Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 215
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2020  |  Volume : 17  |  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


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 Submission11-Jun-2019
Date of Acceptance25-Jul-2020
Date of Web Publication19-Oct-2020

Correspondence Address:
Dr. Tinuade Adesola Ajani
Department of Medical Microbiology, Ben Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_47_19

Rights and Permissions
  Abstract 


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 2020 Nov 27];17:131-5. Available from: https://www.jcsjournal.org/text.asp?2020/17/4/131/298453




  Introduction Top


Urinary tract infections (UTIs) are considered to be the most frequent bacterial infection, estimated to 150 million per annum worldwide.[1] They account for about 100,000 hospitalization each year in the United States (US).[2] Although UTI affect all age groups and gender, the incidence is very high in women compared to men.[3] In general, as a consequent of the peculiar female anatomy and activity,[3] such as the shortness of the female urethra and contamination during sexual activity.[4],[5] By the age of 24 years, one in every three women would have had at least one episode of UTI that requires antimicrobial therapy.[6] while more than half of the women will experience, at least, one episode of UTI during their lifetime.[7] 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.[8] In India, females were reported to have a higher prevalence of UTI compared to males,[9] and in a rural community in Nigeria, females had a 3–17 fold increase risk of acquiring UTI than their male counterpart[10] Other studies in Nigeria also reported a higher incidence of UTI in females compared to males.[11],[12],[13]

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.[14],[15]

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.[2],[16],[17] Women, especially in colleges, have been reported to have a higher incidence of uncomplicated UTI, which may be undetected until they result in complications[18],[19],[20] 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.[6],[12],[18]

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 Top


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.[21] The antimicrobial susceptibility test (AST) of the isolated organism was done using Modified Kirby Bauer method[22],[23] according to the Clinical and Laboratory Standard Institute standards. E. coli ATCC 25,922 was used as the control strain.[24]


  Results Top


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)

Click here to view


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].
Table 2: Prevalence of pathogens and antibiotic susceptibility pattern

Click here to view


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].
Table 3: Factors associated with urinary tract infections (n=200)

Click here to view



  Discussion Top


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.[5],[25] 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.[10],[17],[26]

The predominant pathogen of UTI in this study was Esherichia coli and this is similar to previous reports[5],[27] although some other studies have reported otherwise.[28],[29] E. coli is widely known as the most common pathogen causing uncomplicated UTI.[2],[16],[17] 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.[5],[27] 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.[30] 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.[13],[31] 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.[12] 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.[12] The pseudomonas isolated from this study were susceptible to gentamycin and ofloxacin. This is similar to a previous report in Nigeria.[27] 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.[32]

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.[26],[27] Sex has been reported to be associated with UTI,[33] but in our study, there is no association with sex and UTI. Our findings are similar to a previous report by Olabimtan et al.[16] 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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Stamm WE, Norrby SR. Urinary tract infections: Disease panorama and challenges. J Infect Dis 2001;183 Suppl 1:S1-4.  Back to cited text no. 1
    
2.
Kolawole AS, Kolawole OM, Kandaki-Olukemi YT, Babatunde SK, Durowade KA, Kolawole CF. Prevalence of urinary tract infections (UTI) among patients attending Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria. Int J Med Sci 2009;1:163-7.  Back to cited text no. 2
    
3.
Enrico M, Vittorio G, Loredana D, Antonia IL, Roberto M, Paolo R, Clementina EC. Gender and age-dependent etiology of community-acquired urinary tract infections. The scientific world J 2011;2012:01-6.  Back to cited text no. 3
    
4.
Okonko IO, Ijandipe LA, Ilusanya AO, Donbraye-Emmanuel OB, Ejembi J, Udeze AO, et al. Detection of urinary tract infection (UTI) among pregnant women in Oluyoro Catholic Hospital, Ibadan, South-Western Nigeria. Malaysian J Microbiol 2010;6:16-24.  Back to cited text no. 4
    
5.
Ojo OO, Anibijuwon II. Urinary tract infection among female students residing in the campus of the University of Ado Ekiti, Nigeria. Afr J Microbiol Res 2010;4:1195-8.  Back to cited text no. 5
    
6.
Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Dis Mon 2003;49:53-70.  Back to cited text no. 6
    
7.
Khalil A, Imran R, Ishtiaq H, Methab J, Maisoor AN, Zahida J, et al. Prevalence of Escherichia coli in suspected urinary tract infected patients and their sensitivity pattern against various antibiotics in Gilgit-Baltistan, Pakistan. Pakistan J Zool 2014;46:1783-8.  Back to cited text no. 7
    
8.
Chin TL, McNulty C, Beck C, MacGowan A. Antimicrobial resistance surveillance in urinary tract infections in primary care. J Antimicrob Chemother 2016;71:2723-8.  Back to cited text no. 8
    
9.
Maria SJ, Meenakshi K, Lakshmi MP, Sreenivasulu PB. Prevalence and distribution of bacterial pathogens causing urinary tract infections in humans: A study from tertiary care hospital in AP, India. Int J Current Microbiol Applied Sci 2015;4:251-7.  Back to cited text no. 9
    
10.
Oladeinde BH, Omoregie R, Olley M, Anunibe JA. Urinary tract infection in a rural community of Nigeria. N Am J Med Sci 2011;3:75-7.  Back to cited text no. 10
    
11.
Kemebradikumo P, Orutugu L, Pondei J. Current microbial and culture sensitivity pattern of urinary tract infection in a private hospital setting in Bayelsa State, Nigeria. Int Res J Microbiol 2012;3:393-8.  Back to cited text no. 11
    
