Clean Catch Midstream Urine Samples Research Articles

Antimicrobial Susceptibility Pattern of Uropathogens Isolated at a Private Hospital in Khulna, Bangladesh

Background & objectives: Urinary tract infection (UTI) is one of the most common infectious diseases affecting all age & sex groups, causing significant morbidity & mortality with a substantial economic burden. Due to the irrational empiric use of antibiotics, resistance is increasing at an alarming rate. Bacteria causing UTIs & their antimicrobial susceptibility pattern varies among different areas & changes frequently over time. This study aimed to identify microorganisms causing UTI at a private hospital in the southern part of Bangladesh & to determine their sensitivity pattern towards commonly used antibiotics. Methods: A cross-sectional study was conducted in the clinical pathology & microbiology laboratory at Islami Bank Hospital (IBH), Khulna during the period of January’2021 to July’2021. Clean catch midstream urine samples (MSU) from 221 clinically suspected UTI cases of all age & sex groups were included in the study. Uropathogens were isolated & identified by standard microbiological techniques & susceptibility was determined by Kirby Kirby-Bauer disc diffusion method. Results: Among 221 suspected UTI cases, 108 (48.8%) were positive for urine culture, of which 103 (95.37%) showed antimicrobial growth. The majority 75 (69.4%) of the culture-positive cases were female. E. coli 50(44.24%) was the most predominant bacterial isolate, followed by Klebsiella 18(15.92%) & Enterococcus 16(14.15%). All Isolated gram-positive cocci (GPC) showed very high sensitivity to Vancomycin (83.3% to 100%), Linezolid (87.5% to 100%) & moderate sensitivity to Meropenem (66.7% to 75%). However, they showed relatively lower sensitivity to Ciprofloxacin, Doxycycline, Gentamicin, and Amoxiclav & very poor sensitivity to Nitrofurantoin (31.3% to 50% only). Levofloxacin had relatively better sensitivity against GPC (S. aureus- 83.3% & CONS- 75%), except Enterococcus. All gram-negative bacilli (GNB) showed a very good sensitivity towards Amikacin & Meropenem, ranging from 77.8% to 100%. E. coli & Pseudomonas were highly sensitive to Piperacillin-Tazobactam (90% & 88.9% respectively). GNB were poorly sensitive to commonly used 3rd generation cephalosporins, Azithromycin, Amoxiclav & Ciprofloxacin. Except for Pseudomonas & Klebsiella, Levofloxacin showed relatively good sensitivity against other GNB. Nitrofurantoin showed lower sensitivity against GNB, except for Pseudomonas (66.7%) & Enterobacter (75%). Conclusion: E. coli remains the most predominant uropathogen. Vancomycin, linezolid, Levofloxacin & Meropenem were very effective against GPC whereas Amikacin, Piperacillin- tazobactam & Meropenem showed good responses against GNB. Empiric antibiotics must be selected based on the current antibiogram of uropathogens in a particular area to prevent the increasing trends of antimicrobial resistance. Mediscope 2024;11(1): 01-12

Bacterial abundance and antimicrobial resistance patterns of uropathogens among pregnant women with asymptomatic bacteriuria: Association with glycemic status

ObjectivesAntimicrobial resistance (AMR), a growing global menace, poses a significant threat to maternal and fetal health. Gestational diabetes mellitus (GDM) causes double trouble in pregnancy, increasing the risk of a variety of infectious morbidities while also raising the possible association with AMR. Asymptomatic bacteriuria (ASB) is a common problem in pregnancy, but little research has been done to date explicitly examining the relationship between GDM and ASB and yielded conflicting results. Even fewer studies have specifically examined the relationship between GDM and AMR in women with ASB. Retrieving the most recent information on the disease burden, the range of causative pathogens, their patterns of AMR, and associated risk factors in pregnant women is crucial to stop the exponential rise in AMR in pregnancy and improve maternal and neonatal outcomes of infectious morbidities. Hence, this study was planned to investigate the association between glycemic status and the contemporary bacterial profile, antimicrobial resistance(AMR), and associated variables among pregnant women with ASB Study designThis prospective, hospital-based, cross-sectional study was conducted among 320 pregnant women; divided into two groups, GDM and non-GDM. Data regarding sociodemographic and clinical characteristics were collected using a structured questionnaire. Clean-catch midstream urine samples were investigated for the presence of significant bacterial uropathogens and their AMR pattern was determined using recommended culture methods. ResultsWe found ASB in 46.25% of study participants with significantly higher occurrence in the GDM group. Dominant isolates were Escherichia coli followed by Klebsiella pneumoniae. AMR was noted in 51.35% and multidrug resistance(MDR) in 23.65% of isolates. Overall AMR, MDR and higher degrees of AMR were higher among uropathogens isolated from the GDM group as compared to the non GDM group, although the difference was not statistically significant. ConclusionThe high occurrence of ASB in pregnancy along with substantially high AMR in this study suggests the need for effective infection control and stewardship programmes. By defining the association of ASB and AMR with hyperglycemia, our study calls for the exploitation of this potential association in halting the pandemic of AMR and in improving the management of infectious morbidities, thus in-turn alleviating their undesired maternal and infant outcomes.

Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease.

Identifying and appropriately managing urinary tract infections (UTIs) among chronic kidney disease (CKD) patients are essential to reduce further disease complications and economic burden. Hence, this study aims to determine the prevalence of UTIs among CKD patients and study the antibiogram of the bacterial isolates. Four hundred eighty-two clean catch midstream urine samples were collected from CKD patients during the study period. The samples were cultured, and bacteria were isolated using standard microbiological techniques. Antibiotic susceptibility testing was performed by the Kirby-Bauer disc diffusion method following the Clinical and Laboratory Standards Institute guidelines. Of the 482 CKD patients, 15.8% were culture positive, and the majority was elderly aged group population. Most bacterial isolates were Escherichia coli 50%, followed by Pseudomonas aeruginosa 15.80%, Enterococcus species 15.80%, and Klebsiella pneumoniae 11.84%. The majority of bacteria were found to be resistant to beta-lactam antibiotics, ampicillin (94.67%), ceftriaxone (89.04%), cefotaxime (87.5%), and ceftazidime (84.0%), while polymyxin, colistin, vancomycin, meropenem, and imipenem were the most sensitive antibiotics. In our study, higher levels of antibiotic resistance were observed among urinary isolates. Therefore, our findings suggest clinicians to choose better antibiotic options to treat UTIs among CKD patients.

PREVALENCE OF URINARY TRACT INFECTIONS AMONG FEMALES OF REPRODUCTIVE AGE GROUP IN TERTIARY CARE TEACHING HOSPITAL

Objective: The purpose of the current study is to isolate, characterize, and evaluate the antibiotic susceptibility profile of the pathogenic bacteria causing urinary tract infections (UTIs) in females of reproductive age. Methods: This is a cross-sectional descriptive study carried out in a Tertiary care teaching hospital for 1 year. A total of 100 urine samples from female patients in the reproductive age range of 15–44 years constitute the study’s sample size. Clean catch midstream urine samples were taken in sterile containers and inoculated on a different culture medium, such as cysteine, lactose, and electrolyte-deficient agar, to isolate the UTI pathogen. MacConkey agar was inoculated in parallel to target the growth of Gram-negative bacilli. Thereafter, using the common microbiological procedures, all positive cultures with significant bacteriuria were identified at the species level based on the colony features, Gram-staining reaction, and pattern of biochemical profiles. To investigate the pattern of antibiotic susceptibility, the disc diffusion method was used. Results: Among the 100 study cases, the prevalence of UTI was seen in 38% of individuals and UTI was absent in 62% of individuals. Among the females (38% cases) who had UTI, 81% had symptomatic UTI and 19% had asymptomatic UTI. Among the 81% symptomatic individuals of UTI, all they showed burning micturition followed by 74% of individuals showed dysuria Among the uropathogens isolated, majority were Escherichia coli (40.7%) followed by CONS (22.3%) Majority of the E. coli isolates showed sensitivity to piperacillin/tazobactam and nitrofurantoin. Conclusion: If left untreated, UTI is a significant public health issue. Early detection and timely treatment will lower the risk of developing further UTI complications, as well as the patient’s pain, length of stay in the hospital, and economic loss.

