Clean Catch Midstream Urine Samples Research Articles

ASYMPTOMATIC BACTERIURIA IN REPRODUCTIVE AGE GROUP FEMALES.

Background: Asymptomatic bacteriuria is one of the important causative factors for premature or low-birth infants, postpartum urinary tract infections and higher fetal mortality rates in pregnant women Methods: Thirty-two asymptomatic females from the antenatal clinic, twenty-five females admitted to the post-natal ward and ten nonpregnant females were randomly selected. Clean-catch midstream urine sample was collected and processed for culture and sensitivity as per standard guidelines.Results: Overall incidence of asymptomatic bacteriuria was 11.9%. The incidence of asymptomatic bacteriuria in pregnant females was 3.1% whereas the incidence in post-natal females was 40%. None of the non-pregnant females had asymptomatic bacteriuria. Conclusion: Screening of antenatal and post-partum females is required to avoid adverse outcomes.

Epidemiology of Pathogens Causing Urinary Tract Infections in Rural Communities of Enugu State, Nigeria

Urinary tract infection (UTI) is the infection of any part of the urinary tract, and about 150 million people worldwide develop UTI each year. Its is caused by bacteria, though fungi and viruses are etiologic agents, and can occur in community and hospital settings. This study was conducted to determine the epidemiology of pathogens causing urinary tract infections in Rural Communities of Enugu State, Nigeria. A total of 735 clean catch mid-stream urine samples were collected and tested for bacteriuria from February, 2021 to June, 2021. The participants were assessed clinically to ascertain eligibility for participation, and urine samples were assessed microbiologically to isolate pathogens causing UTI. Pathogens isolated were identified morphologically, and biochemically, and results were tabulated, with respect to participants demographics. Total number of participants that participated in urine culture was 735, of this number, 172(23.40%) were males, whereas 563(76.60) were females. 510(69.39%) were married whereas 225(30.61%) were single. Total number of bacterial isolates obtained was 649 (88.30%). Of this, Escherichia coli was the most prevalent, 316 (48.7%), followed by Staphylococci, 154 (27.7%). The least represented isolate was Pseudomonas, 2 (0.3%). Of the total number of isolates obtained, 151(23.27%) came from males, whereas 498 (76.73%) were from females. Total number of married participants with positive bacteriuria was 449 (69.18%), and those of them that were single constituted 198(30.51%). Age range of 31-40 gave the highest level of bacteriuria 151 (23.27%), followed by age range of 21-30, 146 (22.50%). The least representation of bacteriuria was seen among age group 10-20, 39(6.01%). The prevalent of UTI in this study was high, and females, youths, and married people showed a positive correlation with community acquired urinary tract infection. Intermittent screening of rural dwellers for positive bacteriuria, with emphasis paid on clinical symptoms and proper treatment will go a long way in tackling the menace of urinary tract infection in our rural communities.

Genotypic characterization of extended-spectrum β-lactamase producing urinary isolates among pregnant women in Ho municipality, Ghana

ObjectiveThe case of antibiotic resistance has become a major global concern and Extended Spectrum β-lactamase (ESBL) producing organisms have so far remained the biggest culprit. The consequences of urinary tract infection (UTI) and antibiotic resistance among pregnant women cannot be underestimated. We investigated UTI and ESBL production among urinary pathogens isolated from pregnant women. MethodWe obtained non-repeat, clean catch midstream urine samples from 1345 pregnant women suspected of having UTI for bacterial identification at the Ho Teaching Hospital Laboratory between June 2013 and March 2015. The isolates were taken through relevant biochemical testing for identification and then subjected to antimicrobial agents for susceptibility testing using the disc diffusion method. We tested for ESBL production by the combined disc method and ESBL positive (+ESBL) phenotype isolates were genotyped for BlaTEM, BlaSHV, and BlaCTX-M using polymerase chain reaction (PCR). Data were analyzed using SPSS v24 and p-values < 0.05 were considered statistically significant. ResultsOf the 1345 urine samples tested, 230 (17.1%, 95% CI: 15.1%–19.1%) yielded significant bacteriuria. The most common bacterium isolated was Staphylococcus aureus (29.6%) followed closely by Escherichia coli (28.7%) both of which were highest during the second trimester of gestation. We isolated 152 gram-negative isolates with 41.4% (63/230) being + ESBL. Of the 63 + ESBL, 45 (71.4%) possessed blaTEM, 42 (66.7%) had blaCTX-M and 2 (3.2%) possessed blaSHV genes; 38 possessed multiple ESBL genes comprising 2 with both SHV and TEM genes and 36 with both CTX-M and TEM genes. ConclusionHigh prevalence of UTI and persistent transmission of ESBLs among pregnant women in the Ho Municipality is worrying and a course for public health concern. We recommend urine culture during pregnancy as a routine laboratory investigation to avoid birth-related complications.

