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9 Oct 2017

PREVALENCE AND ETIOLOGY OF GRAM NEGATIVE BACTERIA IN THE URINE

INTRODUCTION :

GRAM NEGATIVE Bacteria are bacteria that do not retain their crystal violet dye in the gram staining protocol. They constitute a serious problem in the urinary tract in various parts of the world today. Gram negative bacteria are non spore forming bacilli that grow rapidly on ordinary laboratory media under aerobic and anaerobic conditions. They are differentiated by their cell wall structure and characterised as;

  1. Thin peptidoglycan layer (much thinner than gram positive).
  2. Cytoplasmic membrane.
  3. Outer membrane containing lipopolysaccharide outside the peptidoglycan layer.
  4. Poringland exists in the outer membrane which acts like pores.
  5. No teichoic acid.

 

Many pathogens are gram negative species with predominance of Enterobacteria. Escherichia coli accounts for majority of urinary tract infections in young women but other gram negative rods of different general such as proteus specie. Antibiotics are used for the treatment of bacterial infections but the carriers differs from the treatment to the sensitivity of drugs.

 

AIMS AND OBJECTIVES

To find out the prevalence of gram negative organism in the urinary tract.

 

To determine the age and sex prevalence.

 

To  determine the prevalence of bacteria stains in the urine.

 

ETIOLOGY

 

The etiology of is dependent on four factors but bacterial species are the most common thereby causing up to 80-85% of all symptomatic UTI in women . There are also factors which enhance the invasion of organisms in the urine. They include sex, age, hospitalization and obstruction in urinary tract. Females are however believed to be affected more than males because of their shorter urethra and wider urethra. The anatomical relationships of the female’s urethra and vagina makes the bacteria been massed up from the ureter into the bladder during pregnancy and childbirth. The factors are namely:

Bacteria: which are subjectively quantified in the urine as few moderate and many can be detected in unstained urine sediments when insufficient in quantity.

Fungi: Yeast and yeast like forms have been known to associate with UTI. Pathogenic species of Candida in which the predominating is Candida albicans infect the urinary tracts.

Virus: Most times virus infects the urinary tract during Measles , Mumps etc

occurrence. Epithelial cells containing viral inclusions appear in the urine in
measles cyto glomerulus infections, varicella and other common infections.
Fatal cases of intestinal nephritis associated with mumps increases the
infections in urine.

Protozoa: Protozoan infections of the urinary tract area sexually transmitted disease in man and woman.

 

ROUTES OF BACTERIAL INFECTIONS

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It is known that infections from the ascending route affect mostly the kidney
which emerges to the urethra and periurethral tissues into the bladder and then enter into the ureter finally into renal pelvis, several factors can be dispose the urinary tract to infection. Any abnormality of the urinary tract that obstructs the flow of urine sets the pace for infection to occur.Pregnant women are more prone to UTI due to hormonal changes and the movement of the urinary tract during childbirth. Wearing of tight underwear like tight pants, bike riding, perfumes causes irritation to the genital area and may be associated with bladder infection. Lack of fluids also promotes the risk of UTI as the individual does not have a frequent irritation. An enlarged prostate gland can also slow the flow of urine, thus raising the risk of infection.

 

SYMPTOMS OF UTI

An individual might be infected without having any symptoms showing up,while most have the symptoms. Based on the records, the most common clinical symptoms associated with UTI that brings medical attention are those referable to the urinary includes

Dysuria its early symptoms, may be burning or pain on the tip of the penis
(for men), itching or in pain during urination, discomfort in the lower abdomen and a frequent urge to urinate may arise.The clinical preservation associated with acute polyneuritis is familiar and include recurrent regions and fever, nausea and vomiting etc. the clinical signs associated with it is divided into two categories.

  • Those related to infection and they are related to degree and location of injury within the kidney, consequently the infectious aspect of the disease may be minor.
  • More common is asymptomatic symptoms referable to lower
    urinary vague complaints or flank or abdominal discomfort and intermittent
    low grade fever.

 

DIAGNOSIS
The standard for Diagnosis is the detection and identification of the causative pathogens in urine. Information obtained from from medical history is essential also the signs and symptoms at the moment leads to a proper diagnosis. After the clean catch urine is collected in a sterile container, it is sent to laboratory where the urine test is done using cysteine lactose Electrolyte deficient Agar (Cled) and Blood Agar (BA) is carried out, in and microscopy is also done along with the gram stain technique.

 

TREATMENT

The importance of treating UTI is to avoid reoccurrence of the infection and also to eradicate the uropathological bacterial from the faecal and verginal reservoirs. Drugs used in the treatment includes Gentamycin, Amoxicillin, ciprofloxacin, etc. Recently, resistance of organisms to some antibiotics has increased and it has been observed that frequent use of these antibiotics have
caused an obvious increase in the development of resistance.

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AIMS IN THE TREATMENT OF UTI

  • To prevent reoccurrence of infection in persons treated.
  • Prevention of further increase in resistance.

 

PREVENTION AND CONTROL

The urinary system is structured in a way that helps to ward of infection. The
following are preventive measures of UTI which includes:
1. Constant drinking of water eliminates live bacteria from patching on the walls of the                bladder.

  1. Consumption of cranberries, blueberries and vitamins help to eliminate infections.
    3. Wiping of the vagina immediately after urination is also advised.
    4. Contraceptive methods other than a diaphragm and spermicides is also
    encouraged.
    5. Abstinence from sex without contraception like condoms.
  2. Abstinence from wearing tight wears and clothes helps to ward off these organisms.

 

DISCUSSION

The prevalence of UTI was high and females are significantly more affected than males. Previous reports carried out in different parts of the world indicates higher incident among females than males, this may be explained by the fact that females pass short urethra. Also the spread of normal flora in faecal materials from the anus to the vagina from where the bladder could be infected as a result of poor anal cleaning could be responsible for the increase in females.
The prevalence of UTI calls for caution among the female maybe due to poor hygienic practice and also indiscriminate sexual behaviour among females.E.coli is the commonest organism found. The least resistance of the bacterial isolates to antimicrobial agents was observed to be Tetracycline, Cotrimozole, Ampicillin, Cephalexin. The factors contributing to those resistance may be due to indiscriminate abuse of antibiotic. Other factors may include poor quality of drugs, poor storage and exposed drug etc. Antibiotics prescription and dispensation have been associated with reduced antibiotic resistance.

 

CONCLUSION

 

UTI among females is a very difficult
health problem which must be properly addressed. It also revealed that the most causative organisms of UTI in schools,  community,  hospitals, etc are the gram negative organisms which were shown to be sensitive to the following drugs. Gentamycin, Ciprofloxacin and Nitrofurantoin. It could be suggested that in the face of clear UTI symptoms and in the absence of physician or clinician of these three drug abuse (Gentamycin, Ciprofloxacin and Nitrofurantoin) could be procured and used with an experienced doctor.

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RECOMMENDATIONS

Females especially should make sure to keep proper hygiene, and avoid wearing tight underwear.

There should always be interactions between the microbiologist and physician because there have been cases where drugs sensitivity is always different from the ones prescribed to person infected.

Informing the public is necessary because so many people are ignorant through seminars etc.

 

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