Antimicrobial Resistance and Biofilm Production in Uropathogens from Renal Disease Patients Admitted to Tribhuvan University Teaching Hospital, Nepal

Background. Various antibiotics are prescribed empirically by physicians to cope with infections in renal disease patients. A urinary tract infection (UTI) is often caused by biofilm-forming multidrug-resistant (MDR) uropathogens. This study aimed to analyze the antibiogram of UTI strains from renal disease patients and the biofilm-forming ability of those strains. Methods. 102 patients clinically diagnosed with a UTI and renal disease were recruited into the study from August 2017 to January 2018. Clean-catch midstream urine samples were processed for the isolation and identification of the bacteria following standard methodologies. The antibiogram of the isolates (n = 106) was produced by the Kirby–Bauer disc diffusion method. Detection of biofilm formation was performed in tissue culture plates. Results. The incidence of a UTI in renal disease was 19.1%. Most patients were diagnosed with chronic kidney disease (18.63%), nephrotic syndrome (16.67%), and nephrolithiasis (14.71%). The commonest uropathogens were Escherichia coli (52.8%), Klebsiella pneumoniae (16%), and Enterococcus spp. (15.0%). Ceftriaxone was the most common antibiotic prescribed empirically (37%), whereas nitrofurantoin was the most prescribed antibiotic as adjusted therapy (36.1%). Among the first- and second-line antibiotics, most Gram-negative bacteria were sensitive to amikacin (70.7%), meropenem (70.7%), cefoperazone-sulbactam (70.0%), piperacillin-tazobactam (67.2%), gentamicin (66.7%), and nitrofurantoin (66.7%). Most Gram-positive bacteria were sensitive to doxycycline (90.0%), nitrofurantoin (72.2%), gentamicin (66.7%), and tetracycline (62.5%). All MDR Gram-negative uropathogens were susceptible to colistin sulfate and polymyxin B. Among the 106 isolates, 74.5% produced biofilms and 70.8% were MDR. In 67.0% of cases, including both MDR and biofilm-producing bacteria, the empirical therapy needed adjustment. Conclusions. Aminoglycoside, carbapenem, beta-lactam inhibitor, and nitrofuran group of antibiotics may be the optimal first-line empirical therapies for uropathogens in hospitalized renal disease patients. Regular surveillance of resistance patterns and the study of biofilm formation in uropathogens must be performed to ensure effective management of the patients.

Extended-Spectrum Beta-lactamase and Metallo-beta-lactamase Production among Escherichia coli and Klebsiella pneumoniae Strains from Urine of Pregnant Women in Afikpo, Ebonyi State, Nigeria

Aim: The aim of this study was to determine the occurrence of Extended-spectrum beta-lactamase (ESBL) and Metallo-beta-lactamase (MBL) among Escherichia coli and Klebsiella pneumoniae strains from pregnant women attending Mater Misericordia Hospital Afikpo, Ebonyi state, Nigeria.
 Study Design: This is a laboratory based prospective study carried out on pregnant women suspected of having urinary tract infection and was requested to undergo diagnosis at microbiology laboratory of the hospital.
 Place and Duration of Study: The study was conducted in the Department of Science Laboratory Technology, Akanu Ibiam Federal Polytechnic, Unwana, Afikpo, Ebonyi State, Nigeria from October, 2022 to January, 2023.
 Methodology: Clean-catch midstream urine samples were collected from 206 pregnant women suspected of having urinary tract infection and were requested to undergo medical diagnosis at microbiology laboratory of the hospital. The urine samples were processed following standard microbiological procedure. Antimicrobial susceptibility testing was determined using the disc diffusion method, while ESBL phenotypes were determine by the Double-Disc Synergy Test (DDST). Disc potentiation test was performed to check for MBL production.
 Results: Out of the 206 urine samples processed, 24 (11.7 %) E. coli and 12 (5.8 %) K. pneumoniae were isolated. The antimicrobial susceptibility of the isolates recorded a 100 % resistance with Amoxicillin/Clavulanic acid and Cotrimoxazole. The Gram-negative isolates showed a high sensitivity of 100 % to Netilmicin, Meropenem and Ofloxacin. Overall, 35 (97.2 %) multidrug resistance (MDR) was observed of the bacteria isolates. A total of 9 (37.5 %) E. coli and 4 (33.3 %) K. pneumoniae was found positive for ESBL production whereas, 5 (20.8 %) E. coli and 2 (16.7 %) K. pneumoniae were MBL positive.
 Conclusion: The level of drug resistance in this study underscores the need for regular surveillance for effective management of urinary tract infection in pregnancy.

Identification of Bacterial Uropathogen and Antimicrobial Resistance Patterns Among Patients with Diabetic and Hypertension Attending Dilla University General Hospital, Dilla, Ethiopia.

