Asymptomatic Urinary Tract Infection among Female Students of Abia State Polytechnic, Aba, Southeastern Nigeria

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1 Merit Research Journal of Medicine and Medical Sciences (ISSN: X) Vol. 3(12) pp , December, 2015 Available online Copyright 2015 Merit Research Journals Original Research Article Asymptomatic Urinary Tract Infection among Female Students of Abia State Polytechnic, Aba, Southeastern Nigeria *Ezeigbo O. R., Ejike E. N., Ibebuike C. C., Okorie A. C. and Asuoha-Chuks N. Abstract Department of Biology/Microbiology, Abia State Polytechnic, Aba, Nigeria *Corresponding Author Tel.: Urinary Tract Infection (UTI) is an infection caused by the presence and growth of microorganisms anywhere in the urinary tract. It is among the most common bacterial infections in humans and common among women than men. It is a serious health problem affecting millions of people each year. Asymptomatic bacterial infection is a condition where the symptoms are not observed in the patients. A total of 400 midstream urine samples weree collected from female students without symptoms of urinary tract infections (UTIs) between the months of February to April A cross- were analyzed using sectional study design was used. The sampless standard bacteriological tests and sensitivity tests were done on the isolates using a range of antibiotics. Out of the 400 samples collected, 238( (59.5%) were positive for UTI while age bracket years had the highest rate of infection (74.2%). The bacterial isolates include Klesiella, Pseudomonas aeruginosa, Staphylococcus aureus, Escharichia coli and Proteus. The only fungal isolate identified was Candida. The results also showed ciprofloxacin, Gentamycin and Augmentin were the most active antibiotics sensitive to the bacteria isolated. The high prevalence of UTI reported in this study could be as a result of poor personal and environmental hygiene, poor toilet facilities and lack of portable water. Health education with the provision of proper toilet facilities is recommended. Key words: Antibiotics, Asymptomatic, Microorganisms, UTI, Sensitivity test INTRODUCTION Urinary tract infection (UTI) is the infection of any part of the urinary tract which consists of the kidney, ureter, bladder, and urethra. Any part of these structures can become infected. However, the infectionn of the bladder (cystitis) and the urethra (pyelonephritis) are the most common. Most UTIs are caused by bacteria that can live in the digestive tract, the vagina or around the urethra. Bacteria can enter the sterile urinary system through the urethra or more rarely through the blood stream (Feitosa et al., 2009). The bacteria usually implicated in UTI patients include E. coli, Staphylococcus aureus, Klebsiella aerogenes, Pseudomonas aeroginosa, Proteus, Streptococcus facalis and Enterobacter (Oladeinde et al., 2015; Ebidor et al., 2015; Okonko et al., 2010; Al-Haddad, 2005). The prevalence and degree of occurrence of one or two of these microorganisms over others are dependent on the environment (Omonigbo et al., 2001). Gram-negative bacteria have been found to be most frequent in UTI cases (Omonigbo et al., 2001; Ebie et al., 2001). UTI are knownn for their resistance and exhibit the property of antimicrobial tolerance (Foxman and Brown, 2003). Stewart et al (1993) reported the isolation of an unusual multiple resistance Corynebacterium from urine of a comatose patient. The pathogen was reported to be resistance to Sulphurfurazole, Trimethroprion, Nalidixic acid, Cefazolin,

2 582 Merit Res. J. Med. Med. Sci. Floxacin, Norfloxacin, Vancomycin and Fusidin (Omonigbo et al., 2001). In healthy females, the prevalence of bacteriuria increases with age from 1% in females within 5-14 years of age to more than 20% in females at least 80 years of age (Colgan et al., 2006). This is higher among individuals in lower socioeconomic classes and those with past history of UTI (Turpin et al., 2007). Sickle cell trait, diabetes mellitus and grand multiparity have been reported to cause two-fold increase in the rate of bacteriuria (Enayat et al., 2008). There is also increase in the risk of developing UTI due to sexual activity, catheterization, contraceptive usage, urethral structure, kidney stone, etc (Emiru et al., 2013; Aboderin et al., 2009; Ramzan et al., 2004). The aim of this study therefore, is to determine the prevalence of UTI among these vulnerable and sexually active females and to determine the sensitivity of the isolated microorganism to regular antibiotics. MATERIALS AND METHODS