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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 56-61

An appraisal on antibiotic susceptibility of common bacterial pathogens in urinary tract infections at a Nigerian Tertiary Health Center


1 Department of Surgery, Federal Medical Center, Nguru, Yobe State, Nigeria
2 Department of Surgery, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
3 Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
4 Department of Microbiology, Federal Medical Center, Nguru, Yobe State, Nigeria
5 Department of Surgery, Federal Medical Center, Katsina, Katsina State, Nigeria
6 Department of Obstetrics and Gynecology, Usman Danfodio University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication4-Apr-2018

Correspondence Address:
Dr. B M Abubakar
Department of Surgery, Federal Medical Center, Nguru, Yobe State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_17_17

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  Abstract 


Background: Urinary tract infections (UTIs) with concomitant rise in antibiotic resistance among uropathogens remained a major health problem. A periodic appraisal of the microbial agents responsible for UTIs with their antimicrobial susceptibility is, therefore, fundamental for a fitted empirical antimicrobial intervention. This study determined the range of bacterial species in patients with suspected UTI and their antibiotic susceptibility pattern at a tertiary care center in Nigeria.
Patients and Methods: This was a retrospective review of urine samples subjected to microscopy, culture, and sensitivity from patients with suspected UTI in 2015. Bacterial isolates were identified by biochemical profiling. The antibiotics susceptibility of the culture-positive isolates was achieved by disk diffusion method as recommended in the Clinical Laboratory Standard Institute guidelines.
Results: There were 1,096 urine samples subjected to microscopy, culture, and sensitivity during the study period; 1,001 met the inclusion criteria. Urine microscopy yielded significant pyuria in 23.2% and sterile pyuria in 8%. Urine culture was positive in 43% of the specimens and yielded Escherichia coli in 28%, Staphylococcus aureus was seen in 6.1%, and Klebsiella in 4.8%. Out of the positive cultures, 35.3% specimens have significant pyuria. The most sensitive antibiotics were Streptomycin, Ciprofloxacin, and Gentamycin. Resistance was predominantly to Nalidixic acid, Ceftriaxone, and Ampicillin.
Conclusion: Periodic appraisal of the uropathogens and evaluation of their sensitivity is a needed guide in empirical antibiotic interventions. In this appraisal, E. coli was the commonest agents in patients with UTI. Most of the microbes were sensitive to Aminoglycoside and Ciprofloxacin but often resistant to Nalidixic acid and Ceftriaxone.

Keywords: Antimicrobial, culture and sensitivity, urinary tract infections, urine microscopy, uropathogens


How to cite this article:
Abubakar B M, Abubakar A, Tela U M, Gabchiya M N, Isah M J, Dogo H M, Panti A A, Ogunyele T T. An appraisal on antibiotic susceptibility of common bacterial pathogens in urinary tract infections at a Nigerian Tertiary Health Center. Arch Int Surg 2017;7:56-61

How to cite this URL:
Abubakar B M, Abubakar A, Tela U M, Gabchiya M N, Isah M J, Dogo H M, Panti A A, Ogunyele T T. An appraisal on antibiotic susceptibility of common bacterial pathogens in urinary tract infections at a Nigerian Tertiary Health Center. Arch Int Surg [serial online] 2017 [cited 2018 Nov 19];7:56-61. Available from: http://www.archintsurg.org/text.asp?2017/7/2/56/229185




  Introduction Top


Urinary tract infection (UTI) is the foremost of all the urinary tract afflictions worldwide.[1],[2] It is one of the most prevalent presenting pathologies in the health care centers and has prevailed as a prominent cause of morbidity and mortality. Urine samples microscopy, culture, and sensitivity that provide authentication in the therapeutic use of antibiotics constitute the largest in the category of specimens examined in medical microbiology laboratories.[3] Furthermore, clinical impression of UTI is the second most common indication for the empirical antimicrobial therapy at all levels of health care delivery.[1],[4] The concomitant rise in the resistance of uropathogenic organisms to the currently used antibiotics is a unique serious concern in the empirical usage of antibiotics amidst patients with UTI globally.[5],[6] This is in the face of a fewer breakthrough in novel antibiotics development.[7]

It was ascertained that one way to repress the antibiotic resistance is a sure-enough empirical treatment of infections.[8],[9] The precise data on the uropathogenic organisms and their patterns of sensitivity and resistance in most regions of the developing world are often not available or outdated as antimicrobial sensitivity patterns are bound to change over a period of time.[10],[11],[12] This makes a periodic appraisal on the etiological agents of UTIs with their antimicrobial susceptibility not only desirable but also fundamental for a fitted empirical antimicrobial intervention in the patient with suspected UTIs.[13] This study aimed to determine the range of bacterial agents in patients with suspected UTI and their antibiotic susceptibility at Federal Medical Center, Nguru, Nigeria, which is a tertiary health care center in Nigeria. This will help to facilitate a sure-enough empirical treatment in patients with symptoms of UTIs and formulation of antibiotic prescription policies, at least for the region.