Polybacteria in Urinary Tract Infection among Antenatal Patients Attending University Teaching Hospital Ado-Ekiti, Ekiti State, Nigeria

A study of the polybacteria in UTI among antenatal patients attending clinics at the Ekiti State University Teaching Hospital, Ado-Ekiti, southwest, Nigeria was conducted between October, 2009 and July, 2011. Two hundred consenting symptomatic and asymptomatic pregnant women were recruited into the study and clean-catch midstream urine samples were collected from them. Structured questionnaires were also administered to the subjects to obtain relevant socio-demographic data from them. The results showed that 98(49%) out of the 200 samples had significant bacteria growth, 22 (11%) yielded growth of Candida albicans, 30 (15%) yielded no significant growth, 14 (7%) yielded mixed growth of contaminants, while 44 (22%) yielded no bacteria growth. Microscopically, the presence of Trichomonas vaginalis was detected in 8 (4%) of the samples. Thirty (28.8%) of the samples yielded growth of Escherichia coli, Klebsiella spp 28 (26.9%), Staphylococcus spp 22 (21.2%), Pseudomonas spp 10 (9.6%), Proteus spp 6 (5.8%) and Streptococcus spp 2 (1.9%). Statistical analysis of the result reveal that there’s an association between polybacteria UTI and subjects’ socio-economic status. It was more prevalent in subjects with low socio-economic status, was highest in subjects’ in first trimester and lowest in the third trimester. Antibiotic susceptibility testing shows that the isolates had high sensitivity to peflacine, gentamicin, nitrofurantoin, rocephin and cloxacillin. They had fairly good sensitivity to ciprofloxacin and nalidixic acid, whereas they had moderate sensitivity to chloramphenicol and zinacef. They were however resistant to tetracycline, cotrimoxazole, colisitn, streptomycin, ampicillin and penicillin.

Magnitude of Multidrug-resistant Bacterial Uropathogens and Associated Factors in Urinary Tract Infection Suspected Adult HIV-Positive Patients in Southern Ethiopia

Background: Due to the reduction of their immunity, people living with the human immunodeficiency virus (HIV) are more susceptible to acquiring urinary tract infections (UTI). Moreover, the emergence of drug-resistant bacterial uropathogens has grown widely and now constitutes a severe clinical problem among HIV-positive patients. Methods: An institution-based cross-sectional study was conducted at the ART clinic of Arba Minch General Hospital from 1st January to 30th May, 2021. A total of 251 adult HIV-positive patients clinically suspected of having UTIs were systematically recruited. Socio-demographic and other factors were collected by a pre-tested structured questionnaire. A clean-catch mid-stream urine sample was collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated aerobically at 37°C for 24 hrs. After overnight incubation, significant bacteriuria, 105 CFU/ml, was considered. Bacterial identification was made by standard protocols. Antimicrobial susceptibility testing was done by Kirby Bauer’s disk diffusion method. The data was analyzed using SPSS version 25. A P-value less than 0.05 was used as statistical significance. Results: The overall magnitude of multidrug-resistant (MDR) uropathogens was found to be 14.3%, with a 95% CI (10-19.1). Gram-negative bacteria (83.3%) were the predominant MDR isolates, with E. coli (41.7%) followed by K. pneumoniae (22.2%). All isolates of S. aureus and two-thirds of the isolated CoNS were MDR. A total of 30% and 16.7% of Gram-negative isolates were ESBL and carbapenemase producers, respectively, whereas 50% and 33.3% of isolated S. aureus and CoNS were methicillin-resistant, respectively. Antibiotic use in the previous 6 months [AOR = 6.7, 95% CI: (2.53-17.6)], presence of chronic underlying disease [AOR = 7.03, 95% CI: (1.72-28.73)], antibiotic use without a prescription [AOR = 9.7, 95% CI: (3.53-26.675)], CD4+ counts less than 250 cells/mm3 [AOR = 8.05, 95% CI: (2.078–31.154)], and CD4+ count in between 250-500 cells/mm3 [AOR = 2.49, 95% CI: (1.05-5.923)] were found to be statistically significant associated with MDR uropathogens. Conclusion: This study found a significant number of multidrug-resistant uropathogens, indicating that healthcare providers should be aware of this and take urgent action to minimize resistance spread, as well as consider current empirical antibiotic therapy for UTI in HIV-positive patients.

