocoa and groundnuts.
3.2 Study Population
Study population was selected among patients attending Lognard Memorial Specialist Hospital, Ipet. A sample size of 200 subjects was used while the age and sex of the patients were known.
3.3 Ethical Consideration
Proper informed consent was solicited from the hospital's management before the commencement of the the research work.
3.4 Sample Collection
Twenty (20) ml of early morning midstream urine was aseptically obtained from each patient in a dry wide-necked, leak proof, screw capped container and identified by a serial number. The patients were asked to rinse the area around the urethral opening with clean water and allowed to dry before urine collection with the labia held apart. Male patients were also asked to properly wash their hands before collecting the specimen.
3.5 Sample Analysis
3.5.1 Macroscopy
The color, clarity and turbidity of the specimens as well (clear or cloudy) were observed and reported.
3.5.2 Microscopy
About 10ml of well mixed urine was transferred to a labeled conical tube and centrifuged at 5000 r.p.m for 5 minutes. The supernatant was discarded into another empty container of the original urine used for culture.
The remaining sediment was mixed by gently tapping the bottom of the tube. A drop of the sediment was transferred to a clean slide and covered with a cover glass. The preparation was examined microscopically using 10x and 40x objective with the condenser iris closed sufficiently to give good contrast and reported.
A volume of the urine samples was placed on a glass microscope slide with care, allowed to air dry, stained with a gram stain and examined microscopically.
3.5.3 Biochemical Test
The specimens (supernatant) were biochemically tested using urine reagent strips to investigate the presence of protein, nitrite and leukocyte.
3.5.4 Culture
The specimens were mixed by rotating the container and a sterile wire loop was used to inoculate a loopful of urine on a plate of MacConkey agar and CLED (Cystine Lactose Electrolyte deficient agar). The plates were incubated aerobically at 370C overnight. The second day, plates were examined for growth and characteristic colonies of the different isolates were noted.
3.5.5 Antibiotic Susceptibility
The isolates were subjected to antimicrobial susceptibility testing using the disc/agar diffusion method. Interpretation of results was done using the zone sizes.
3.5.6 Statistical Analysis
The data were passed through 95% (p < 0.05) confidence interval chi square test.
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Chapter 4
RESULTS
Out of the 200 urine samples cultured, six different microbial agents were isolated and identified in culture with Escherichia coli being the most prevalent organism (32.0%), closely followed by Staphylococcus aureus (19.0%), Proteus mirabilis (4%), Streptococci (1.5%) and Candida albicans (1%) while 42.0% showed no bacterial or fungal growth. (See table 4. 1).
Table 4.2 depicts the relationship between sex and age of subjects with urinary tract infection. Out of 116 subjects with urinary tract infection, the female presented 54.31% while the males account for 45.69%. The highest number of patients with UTI (20%) was found in the age group 21 to 30 years. The females in the age range presented 25.40% UTI, whereas the lowest percentage is from the age range 81-90 years. The occurrence of Urinary Tract Infection was found to be insignificantly higher in females compared to males (P > 0.05).
Table 4.3 shows the effect of gender and age on the prevalence of urinary tract infection. Females were at high risk for acquiring a UTI (female and male presents 57.80% and 58.24 %, X2 = 40.50 and 33.75 respectively).
The susceptibility profile of the bacterial isolates showed that Ofloxacin was the most active antibacterial agent while Amoxicillin, Augmentin, erythromycin and cefuroxime were poorly active against the bacterial isolates (Table 4.4).
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