|ORIGINAL RESEARCH REPORT
|Year : 2020 | Volume
| Issue : 4 | Page : 131-135
Urinary tract infections and antimicrobial susceptibility pattern among female students in a tertiary institution in southwest Nigeria - A cross sectional study
Tinuade Adesola Ajani1, Charles John Elikwu1, Victor Ugochukwu Nwadike1, Babatunde Tayo1, Opeoluwa Akinleye Shonekan1, Celen Chika Okangba1, Chinenye Gloria Anaedobe2, Tunde Ehimen Thompson1, Azubuike Chidiebere Omeonu1, Faluyi Bibitayo1, Mustapha Akanji Ajani3, Nkadinma Florence Nkwogu4, Joseph Emejuru1, Kelechi Okangba1, Obinna Mark Ugwa1, Marvelous Afolabi1, Abisola Atere1, Temidola Kalejaye1, Timothy A Oluwasola5, Olusegun Akintoye Coker1
1 Department of Medical Microbiology, Benjamin Carson College of Health and Medical Sciences, Ilishan-Remo, Ogun State, Nigeria
2 Department of Medical Microbiology, Federal Capital Territory, University of Abuja, Abuja, Nigeria
3 Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
4 Department of Haematology, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
5 Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
|Date of Submission||11-Jun-2019|
|Date of Acceptance||25-Jul-2020|
|Date of Web Publication||19-Oct-2020|
Dr. Tinuade Adesola Ajani
Department of Medical Microbiology, Ben Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State
Source of Support: None, Conflict of Interest: None
Background: Urinary tract infections (UTIs) is a common medical problem that affects all age groups but with significant morbidity in females because of the nature of their anatomy and physiology. This study was aimed to identify the common causative organisms of UTI and their antimicrobial susceptibility pattern among female students in Babcock University. Methods: A cross-sectional study, in which 200 female participants with symptoms of UTI were recruited. Mid-stream urine was collected from them and processed using the standard microbiological procedures. Antimicrobial susceptibility testing was performed on isolates from the samples with significant bacteriuria. Sociodemographic and risk factors were obtained using standard questionnaires, and statistical analysis was performed using SPSS version 23.0. Results: UTIs were confirmed in 14.5% (29/200) participants. Of the pathogens isolated, Escherichia coli was predominant 30.6% (11/36). Most of the pathogens isolated were susceptible to ofloxacin and gentamicin, while ceftriaxone had the least susceptibility (18.2%). The majority of the participants, 165 (82.5%) though symptomatic, did not have bacteriuria. The participants aged 15–20 years were mostly infected [24 (13.4%)]. No significant association was found between the sociodemographic factors and UTI. Conclusion: The prevalence of UTI from this study was 14.5%. E. coli was the predominant bacteria pathogen isolated, and ofloxacin and gentamycin were the most active antibiotics on susceptibility pattern. The majority of the patients though symptomatic, had no pathogens isolated from their urine. Therefore, caution should be applied on the use of antibiotics when managing UTI based on symptoms alone, to prevent antibiotic resistance
Keywords: Antimicrobial susceptibility test, Escherichia coli, gentamycin, Klebsiella pneumoniae, ofloxacin, Proteus mirabilis, significant bacteriuria, urinary tract infection
|How to cite this article:|
Ajani TA, Elikwu CJ, Nwadike VU, Tayo B, Shonekan OA, Okangba CC, Anaedobe CG, Thompson TE, Omeonu AC, Bibitayo F, Ajani MA, Nkwogu NF, Emejuru J, Okangba K, Ugwa OM, Afolabi M, Atere A, Kalejaye T, Oluwasola TA, Coker OA. Urinary tract infections and antimicrobial susceptibility pattern among female students in a tertiary institution in southwest Nigeria - A cross sectional study. J Clin Sci 2020;17:131-5
|How to cite this URL:|
Ajani TA, Elikwu CJ, Nwadike VU, Tayo B, Shonekan OA, Okangba CC, Anaedobe CG, Thompson TE, Omeonu AC, Bibitayo F, Ajani MA, Nkwogu NF, Emejuru J, Okangba K, Ugwa OM, Afolabi M, Atere A, Kalejaye T, Oluwasola TA, Coker OA. Urinary tract infections and antimicrobial susceptibility pattern among female students in a tertiary institution in southwest Nigeria - A cross sectional study. J Clin Sci [serial online] 2020 [cited 2021 Jan 25];17:131-5. Available from: https://www.jcsjournal.org/text.asp?2020/17/4/131/298453
| Introduction|| |