Bacterial profile and antibiotic susceptibility pattern of uropathogens causing urinary tract infection in the eastern part of Northern India.

Urinary tract infection (UTI) is a common infectious disease that affects men and women. It is a significant health concern due to multidrug-resistant (MDR) organisms. Therefore, it is necessary to have a current understanding of the antibiotic susceptibility (AS) pattern of uropathogens to manage UTI effectively. Since the bacterial pathogen causing UTI and its AS vary with time and place, the prevailing AS pattern of the causative agents are essential for empirical antibiotic therapy. This study aims to determine the prevalence and AS of uropathogens isolated from UTI patients in the eastern part of Northern India. The study was carried out between November 2018 and December 2019. Clean catch midstream urine samples were collected and processed using standard guidelines for microbiological procedures. Positive microbiological cultures were found in 333 of the 427 patients, where 287 were gram-negative bacteria (GNB), and 46 were gram-positive bacteria (GPB). Females had a higher prevalence of UTI (60.7%) than males (39.3%) (p = 0.00024). The most susceptible age group in females was 18–50 years as compared to males, whereas at the age of 51–80 years and >80 years males were more susceptible than females (p = 0.053). The most prevalent pathogen identified were Escherichia coli (55.0%), followed by Proteus sp. (6.9%), Klebsiella pneumoniae (6.6%), Pseudomonas aeruginosa (6.3%), of which 96.0% were MDR bacteria. The susceptibility pattern of our study also revealed that amikacin, gentamycin and imipenem were the most effective drugs against GNB. In contrast, nitrofurantoin, vancomycin, and chloramphenicol were the most effective drugs against GPB. According tothe findings, MDR pathogens are very much prevalent. Since UTI is one of the most frequent bacterial diseases, proper management necessitates extensive investigation and implementation of antibiotic policy based on AS patterns for a particular region.

Prevalence of ESBL genes in Klebsiella pneumoniae from individuals with community-acquired urinary tract infection in rural communities of Enugu State, Nigeria

Background: The emergence and spread of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae is now a major challenge in treating urinary tract infections. This study was conducted to determine the Prevalence of ESBL genes in Klebsiella pneumoniae and the influence of these genes on the antimicrobial susceptibility patterns of the isolates, obtained from community acquired urinary tract infection in Enugu state rural communities. Method: A total of 735 clean catch mid-stream urine samples were collected from February, 2021 to June, 2021. The urine samples were cultured and Klebsiella pneumoniae were identified morphologically, biochemically, and then typed down, using PCR, Gel electrophoresis, and Sanger Sequencing by Genewiz. Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL screening was done by the phenotypic method, using the standard disk diffusion method, whereas the phenotypic confirmation of ESBL producers was done by the double-disk synergy method, and interpreted according to CLSI guidelines. Multiplex PCR was used to detect the genes for SHV and CTX-M while conventional linear PCR was done for TEM and blas GES type ESBL genes. Results: A total of 77 isolates were identified as Klebsiella pneumoniae, and the prevalence of positive ESBL in them were 10(12.9%). Of the 77 isolates that were tested for antibiogram, 29 isolates were multidrug-resistance (MDR). Out of the MDR isolates, 10 were ESBL positive, whereas 19 were not. Of this 29 MDR isolates, 6 were extensively-drug resistant (XDR). Of the 6 XDR isolates, 3 do not possess ESBL enzymes, whereas 3 of them do. Age range of 31-40 contributed the highest prevalence of ESBL genes (60%), whereas age range of 10-20, 21-30, and 51-70 did not produce any ESBL gene. bla TEM gene was the most prevalent ESBL resistant genes with a prevalence of 10 (100%), followed by SHV 9(90%), whereas bla GES gene and bla CTX-M have the least prevalence of 4 (40%) each. Conclusion: Higher prevalence of MDR, XDR, and ESBL-producing Klebsiella pneumoniae were observed, thus the need for public health intervention for effective prevention and control of antimicrobial resistance, and proper treatment of UTIs.