  Patients and Methods Top


It was a retrospective review of the urine samples subjected to microscopy, culture, and sensitivity test. This was from patients with clinical features of UTI from January 1 to December 31, 2015 at Federal Medical Center, Nguru, Nigeria. Ethical approval was obtained from the Ethics Committee of the hospital. Information extracted include patients' biodata, microscopic features of the urine, organisms cultured, and the sensitivity and resistance pattern. Samples with incomplete biodata and incomplete results were excluded from the study.

The urine sample (10 ml) was collected and centrifuged in 3000 rpm for 15 min. The deposits were placed on a clear grease-free slides and examined under ×10 and ×40 objective lens. Bacteriological studies were performed by inoculating the urine samples on a suitable media and incubated for 24 h at 37°C. All incubated culture media were examined after 24 h for the presence of bacterial growth. Disc diffusions test was used to determine the susceptibility (sensitivity) test (Kirby–Bauer method). A disc of blotting paper impregnated with different antibiotics is placed on a sensitivity test agar plates (Muller–Hilton), inoculated with test organism. The plates were incubated at 37°C for 24 h. After 24 h incubation, the inhibition zones were measured as indicated in guidelines of National Committee for Chemical Laboratory Standards (NCCLS).[14],[15],[16]

The three most sensitive and most resistance antibiotics for each of the bacteria cultured from the sample were noted. Children in this study are those of 12 years of age and below; while higher than 12 years are categorized as adults in view of the often similar choice of antibiotic prescription to individuals within these two groups.[17],[18] The data were analyzed using Statistical Package for the Social Sciences (SPSS), version 22 and the result is presented as percentages in tables.


  Results Top


There were 1,096 urine samples subjected to microscopy, culture, and sensitivity during the study period. Of these, 1,001 met the inclusion criteria. There were 542 males (54.1%) and 459 females (45.9%) equivalent to M:F ratio of 1.2:1. Most of the patients are young adults with a mean age of 35.13 years (±19.75) and modal age group of 20–29 years. The age range was 6 months to 93 years. Children below 12 years constitute 105 (10.5%). Urine microscopy revealed significant pyuria (pus cells >3 phf) in 232 (23.2%) [Table 1]. Urine culture was positive in 431 (43%) urine samples; out of these 219 were females and 212 were males. Hence the incidence of UTI among studied females and males was 47.71 and 39.11%, respectively. E. coli was cultured in 280 (65%) samples, as shown in [Table 1]. Out of the entire 431 positive cultures, 152 (35.3%) specimens have significant pyuria. Sterile pyuria was seen in 80 specimens, as shown in [Table 2]. Applying significant pyuria as a diagnostic yardstick, its sensitivity and specificity were 65.5 and 63.7%, respectively; positive predictive value was 35.3% and the negative predictive value was 14.0%.
Table 1: Pattern of distribution of urine microscopy culture and sensitivity

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Table 2: Sensitivity and specificity of pyuria

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In the index analysis, organisms were predominantly sensitive to Streptomycin, Ciprofloxacin, and Gentamycin; at the same time, they showed resistance to Nalidixic acid, Ceftriaxone, and Ampicillin, as shown in [Table 3]. [Table 4] showed sensitivity and resistance pattern for different organisms isolated.
Table 3: Overall sensitivity and resistance pattern

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Table 4: Sensitivity and resistance pattern based on microorganism cultured

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  Discussion Top


UTI tops amidst most prevalent afflictions of the urinary system and is among most prevalent cause of infectious ill health in the general populace.[1],[19] It is second to only surgical site infection amid nosocomial infections.[20] This survey was of microbial agents in UTIs with their antibiotics sensitivity at a Nigerian Tertiary Health Center. UTIs spans crosswise age categories, although children and young adults are the most vulnerable as affirmed in this and other reviews.[21],[22] The age 12 years is often the cut-off age for appropriate selection and dosage in antibiotics therapy between pediatrics and adults.[17],[18] Unlike other studies,[23],[24] our study showed a higher number of males; this may be due to the higher count of health-seeking behavior among males as observed by Saleh et al.[25] However, the incidence of UTI is still higher among females (47.71%) compared to males (39.11%) as was reported by Akingbade et al.[26]