12.
Oluremi BB, Idowu AO, Olaniyi JF. Antibiotic susceptibility of common bacterial pathogens in urinary tract infections in a Teaching hospital in Southwestern Nigeria. Afr J Microbiol Res 2011;5:3658-63.  Back to cited text no. 12
    
13.
Aiyegoro OA, Igbinosa OO, Ogunmwonyi IN, Odjadjare EE. Igbinosa OE, Okoh AI. Incidence of urinary tract infections (UTI) among children and adolescents in Ile-Ife, Nigeria. Afr J Microbiol Res 2007;1:013-9.  Back to cited text no. 13
    
14.
Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med 2012;366:1028-37.  Back to cited text no. 14
    
15.
Foxman B, Frerichs RR. Epidemology of urinary tract infection: II. Diet, clothing and urination habits. Am J Public Health 1985;75:1314-7.  Back to cited text no. 15
    
16.
Olabimtan OS, Ojo DA, Oyebode GI. Urinary tract infection among undergraduate students residing in the hostel of the Federal University of Agriculture Abeokuta, Ogun State, Nigeria. European Int J Scien Technol 2018;7:01-16.  Back to cited text no. 16
    
17.
Umesh PG, Suresh J, Laxmi T, Nirma P, Sarmila N. Prevalence of urinary tract infection among suspected female patients attending Manipal teaching hospital, Pokhara, Nepal. Res Rev 2013;3:01-13.  Back to cited text no. 17
    
18.
Omigie O, Okoror L, Umolu P, Ikuuh G. Increasing resistance to quinolones: A four-year prospective study of urinary tract infection pathogens. Int J Gen Med 2009;2:171-5.  Back to cited text no. 18
    
19.
Olson RP, Harrell LJ, Kaye KS. Antibiotic resistance in urinary isolates of Escherichia coli from college women with urinary tract infections. Antimicrob Agents Chemother 2009;53:1285-6.  Back to cited text no. 19
    
20.
Chedi BA, Wannang NN, Halliru MA, Bichi LA. A seven months retrospective study on urinary tract infection among patients at Aminu Kano teaching hospital, Kano – Nigeria. Bayero J Pure Appl Sci 2009;2:95-8.  Back to cited text no. 20
    
21.
Barrow GI, Felthham RK. Cowan and Steele's Manual for the Identification of Medical Bacteria. 3rd ed. Cambridge: Cambridge University Press; 1993.  Back to cited text no. 21
    
22.
Bauer AW. Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966;44:493-6.  Back to cited text no. 22
    
23.
Karzan MK, Faeza BO, Shahida NY. Isolation and identification of urinary tract infectious bacteria and exploring their anti-drug potential against some common antibiotics. J Microb Biochem Technol 2017;9:285-9.  Back to cited text no. 23
    
24.
Patel JB, Weinstein MP, Eliopoulos GM, Jenkins SG, Lewis JS, Limbago B, et al. Performance Standards for Antimicrobial Susceptibility Testing M100. 27th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.  Back to cited text no. 24
    
25.
Begum N, Mamoon AB, Hossain M, Begum N, Chowdhury SA, Rahman MF. UTI among female workers in a selected garment industry of Dhaka city: A cross sectional study. Orion Med J 2006;23:325-7.  Back to cited text no. 25
    
26.
Huppert JS, Biro FM, Mehrabi J, Slap GB. Urinary tract infection and Chlamydia infection in adolescent females. J Pediatr Adolesc Gynecol 2003;16:133-7.  Back to cited text no. 26
    
27.
Abdulrasheed A, Mohammed K, Dalhatu YB. Antibiotic susceptibility patterns of Uropathogenic Escherichia coli among patients with urinary tract infections in a tertiary care hospital in Maiduguri, North Eastern, Nigeria. J Biosci Biotechnol Dis 2018;3:14-24.  Back to cited text no. 27
    
28.
Azubike CN, Nwamadu OJ, Oji RD, Uzoije N. Prevalence of urinary tract infection among school children in a Nigerian rural community. West Afr J Med 1994;13:48-52.  Back to cited text no. 28
    
29.
Richard O, Joyce OE, Ijeoma JO, Helen OO. Observed changes in the prevalence of uropathogens in Benin City, Nigeria. NZ J Med Lab Sci 2008;62:29-31.  Back to cited text no. 29
    
30.
George CE, Norman G, Ramana GV, Mukherjee D, Rao T. Treatment of uncomplicated symptomatic urinary tract infections: Resistance patterns and misuse of antibiotics. J Family Med Prim Care 2015;4:416-21.  Back to cited text no. 30
[PUBMED]  [Full text]  
31.
Gupta K, Hooton TM, Wobbe CL, Stamm WE. The prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in young women. Int J Antimicrob Agents 1999;11:305-8.  Back to cited text no. 31
    
32.
Getasew AA, Belayneh KG, Abebe ZB, Jimma LL. Drug use evaluation of ceftriaxone in medical ward of dessie referral Hospital, North East Ethiopia. Int J Chem Natl Sci 2013;1:12-6.  Back to cited text no. 32
    
33.
Onwuezobe IA, Orok FE. Associated risk factors of asymptomatic urinary tract infection among pregnant women attending antenatal care in a secondary health care facility in a South South Nigerian City. Int J Curr Microbiol Appl Sci 2015;4:223-30.  Back to cited text no. 33
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed196    
    Printed0    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]