Current Antibiotic Resistance Pattern of Prevalent Uropathogens in Urinary Tract Infection of Diabetic Patients in Comparison with non-Diabetics

Introduction: Urinary tract infections (UTIs) are a common infectious disease worldwide. Bacterial resistance to antibiotics is one of the most challenging global health problems. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance patterns for empirical antibiotic treatment of the patients. This study aimed to explore the bacteriology and antibiotic resistance pattern of urological pathogens in diabetic patients compared to that in non-diabetics. Materials and Methods: A prospective study during the period from June 2021 to November 2021 in Khulna City Medical College Hospital was carried out including 347 diabetic and non-diabetic patients. Midstream clean-catch urine samples were collected from suspected UTI patients of age more than 14 years and inoculated in Mac Conkey &amp; Blood agar media for semi-quantitative urine culture and sensitivity test. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program. Results: Among the 347 inoculated samples, Culture positive were in 286 cases. Gram-negative E. coli was isolated from 119 (overall 41.6%, 51% in diabetics and 36.5% in non-diabetic patients) samples which were the most predominant bacteria, followed by Enterococcus, Pseudomonas and Klebsiella. UTI with E. coli was significantly at a higher rate in diabetic patients and Exhibits 100% resistance to Ceftriaxone, Nalidixic acid, Cefuroxime and Cefixime. Bacteria offered a high degree of resistance against commonly used antibiotics-Amoxycillin, Ciprofloxacin, Amikacin, Gentamycin, Levofloxacin, Nalidixic acid and Nitrofurantoin ranging from 7% to 93%. Conclusion: E. coli infection is significantly predominant in UTI cases in this study and exhibits a higher rate of resistance to all antibiotics in diabetic patients than that in non-diabetics. None of the antibiotics is 100% sensitive in diabetic patients. Imipenem, meropenem and Piperacillin remain .......

Bacteriological Profile and Their Antimicrobial Susceptibility Pattern of Urinary Tract Infection Patients Attending at the Nephrology Department of Enam Medical College and Hospital, Savar, Dhaka.

Introduction: Urinary tract infection (UTI) is one of the common bacterial infections encountered by clinicians in clinical practice. Distribution and susceptibility of UTI-causing pathogens change according to time and place. Area-specific studies to gain knowledge about the type of pathogens and their resistance patterns may help the clinician to choose the proper antimicrobials for empirical treatment. Objective: This study was conducted to determine the distribution and antimicrobial susceptibility of uropathogens. Materials and Methods: This study was conducted in the Enam Medical College &amp; Hospital, savar, Dhaka between January 2021 to June 2021 to identify the organisms causing UTI and their antibiotic susceptibility. Clean catch midstream urine samples were collected from 476 clinically suspected UTI patients and tested bacteriologically using standard procedures. Antimicrobial susceptibility test was performed by Kirby-Bauer disk diffusion method. Results: The prevalence of UTI was higher in females than in males. Out of the 170 culture positive bacterial isolates Escherichia coli was the most common 51.76% organism, followed by Staphylococcus aureus 28.82%, Staphylococcus saprophyticus 11.17%, Klebsiellaspp 8.23 % and Enterococcusspp 4.70%. Meropenem (100%) followed by Imipenem (92.86% to 100%) were found most susceptible drugs. While Trimethoprim-sulfamethoxazole and Cephradine were the most resistant drug against the isolated uropathogens. Conclusion: As bacterial drug resistance is an evolving process, routine surveillance and monitoring studies should be conducted to provide physicians knowledge on the updated and most effective empirical treatment of UTIs. Medicine Today 2022 Vol.34(1): 51-56

Prevalence and Antibiotic Sensitivity Pattern of Pseudomonas Aeruginosa Isolates from Urine Samples in A Tertiary Care Hospital

Background: Urinary tract infection (UTI) is one of the leading causes of infection worldwide. P. aeruginosa is a versatile opportunistic pathogen and it is the third most common organism causing nosocomial urinary tract infections. With the widespread use of antibiotics, multidrug resistance pseudomonas continues to go up rapidly. This multidrug resistance pseudomonas increases the risk of mortality and morbidity.&#x0D; Objective: To determine the prevalence of P. aeruginosa and to understand the current statistics of its antimicrobial resistance pattern.&#x0D; Methods: This retrospective study was conducted from January 2019 to December 2020 in the Department of Microbiology, Bangladesh Medical College Hospital, Dhaka. Clean catch mid-stream urine samples were collected in sterile containers. The samples were cultured on CLED agar media with a standard calibrated loop and incubated at 370C overnight. P. aeruginosa grows well at 25°C to 37°C, and its ability to grow at 42°C helped to distinguish it from other Pseudomonas species. Antibiotic sensitivity test was done according to Clinical and Laboratory Standard Institute (CLSI) guideline.&#x0D; Results: A total of 10427 urine sample were received in the department of Microbiology of BMCH during these two years. Isolation rate of P. aeroginosa was 4% in 2019 and it increased to 6% in 2020. Piperacillin/Tazobactam showed sensitivity which was 63.33% in 2019 and 82% in 2020, followed by imipenem, meropenem, amikacin, ciprofloxacin, ceftazidime and aztreonam; which were 50% to 60% on an average. Sensitivity of the organism to Gentamycin (13.33% in 2019 &amp; 30.3% in 2020), Netilmicin (20% in 2019 &amp; 30.3% in 2020) and Ceftriaxone (13.33% in 2019 &amp; 12.3% in 2020) was found very low.&#x0D; Conclusion: P. aeruginosa isolates in urine culture is increasing in hospital admitted patient and becoming resistant to multiple antibiotics which is frightening.&#x0D; DS (Child) H J 2021; 37(1): 40-44