The 23.2% significant pyuria (pus cells >3 phf) in our review approximates findings from other series.[27],[28] The rate of sterile pyuria was, however, relatively lower (0.8%) than reported by Wise and Schlegel et al.[29] and Hooker et al.[30] Pyuria as a yardstick to the diagnosis of UTI in our appraisal had sensitivity and specificity of 65.5 and 63.7%, respectively; these are low compared to other reports.[31],[32] Conclusion based on absent of pus cells in urine samples as a count out to UTI is associated with a lots of controversies; some found it useful to rule out UTI,[33],[34] while others found it inappropriate.[35],[36]

The urine culture yielded growth in 431 (43.1%) of the specimens; this was higher than the finding by Kehinde et al.[37] and others,[27],[38] who reported 3–25% but approximated well to those from other series.[20],[38] These differences between reviews may be due to variances in the populations studied. While we examined symptomatic patients, Kehinde et al. studied asymptomatic pregnant women.

E. coli was the most prevalent uropathogenic yield from the cultures; this was similar to data in some studies.[22],[23],[39] Some series, however, demonstrated rising trend in the incidence of Klebsiella sp.[11],[25],[40]

The aminoglycosides are antibiotics of choice for the empirical prescription in UTI; this was backed by Onanuga et al. and Selekere.[41] In our review Streptomycin and Gentamycin were first and third most sensitive antibiotics, respectively. The occasional nephron and ototoxicity emanating from aminoglycosides usage were reportedly less with the single-dosage regimen.[42] The uneasiness on possible resistance in the treatment of tuberculosis and parenteral route of administration, these drugs added restraint in their usability.[43]

Most uropathogens in the study are sensitive to quinolones as shown in [Table 4]. Ciprofloxacin is the second most sensitive antibiotic in the review. This makes them antibiotics of choice for empirical treatment of UTI. Growing evidence on the increasing resistance to these drugs as reported in studies within Nigeria [38],[44],[45] is a drawback and more so reservation of Ciprofloxacin as a second-line drug of choice in the treatment of tuberculosis.[46],[47] Empirical treatment based on prudence guideline alleviates these tendencies.[48]

Among the pediatric category, E. coli was also the most common uropathogenic isolate. Sensitivity was also mostly to Streptomycin, Ciprofloxacin, and Ofloxacin, similar to some other reviews.[3],[49] The age-old notions on the safety of quinolones in children could not be substantiated in recent studies.[50],[51],[52] There was raised resistance to Ceftriaxone in the pediatric group in our study; this could be due to frequent misuse and abuse of this antibiotic in children as reported by Rabasa et al.[53]

Resistance to Nalidixic acid, Ceftriaxone, and Ampicillin was strikingly high in index review. The availability of these antibiotics as over-the-counter medications and rise in circulation of substandard drugs encourage misuse and abuse, hence elevated the evolution of their resistance.[54] This opposed their earlier reported good sensitivity.[55],[56] The rise in resistance to Penicillin, Cephalosporin, and Septrin was observed across board. This was similar to several reported series, mainly due to afore-stated factors.[57],[58] Hence, these antibiotics are no longer drugs of choice for empirical antibiotics usage. Another growing resistance is to Septrin [59],[60] as found in our study.

This appraisal had inherent limitations of retrospective studies. There was incomplete data on modes of urine collection, especially in children. The presence of risk factors and other urinary tract lesions in the subjects was not accounted for. There were also no information on whether the patients are on particular antibiotics during the period of sample collection. This shows the need for further studies.


  Conclusion Top


Our study provided point pattern of uropathogens and their antibiotic sensitivity. This knowledge is needed as a guide to empirical antibiotic interventions in treatment of suspected UTI. This appraisal revealed E. coli as the commonest agents in patients with UTI. Most of the microbes were sensitive to Aminoglycoside and Ciprofloxacin. Further studies with support from the state, biomedical institutions, and clinicians remain critical in curtailing rising antibiotics resistance and development of additional strategies in the most win-war over uropathogenic agents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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