Study Area Abia State Polytechnic is a tertiary institution located in Aba, a major settlement and commercial center in the southeastern part of Nigeria. The geographical coordinates for Aba are 5º 07 N latitude and 7o 22 E longitude and 205m (673ft) above sea level. Aba is thickly populated and has stagnant water in many places particularly during the rainy seasons with garbage dumps littered in some parts of the city. People are exposed to poor hygiene and availability of portable water is not within the reach of the poor. These factors actually promote infection and their transmission. Research Ethics Ethical review and clearance of the research protocol were obtained from the Ethical Review Committee of the Department of Biology/Microbiology, Abia State Polytechnic, Aba. Permission was sought from the school authorities. Each of these students gave consent of their willingness to participate in this study. educated on the precaution to prevent contamination of the specimen. The samples were taken to the Microbiology Laboratory of the institution for analysis. The samples were analyzed within 30minutes to 1 hour of collection. The sample size was determined using kreijcie and Morgan (1970) formula for determining sample size: S= X 2 NP (1-P)/d 2 (N-1) +X 2 P (1-P). Microbiological Analysis Culturing of the Urine Samples With the aid of a micropipette, 1.0 ml of each urine sample was collected and serially diluted up to ten fold dilution. From the appropriate dilution, 0.1mL was transferred into pre-sterilized Nutrient agar, MacConkey, Manitol salt agar (MSA) and Potato Dextrose agar (PDA) plates (Cheesbrough, 2006). After overnight incubation at 37 o C for 24 hours, the plates were then examined macroscopically for bacterial growth. The bacterial colonies were counted. Only specimens which produced 10 5 CFU/mL of urine were considered significant while specimens that produced < 10 5 colonies of urine were considered insignificant or due to contamination (Oladeinde et al., 2015; Emiru et al., 2013; Okonko et al., 2010). Representative of growing colonies were picked with a wire loop from incubated Nutrient agar and MacConkey plates and pure cultures were made with repeated subculturing. Resulting cultures were used for Gram stain, fermentation and Biochemical tests which include catalase, coagulase, Indole, urease, Oxidase tests etc, aimed at identifying the bacterial isolates. Cultures plated on Potato Dextrose agar were incubated at room temperature for 5 days (Cheesbrough, 2006). The results were taken and accurately recorded. Sensitivity Test Diagnostic sensitivity test agar (DSTA) was used for the antibiotic sensitivity test. The method described by Singh et al (1997) was employed. The bacterial isolates were subjected to in-vitro susceptibility test against some common antibiotics. Sample Collection A cross-sectional study of female students who were asymptomatic to UTIs was recruited into this study, between the months of February and April, Those who were not willing to participate were excluded. Midstream urine (MSU) samples were collected with sterile wide-necked leak-proof plastic universal containers. Each of the students was adequately RESULTS Table 1 shows the age distribution of UTI among the students. The age bracket years had the highest prevalence of 23(74.2%) while the least rate of infection (45.2%) was obtained from the age group 33 and above. The morphological and biochemical characteristics of the bacterial isolates are shown in Table 2. A total of five bacterial isolates were identified, which include Klebsiella

3 Ezeigbo et al. 583 Table 1. Age Distribution of UTI among the Students Age (years) Number Examined Number positive (%) (74.2) (61.0) (58.7) 33 and above 42 19(45.2) Total (59.5) Table 2. The Morphological and Biochemical Characteristics of Bacterial Isolates Test Klebsiella Pseudomonas E. coli Proteus Staphylococcus Morphology rod rod rod Rod cocci Gram reaction Catalase Coagulase Citrate Oxidase Indole urease - + Methy red Voges-Proskauer - - Glucose A/G A/- A/G A/G A/G Lactose A/G A/G A/G A/- A/- Sucrose A/- A/G A/- A/- A/- Manitol A/- A/- Key: A/G= Acid and gas production; A= Gas production; - = Negative; + = Positive; NA= Not applicable Table 3. Microscopic and Macroscopic Morphologies of Isolated Fungi Microscopy Macroscopy Probable Isolate Single cluster of Blastoconidia which A creamy to yellowish colony with Candida is round and elongated with smooth pasty glistering, wrinkled and pseudohyphae observed. dull colour. Table 4. Antibiotic Sensitivity Pattern of the Isolates Antibiotics Klebsiella Pseudomonas E. coli Proteus Staphylococcus Candida % Sensitivity pattern Streptomycin 15.0 Nil Nil NA 60 Ampicilin Nil Nil Nil NA 40 Ceporox 20.0 Nil Nil 25.0 Nil NA 40 Tarivid Nil NA 80 Nalidixic acid Nil Nil Nil Nil Nil NA - Reflaxine 15.0 Nil Nil NA 60 Gentamycin NA 100 Augmentin NA 100 Ciprofloxacin NA 100 Septrin 14.0 Nil NA 80 Nystatin NA NA NA NA NA % Susceptibility pattern Key: NA= Not applicable, Pseudomonas, E. coli, Proteus and Staphylococcus. Table 3 shows the microscopic and macroscopic mor- phology of fungi isolated. The result revealed that only Candida were observed. Table 4 shows the antibiotic sensitivity pattern of the