Prevalence and antimicrobial susceptibility pattern of urinary tract infection among pregnant women attending Hargeisa Group Hospital, Hargeisa, Somaliland

The aim of this study was to determine the prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland. A cross-sectional study was conducted at HGH, Hargeisa, Somaliland and participants were selected by systematic random sampling technique. Clean catch midstream urine samples were collected from 422 participants and cultured and antimicrobial susceptibility pattern was determined for the isolates. Univariable and multivariable logistic regression analyses were utilized to identify the independent risk factors for UTI. The prevalence of UTI was 16.4% (95% CI 13.3–19.9). The predominant bacteria isolate was E. coli (43.5%) followed by Coagulase negative staphylococcus (CoNS) 11(16%), S. aureus 9(13%), K. pneumonia 6(8.7%), Pseudomonas aeruginosa 5(7.2%), Proteus mirabilis 4(5.8%), Citrobacter spp 3(4.4%) and M. morganii 1(1.5%) Gram negative bacilli were resistant to ampicillin (96%) and tetracycline (71.4%) and Gram-positive cocci were also resistant to ampicillin (90%), tetracycline (55%). Multidrug resistance was observed in 85.5% of bacterial isolated. No formal education participants, previous history of catheterization and previous history of UTI had 3.18, 3.22 and 3.73 times respectively more likely to develop UTI than their counterparts. Culture and susceptibility test is vital for appropriate management of UTI in the study area.

Risk Factors Associated with Urinary Tract Infection in Children

Introduction: Urinary tract infection is infection leading to an inflammatory response in the epithelium of the urinary tract. Urinary tract infection is defined as the growth of significant number of organisms of a single species in the urine, in the presence of symptoms. Significant bacteriuria is a growth with colony count of &gt;105 / ml of a single species in a mid-stream clean catch urine sample. Aims: To find the prevalence of urinary tract infection in children with fever and its risk factor. Methods: A hospital based cross sectional observational study was performed in Nepalgunj Medical College, Kohalpur from October 2019 to October 2020.Children of age two months to 14 years admitted in Department of Pediatrics and visiting in outdoor fulfilling inclusion criteria were taken for the study. Detailed history and examination was performed. Data related to age, sex, predisposing risk factors of Urinary tract infection, symptoms and relevant investigations was carried out in all patients. Results: Among 135 children, maximum 62(45.92%) children were in the age group 1-5 years. There were 70(51.85) male and 65(48.14) female children. The prevalence of culture positive of urinary tract infection was 19.20%. Pyuria was more significant in females in comparison to male, more common in age group less than 5 years. 26 children were culture positive among which males to female ratio in urine culture positive cases were 1: 2.3 and majority had E.coli positive in urine culture sample. Apart from the female children urinary tract infection was commonly seen in uncircumcised male comprising of 8(11.42%) of total male children. Conclusion: In children presenting with fever, urinary tract infection was one of the common causes. It was most common in children less than 5 years, female gender and uncircumcised male children were two commonly associated risk factors

Incidence of Asymptomatic Bacteriuria in Pregnant Women

Background: Asymptomatic bacteriuria is the presence of bacteria in the properly collected urine of a patient that has no signs and symptoms of urinary tract infection.&#x0D; Aim: This study was carried out to determine the incidence of asymptomatic bacteriuria in pregnant women in Saveetha medical college, Thandalam, Tamil Nadu.&#x0D; Materials and Methods: A total of 250 pregnant women attending antenatal clinic at civil hospital, Saveetha medical college, over a period of 3 months, with age groups between 18 to 30 years agreed to enter the study and were clinically evaluated. All these women were asked to submit clean catch midstream urine samples and it was examined under the microscope and by culture method.&#x0D; Results: A total of 250 pregnant women included in our study, with varying age groups between 18 to 30 years and the highest incidence was seen in between the 26 to 30 age group. Asymptomatic bacteriuria was seen in 27.2% of the pregnant women. The prevalence of Escherichia coli was among the most dominant organism, followed by Staphylococcus aureus ,klebsiella and proteus species.&#x0D; Conclusion: The study showed 27.2% of the pregnant women to have asymptomatic bacteriuria. This can be reduced by screening the mothers in first trimester and routine urine culture test must be carried out.