Having a urinary tract infection (UTI) is a serious health issue which is caused by microbial colonization and proliferation in the urinary system. Patients with diabetes and blood pressure are more vulnerable to bacterial urinary tract infections because their host defense is compromised and their urine has a high glucose content. A proper and quick investigation of uropathogen and their antibiogram is key to patient treatment and infection control. Aimed to assess the identification of bacterial uropathogen and antimicrobial resistance patterns among diabetic and hypertension patients attending DUGH, Ethiopia. A Facility-based cross-sectional study was conducted from February to December 2022 among 158 diabetic and hypertensive patients using a clean catch mid-stream urine sample. Pretested structured questionnaires were used to collect data from study participants. Urine samples were taken and cultured on Blood agar, MacConkey agar and CLED Agar for the identification of uropathogen. An antimicrobial susceptibility test was done according to CLSI. Binary and multiple logistic regression were used to assess the association. A P-value less than 0.05 was considered statistically significant. The overall prevalence of bacterial uropathogenic among diabetes mellitus and hypertension patients was 15.2%. E. coli (29.2%), coagulase negative Staphylococci (CoNS) (20.8%), K. pneumoniae 3 (12.5%) and S. aureus 2 (12.5%) were the leading isolated uropathogens. In our study, illiterates (AOR =8.1, 95% CI: (5.1-12.4)), participants with high blood glucose levels (AOR=1.81, 95% CI: (1.01-2.21)) and comorbid patients (AOR = 4.2, 95% CI: (4.1-17.2)) were significantly associated with UTI. Both gram-negative and gram-positive isolated bacteria showed higher resistance to most of the commonly used antibiotics. Multidrug resistance was reported in 62.5% of the total isolates. This study revealed a high prevalence of bacterial isolate and multidrug resistance. Therefore, continuous monitoring of microbiological and antimicrobial surveillance of UTI among DM patients is crucial for appropriate treatment and infection control.

Urinary Tract Infection and Associated Factors among Pregnant Women Receiving Antenatal Care at a Primary Health Care Facility in the Northern Region of Ghana.

Urinary tract infection (UTI) is frequently encountered during pregnancy and is associated with adverse maternal, fetal, and neonatal effects. However, very little information is available on the prevalence of UTI among pregnant women in the northern part of Ghana, a region with a high birth rate. This study employed a cross-sectional analysis of the prevalence, antimicrobial profile, and risk factors associated with UTI in 560 pregnant women attending primary care for antenatal check-ups. Sociodemographic obstetrical history and personal hygiene information were obtained using a well-structured questionnaire. Afterward, clean catch mid-stream urine samples were collected from all participants and subjected to routine microscopy examination and culture. Of 560 pregnant women, 223 cases (39.8%) were positive for UTI. There was a statistically significant association between sociodemographic, obstetric, and personal hygiene variables and UTI (p < 0.0001). Escherichia coli (27.8%) was the commonest bacterial isolate followed by CoNS (13.5%) and Proteus species (12.6%). These isolates exhibited greater resistance to ampicillin (70.1-97.3%) and cotrimoxazole (48.1-89.7%) but were fairly susceptible to gentamycin and ciprofloxacin. Gram-negative resistance to meropenem was up to 25.0%, and Gram positives resistance to cefoxitin and vancomycin was up to 33.3% and 71.4% respectively. The current findings extend our knowledge of the high frequency of UTIs and associated risk factors in pregnant women with E. Coli being the predominant and usual isolate. Variation existed in the resistance pattern of isolates to various drugs, underscoring the need to perform urine culture and susceptibility before treatment.

ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF UROPATHOGENS AT A TERTIARY CARE HOSPITAL IN CENTRAL INDIA DURING COVID ERA.