4 584 Merit Res. J. Med. Med. Sci. isolates. Some of the isolates are showing resistance to antibiotics with less or no zone of inhibition in the plates. Ciprofloxacin, Gentamycin and Augmentin were found to have the highest zone of inhibition. DISCUSSION Urinary tract infection (UTI) is a serious health problem affecting millions of people each year. The present study was carried out to assess the prevalence rate of UTI among the asymptomatic female students of Abia state polytechnic, Aba Southeastern Nigeria. The results obtained revealed a significant number of apparently healthy female students (59.5%) were infected with UTI. A higher prevalence rate of UTI (77.3%) among students of a private university in Western Delta, Nigeria had earlier been reported by Otajevwo and Eriagbor (2014). However, similar study carried out on the female students of the University of Agriculture, Makurdi, Benue State Nigeria, revealed a lower prevalence rate of 47.0% (Amali et al., 2008). A lower incidence rate obtained in this study compared to the results of Otajevwo and Eriagbor (2014) could be linked to the indiscriminate use of antibiotics by some of the students; who confirmed the use of drugs whenever they notice any problem with urination and other symptoms. In addition, the sexual activities of these students could be a contributory factor that predisposed these students to UTI. The high rate of infection in this study could be also linked be linked to the level of personal and environmental hygiene of the students since the institution is off-campus accommodation. Most of the buildings in Aba, particularly those affordable to the students lack proper toilet facilities and as such predisposed them to UTI. It was also observed that prevalence rate decreased with age. Age group years had the highest prevalence rate (74.2%), followed by age group years (61.0%) while ages 33 years and above recorded the least with 45.2%. Similar result was also obtained by Ani and Mgbechi (2008). A total of six (6) microorganisms which were the possible cause of infection were isolated. They include five bacterial isolates: Escherichia coli, Proteus, Klebsiella, Pseudomonas and Staphylococcus with Candida as the only fungi. This result aso agrees with the findings of Ebidor et al. (2015), Vasudevan (2014), Okonko et al. (2010), Obiogbolu et al (2009), Al-Haddad (2005) and Mars (2001), who also identified these organisms as the possible and common causative agent of UTI.The presence of Escherichia coli may be due to faecal contamination of the organisms from the toilets and could be easily transmitted to females due to the shortness of their urethra (Nicolle, 2001). On the susceptibility to the selected antibiotics, a significant result was obtained with Ciprofloxacin, Gentamycin and Augmentin. Earlier reports of Okonko et al. (2009) also gave similar results. The success of Ciprofloxacin could be due to its broad spectrum activities. Other drugs have varying and fair activities on the different isolates. CONCLUSION Urine is generally considered to be sterile and believed to be germ- free. Any source of possible infection occurs through urethra which initiates the incidence of infection. The presence study revealed a high prevalence rate of UTI among asymptomatic female students of Abia State Polytechnic, Aba. Majority of the students are youths, and therefore should be adequately informed and educated on the need of personal and environmental hygiene. The government should ensure that proper toilet facilities are available in Aba and similar environs. Indiscriminate use of antibiotics should be discouraged to avoid resistance to antimicrobial drugs. The high prevalence recorded in this study makes it necessary for people, particularly females to be adequately educated on matters affecting their reproductive health. 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