Chronic Urinary Infection in Overactive Bladder Syndrome: A Prospective, Blinded Case Control Study.

ObjectivesTo investigate whether women with overactive bladder (OAB) symptoms and no evidence of clinical infection by conventional clean-catch midstream urine cultures have alternative indicators of sub-clinical infection.Patients/Subjects, Materials & MethodsThe study was a prospective, blinded case-control study with 147 participants recruited, including 73 OAB patients and 74 controls. The OAB group comprised female patients of at least 18 years of age who presented with OAB symptoms for more than 3 months. Clean-catch midstream urine samples were examined for pyuria by microscopy; subjected to routine and enhanced microbiological cultures and examined for the presence of 10 different cytokines, chemokines, and prostaglandins by ELISA.ResultsThe mean age and BMI of participants in both groups were similar. No significant difference in the number of women with pyuria was observed between OAB and control groups (p = 0.651). Routine laboratory cultures were positive in three (4%) of women in the OAB group, whereas the enhanced cultures isolated bacteria in 17 (23.2%) of the OAB patients. In the control group, no positive cultures were observed using routine laboratory cultures, whereas enhanced culture isolated bacteria in 8 (10.8%) patients. No significant differences were observed in the concentrations of PGE2, PGF2α, MCP-1, sCD40L, MIP-1β, IL12p70/p40, IL12/IL-23p40, IL-5, EGF and GRO-α between the OAB and control groups.ConclusionsPatients with OAB symptoms have significant bacterial growth on enhanced culture of the urine, which is often not detectable through routine culture, suggesting a subclinical infection. Enhanced culture techniques should therefore be used routinely for the effective diagnosis and management of OAB.

Asymptomatic bacteriuria in South Indian pregnant women and treatment effect on outcome of pregnancy

Asymptomatic bacteriuria is defined as bacteriuria where colony count of same species is more than 10 colonies/ml of urine in a clean catch midstream urine sample in an asymptomatic women”. This if left untreated in pregnancy, may progress to pyelonephritis. Due to the physiological and anatomical changes in the genitourinary tract during pregnancy, urinary tract infection is more common in pregnant women. Our aim was to study the effect of asymptomatic bacteriuria on pregnancy outcome and to find the most common organism responsible for asymptomatic bacteriuria in pregnant women.This was a prospective observational hospital based study conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital. A total of 85 pregnant women were included in the study. Clean catch mid stream urine sample was collected and cultured. The organism was identified and patient was treated according to the antibiotic sensitivity pattern. Patient was followed up till delivery to look for maternal and fetal outcomes.In our study, the prevalence of ASB in pregnancy was 24.7%. 61.9% were in age group of 18-25 years and 42.9% were 2 gravida. 85.7% were in 3rd trimester. Of the ASB cases 90.5% had term babies and 85.7% had babies with birth weight of &amp;#62;2.5 Kg. It is important to do Urine culture and sensitivity in all pregnant women irrespective of the symptoms and gestational age so as to detect ASB as early as possible and by treating this we can avoid the adverse effects in the mother and the fetus.

Prevalence of bacterial uropathogens and their antimicrobial susceptibility patterns among pregnant women in Eastern Ethiopia: hospital-based cross-sectional study