Urinary tract infections (UTIs) are considered to be the most frequent bacterial infection, estimated to 150 million per annum worldwide. They account for about 100,000 hospitalization each year in the United States (US). Although UTI affect all age groups and gender, the incidence is very high in women compared to men. In general, as a consequent of the peculiar female anatomy and activity, such as the shortness of the female urethra and contamination during sexual activity., By the age of 24 years, one in every three women would have had at least one episode of UTI that requires antimicrobial therapy. while more than half of the women will experience, at least, one episode of UTI during their lifetime. A survey in the US showed that 10.8% of females aged ≥18 years self-reported at least one uncomplicated UTI in the preceding year. In India, females were reported to have a higher prevalence of UTI compared to males, and in a rural community in Nigeria, females had a 3–17 fold increase risk of acquiring UTI than their male counterpart Other studies in Nigeria also reported a higher incidence of UTI in females compared to males.,,
Risk factors found to be associated with higher prevalence in women include malnutrition, poor hygiene, low socioeconomic status, age at first sexual intercourse, use of barrier contraceptive (diaphragm, cervical cap, male condom), spermicide, recent sexual intercourse frequent sex and prior antimicrobial use.,
UTI is mostly caused by Gram-negative aerobic bacilli found in the gastrointestinal tract known as Enterobacteriacae, with Escherichia More Details coli identified as etiologic agent in about 75%–90% of infections, especially in uncomplicated UTI.,, Women, especially in colleges, have been reported to have a higher incidence of uncomplicated UTI, which may be undetected until they result in complications,, hence the need to determine the etiology of UTI and the antibiotics susceptibility pattern among females. Complications as a result of UTI may include: recurrence, permanent kidney damage from an acute or chronic kidney infection from an untreated UTI, increased risk of delivering LBW or premature infants among pregnant women and sepsis, a potentially life-threatening complication of the UTI, especially if the infection works its way up the urinary tract to the kidneys.,,
Therefore, this study is aimed to identify the causative organism, their antimicrobial susceptibility pattern and associated risk factors among female students of Babcock University.
| Materials and Methods|| |
A descriptive cross-sectional, hospital-based study conducted among female students of Babcock University with clinical symptoms suggestive of UTI. This study was conducted between June 2018 and March 2019. A total of 200 students were recruited from the female hostels by Simple random sampling technique after filling the consent form, and mid-stream urine were collected from them for isolation of pathogens. The inclusion criteria were students having either one or more of symptoms of UTI such as dysuria, nocturia, suprapubic pain, and frequency that gave their consent to participate in the study while exclusion criteria were students on antibiotics or have taken antibiotics within the past 6 weeks. Pretested interviewer–based structured questionnaire designed by the clinical epidemiologist were used to obtain sociodemographic and risk factors for UTI. Ethical approval was obtained from Babcock University's ethical review committee before the commencement of the study.
Mid-stream urine was collected into a sterile universal bottle. A standard wire loop capable of delivering 0.001 ml of urine was used to inoculate uncentrifuged urine unto the surface of blood agar and cysteine lactose electrolyte deficient medium. The culture plates were incubated aerobically at 37°C for 24 h, and any sample with colony count of ≥105 cfu/ml was considered to have significant bacteriuria and was processed further. The bacterial isolate was identified based on their morphological, Gram staining, and biochemical characteristics. The antimicrobial susceptibility test (AST) of the isolated organism was done using Modified Kirby Bauer method, according to the Clinical and Laboratory Standard Institute standards. E. coli ATCC 25,922 was used as the control strain.
| Results|| |
The data were collected from 200 participants, which were females of Babcock University. The prevalence of UTI among the participants was 14.5% (29/200). The mean age was 18.03 ± 1.88 years, and the majority of the participants age ranged between 15 and 20 years. All the participants were unmarried and 43 (21.5%) were sexually active, whereas 49 (13.5%) had their first coital experience at the age of 18 years and above. Sociodemographic and risk factors are further illustrated in [Table 1].
|Table 1: Sociodemographic characteristics and sexual behaviours of respondent (n=200)|
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Six (3%) urine samples did not yield any growth, Of the 194 urine samples, 14.95% (29/194) yielded 36 bacteria pathogen because seven urine samples yielded two different growths of bacteria. E. coli was the predominant pathogen causing UTI among the participants, while Klebsiella oxytoca and Proteus vulgaris had the lowest frequency, 2.8% each [Table 2].