BackgroundUrinary tract infection (UTI) is the commonest bacterial infections during pregnancy, leading to significant maternal and prenatal morbidity and mortality.MethodThis hospital-based cross-sectional study during November 2017 to January 2018 was aimed to determine hospital-based antibacterial susceptibility patterns of bacterial uropathogens among 200 pregnant women in Eastern Ethiopia. ~ 10–20 ml clean-catch midstream urine samples were collected by the study participants. The well-mixed urine samples standardized to 1 µl have inoculated onto Cystine Lactose Electrolyte-Deficient and MacConkey agar. The inoculum was cultured at 37 °C under aerobic conditions for 18–48 h and examined macroscopically to evaluate the colony appearance and size of colonies. The isolate on the plates with pure growth and colonies ≥ 105 CFU/ml were further subjected to biochemical identification and susceptibility testing according to the standard procedures explained in the Clinical and Laboratory Standards Institute guideline. SPSS version 25 was used for data analysis. Descriptive statistics such as frequency, percentage, and cross-tabulation were used to present the findings in the form of graphs and tables.ResultsThe response rate for this study was 98.04%. Thirty-one bacteria were isolated among the 200 urine samples processed, which gave the overall UTI prevalence of 15.5%. The majority (90.3%) of the isolates were Gram-negative. Escherichia coli (45.2%) was the most frequent isolated uropathogen which followed by Proteus spp. (22.6%), Klebsiella pneumoniae (16.1%), Staphylococcus aureus (9.7%), and Pseudomonas aeruginosa (6.5%). Among the isolates, 96.4% of them were susceptible to amikacin and followed by nitrofurantoin (90.3%), and gentamicin (83.9%). However, high rates of resistance to ampicillin (58.1%), amoxicillin-clavulanate (51.6%), and cotrimoxazole (51.6%) were observed. Overall, 16(51.6%) of the bacterial isolates had developed multiple drug resistance to the selected antimicrobials.ConclusionIn general, the overall prevalence of UTI was high, 15.5%. Most of isolated bacterial uropathogens were Gram-negative bacteria, and Escherichia coli was the most frequent isolate. The majority of the isolates were susceptible to amikacin, nitrofurantoin, and gentamicin. However, a high rate of resistance was observed to ampicillin, amoxicillin-clavulanate, and cotrimoxazole. More than half of the isolated bacteria had multiple drug-resistant features. Therefore, periodic and continuous urine culture for screening and diagnosis is mandatory to reduce the consequence of UTI and multidrug resistance bacteria in pregnancy.

Urinary Tract Infections and Antimicrobial Sensitivity Patterns of Uropathogens Isolated from Diabetic and Non-diabetic Patients Attending Some Hospitals in Awka

Background: Diabetic patients have been found to be prone to urinary tract infections, and there is a wide gap of information in developing countries regarding the prevalence and antibiotic sensitivity of the pathogens causing this infection. This study was carried out to determine the prevalence, predisposing factors and antibiotic sensitivity of organisms causing urinary tract infections among diabetic patients and non-diabetics in four hospitals in Awka, Anambra State, Nigeria. Method: A total of four hundred and sixty participants (230 diabetic patients and 230 non-diabetics) were enrolled in a cross- sectional study design with 249 males (54.13%) and 211 (45.87 %) females. Clean catch mid-stream urine samples were collected from all participants in sterile containers and analyzed macroscopically and microscopically. Each urine specimen was streaked onto Nutrient agar, MacConkey agar, Cysteine Lactose Electrolyte Deficient agar and Sabouraud’s Dextrose agar, incubated at 37°C for 24h and identified using standard methods. The sensitivity of the isolates to different antibiotics was tested using Kirby-Bauer disc diffusion method. Data obtained were analyzed statistically. Result: The overall prevalence of urinary tract infections among diabetic patients, 63 (27.39%), was significantly higher than that among non-diabetics, 41 (17.83%) (p= 0.014). Gender and previous history of UTI were found to have significant association with urinary tract infection (0.000). Organisms isolated were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Citrobacter spp, Coagulase negative Staphylococcus, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. The isolates were sensitive to tested antibiotics with Gentamicin (10µg) and Ceftriaxone (30µg) as most effective against Gram negative bacteria isolates while Ampicillin (10µg) and Chloramphenicol (30µg) were most effective against Gram positive bacteria isolates. Conclusion: The prevalence of UTI is significantly higher in diabetics than in non-diabetics with E. coli being the most common isolate.The importance of antibiotic sensitivity testing before treatment is highly recommended.

Catheter-Associated Urinary Tract Infection: Incidence, Associated Factors and Drug Resistance Patterns of Bacterial Isolates in Southern Ethiopia.

IntroductionCatheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity. The aim of this study was to determine the prevalence, associated factors and antibiogram of the bacterial isolates among CAUTIs patients.MethodsA facility-based, cross-sectional study was conducted from March to December 2019 at Arba Minch General Hospital, Southern Ethiopia. Clinical and socio-demographic data were obtained using a questionnaire. Clean catch midstream urine samples were collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated in an aerobic atmosphere at 37°C for 24 h. After overnight incubation, the bacterial growth on the respective media was inspected visually and graded for the presence of significant bacteriuria. A significant bacteriuria was considered, if pure culture at a concentration of ≥105 colony forming unit (CFU)/mL. All isolates were further identified using colony morphology and biochemical tests. Antimicrobial sensitivity was determined by modified Kirby–Bauer disc diffusion method. Data were analyzed using SPSS version 25. P-value less than 0.05 was used as statistical significance.ResultsThe overall incidence of symptomatic CAUTIs was 39/231 (16.8%). Independent predictors of CAUTIs were prolonged (≥7 days) catheterization (AOR = 3.6, 95% CI = 1.0–12.2), diabetes mellitus (AOR = 5.3, 95% CI = 1.4–19.6) and insertion of catheter in surgical ward (AOR = 3.6, 95% CI = 1.08–12.28). The most common bacterial isolates were E. coli 17/42 (40.5%), Klebsiella species 9/42 (21.4%) and Enterococcus species 5/42 (11.9%). High (>80%) drug resistance was observed against cotrimoxazole, cefoxitin and tetracycline. Ciprofloxacin and nitrofurantoin were the most active drugs. The overall prevalence of MDR among isolates was 37/42 (88.1%). Most bacterial isolates 30/42 (71.4%) were biofilm producers.ConclusionHigh levels of drug resistance were observed to commonly used antibiotics. In our study, biofilm-producing bacterial isolates were the predominant cause of CAUTIs. Therefore, continuous surveillance of antimicrobial resistance patterns is necessary to help physicians in treatment and management of CAUTIs.

Urinary tract infection in children presenting with diarrhea

Background: Urinary tract infection (UTI) are the 3rd most common bacterial infection in infants and young children in developing countries after those of respiratory and gastrointestinal tract infection. Because of nonspecific signs and vague symptoms in very young children, they may remain unrecognized. Rapid evaluation and treatment of UTI is important to prevent renal parenchymal damage and renal scarring that can cause hypertension and progressive renal damage. Since gastroenteritis is rampant in developing countries demonstration of an association between UTI and diarrhea will be of clinical significance. The objective of this study was to estimate the prevalence of UTI in children presenting with diarrhea and to identify the clinical co-relates which may guide to identify children with UTI.Methods: This was a descriptive observational study done in 120 children meeting the inclusion and exclusion criteria, who were admitted in the paediatric ward in father Muller medical college hospital for a period of 1 and a half years. After obtaining an informed consent, a detailed clinical examination was performed on children meeting the inclusion criteria and the data was entered to the preformatted sheet. Urine samples were obtained from all the patients by clean catch mid-stream urine sample, following which urine culture was done for all the children.Results: In the present study, out of 120 children presenting with Diarrhea 17% had UTI. E. coli (15 cases) was the most common organism isolated in urine culture followed by Enterococcus. Out of 20 UTI cases, 15 were in the age group of 6 months to 1 year followed by 4 cases among 1-3-year age group.18 out of 20 UTI cases were females. Male:female ratio of UTI patients was 1:9.Conclusions: UTI in young children can present with diarrhea and other nonspecific symptoms. Children presenting with diarrhea need to have a urine analysis and urine culture for the confirmation of UTI, so that long term complications like renal parenchymal damage and hypertension can be prevented.

Pattern of UTI in Chronic Kidney Disease: Experience from A Tertiary Care Hospital, Bangladesh

Background: Urinary Tract Infection (UTI) is common and higher in prevalence in patients with Chronic Kidney Disease (CKD). To find out the frequency and clinicobacteriological pattern of UTI in CKD patients.&#x0D; Materials and methods: A cross-sectional study was done on 1000 of CKD patients attending Nephrology Department of Chattogram Medical College Hospital (CMCH) a tertiary level hospital in Bangladesh during January to December, 2017. Cleancatch midstream urine samples were collected from study populations irrespective of symptoms. Macroscopic and microscopic examinations were done. Urine samples were then inoculated in Blood agar and Mac’Conkey agar and incubated aerobically at 37 °C for 18-24 hours. Microscopic observations and conventional biochemical tests were done to identify the isolated organisms. Significant growth of organisms in urine was defined as UTI. The isolated organisms were tested for antimicrobial susceptibility by using modified Kirby Bauer technique.&#x0D; Results: The prevalence of UTI was 61.8%. with significant asymptomatic UTI for 28%. Gram-negative organisms were most frequent 564 (93%) with predominant Escherichia coli 399 (64%) followed by Klebsiella 113(18%) and Pseudomonas 39(6%). Among Gram positive isolates, Staphylococcus (6%) was the dominant organism isolated. Regarding antibiotic susceptibility, Gram-negative microorganisms were found to be most sensitive to carbapenem and amikacin whereas Gram-positive microorganisms were most sensitive towards carbapenem, colistin and linezolid.&#x0D; Conclusion: In CKD patients, asymptomatic UTI was detected significantly. E.coli was found to be predominant organisms and resistant towards most of the studied common antibiotics.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 41-45