Most of the isolate were susceptible to ofloxacin 27/88 (30.7%) and gentamycin 27/88 (30.7%) followed by Amoxicillin–Clavulanate 18/88 (20.5%) and Ceftriaxone 16/88 (18.2%) [Table 2]. The prevalence of UTI was highest among the participants within the age group of 15–20 years although it is not statistically significant. In addition, there were neither identifiable, statistically-significant, sociodemographic, nor risk factors associated with UTI [Table 3].
| Discussion|| |
UTI is known to cause significant morbidity in women, thus, identifying their common pathogens and antibiotic susceptibility pattern will help to reduce the burden of the disease. The prevalence of UTI among the participants of this study was 14.5% (29/200). This is similar to a previous study in Ado-Ekiti Nigeria by Ojo et al. and another study in Dhakar, Bangladesh, by Begum et al., The similarities observed from the prevalence might be because the studies were conducted among females. Although some other studies among females have recorded higher prevalence.,,
The predominant pathogen of UTI in this study was Esherichia coli and this is similar to previous reports, although some other studies have reported otherwise., E. coli is widely known as the most common pathogen causing uncomplicated UTI.,, Fecal contamination may be a reason for this and good perineal hygiene may explain why in some other studies, E. coli was not the predominant bacteria. In this study, the next most common bacteria isolate was Proteus mirabilis followed by Klebsiella pneumonia. This pattern is similar to previous reports., The high prevalence (22.2%) of Proteus mirabilis observed from this study can be attributed to its swarming ability, which can easily transverse the short female urethra. Although only females with symptoms suggestive of UTI were recruited in our study, majority 165 (82.5%) had insignificant bacteriuria which is in tandem with a previous report by Caroline et al. Treatment of UTI based on clinical symptoms alone should be discouraged as some other disease entity may present with some UTI symptoms. However, it may be necessary to review the volume of bacterial count that will be defined as significant for UTI in this environment.
Ofloxacin and gentamycin were the most active antibiotics in this study, followed by amoxycillin clavulanic acid and ceftriaxone. Similar reports on the antimicrobial activities of quinolones against bacteria causes of UTI have been reported published., However, some literatures have reported that there is increasing resistance of quinolones to UTI pathogens quinolones abuse in the area of study might be responsible for the disparity. Pseudomonas has a prevalence of 8.3% in this study. This is not worrisome because it has been previously reported that pseudomonas can now cause both community acquired and hospital-acquired UTI. The pseudomonas isolated from this study were susceptible to gentamycin and ofloxacin. This is similar to a previous report in Nigeria. Ceftriaxone has the highest level of resistance among the antibiotics. This is worrisome as ceftriaxone is a parenteral antibiotics and not oral. Misuse of ceftriaxone to treat different types of bacterial might be responsible for this resistance.
Although the majority of the participants with UTI were aged 15–20 years, there was no significance between the age group and the infection. This finding is similar to a previous report., Sex has been reported to be associated with UTI, but in our study, there is no association with sex and UTI. Our findings are similar to a previous report by Olabimtan et al. This disparity maybe because all our participants are unmarried, and the prevalence of the sexually active participants that had UTI from this study is not statistically significant.
This study is not without limitations such as all our participants were single, and second, we did not explore the extended spectrum beta-lactamases for isolates resistant to ceftriaxone.
| Conclusion|| |
A prevalence rate of 14.5% (29/200) was identified and E. coli was the predominant bacterial isolated. Majority of the patients though symptomatic, had no pathogens isolated from their urine. Therefore, caution should be applied on the use of antibiotics when managing UTI based on symptoms alone to prevent antibiotic resistance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]