Objective: The purpose of this study was to study the bacteriological profile of UTI in patients attending the tertiary care hospital and to study the antimicrobial sensitivity pattern of uropathogens. Methods: This cross-sectional study was conducted after obtaining clearance from the institutional ethics committee. Clean-catch mid-stream urine samples were collected from patients symptomatic of UTIs. Samples were cultured aerobically on CLED agar. Isolates having significant growth (&gt;105CFU/ml) were further processed for identification using standard microbiological techniques and their antimicrobial susceptibility pattern was evaluated by the Standard Kirby Bauer disk diffusion method as per CLSI 2020 guidelines. Results: A total of 480 urine samples were processed, yielding 174 isolates. Escherichia coli (42.50%) was predominant, followed by Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter spp., Proteus spp., Providencia spp., Enterococcus spp., Citrobacter spp. and Morganella morganii. Gram-positive isolates exhibited high sensitivity towards vancomycin, linezolid, meropenem, and piperacillin tazobactum. Enteric coliforms exhibited high sensitivity towards colistin, meropenem, aminoglycosides, and piperacillin tazobactum. Non-fermenters exhibited high sensitivity towards colistin, meropenem, cefepime, and amoxycillin clavulanate. Conclusion: The rampant injudicious irrational overuse of antibiotics has led to the emergence of multi-drug resistant bugs, which is posing a serious challenge to clinicians in the management of infections. Developing therapeutic protocols guided by susceptibility profiles for tuning antibiotic therapy regimens is an important strategy in tackling this menace.

Pattern of microbial flora and antibiotic sensitivity among healthy adults with bacteriuria in a university community in south-eastern Nigeria

Background: Knowledge of common urine microbial flora and the sensitivity pattern are essential in determination of empirical antibiotic usage Aim: To determine the common microbiological flora in the urine of apparently healthy adults and the sensitivity and resistivity pattern. Materials and Methods: A cross sectional survey of the pattern of urinary microbial organisms and their sensitivity and resistivity antibiotic pattern among adult population in a university community. Multi staged random sampling was used to obtain up to 465 respondents. Clean catch mid-stream urine samples were collected and prepared. Culture was done in three different media for identification and isolation of bacteria. The antimicrobial sensitivity was determined using sensitivity disk by Kirby-Bauer method. Data was analyzed using SPSS version 25 at 95% confidence interval and a p-value of less than 0.05 was considered significant. Data was presented in frequencies and percentages as appropriate. Results: Female respondents (76.97%) were more. 20-24 age group had the highest number of respondents (50.66%). 36.29% had bacteria growth in their urine. Escherichia coli (63.6%) is the commonest microbial agent found in the urine of the population, followed by staph aureus (20%), then Klebsiella (16.4%). The isolated organisms were mostly resistant to the common antibiotics. However, E. coli was slightly susceptible to Levofloxacine (37.1%), Ciprofloxacine (31.4%) and Gentamycin (30%). Klebsiella showed mild susceptibility to Levofloxacine (15%), Ciprofloxacine (12%) and Ceftriazone (9%). Conclusion: E.coli, staph aureus and Klebsiella are the dominant microbial flora found while levofloxacin, ciprofloxacin, ceftriazone and augmentin are the most sensitive antibiotics.

Antimicrobial susceptibility pattern of uropathogens in urinary tract infections (UTI) patients of Punjab, Pakistan

The prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among Punjabi patients attending Tertiary Care Hospitals of Punjab were the objectives of this study. Participants were selected by systematic random sampling in a cross-sectional study at Tertiary Care Hospitals of Punjab. 988 participants provided clean catch midstream urine samples, which were then cultured and tested for antimicrobial susceptibility. We inoculated n=988 urine samples in which 255 samples were found positive for bacterial growth. Among them 126 were E. coli, 66 Klebsiella pneumoniae, 4 Enterobacter cloacae, and 21 were Pseudomonas spp. The frequency of Uropathogens was observed for Gram negative E. coli 49.02% and Gram positive bacteria were 7.78%. The prevalence of urinary tract infections was 16.4%. Pseudomonas aeruginosa (19, 7.3%), Pseudomonas spp. (2, 0.7%), Enterobacter cloacae (4, 1.5%), and Gram positive bacteria such as Methicillin resistant staphylococcus aureus (3, 1.1%), Methicillin sensitive staphylococcus aureus (15, 5.8%), and Enterococcus faecalis (20, 7.7%) were the most common bacteria. Ampicillin and tetracycline were both resistant to Gram-negative bacilli (96%) and Gram-positive cocci (72%), respectively. In the study area, a culture and susceptibility test is essential for effective urinary tract infection management.

STUDY OF BACTERIAL PATHOGENS CAUSING URINARY TRACT INFECTION AND ANTIBIOGRAM PATTERN IN SYMPTOMATIC ADULTS

Objectives: Urinary tract infections (UTIs) are most common infection seen in community and hospital. It is important to know the causative agent and antibiotic susceptibility pattern to administer specific treatment and prevent drug resistance. Hence, the present study was conducted to know the most common etiological agent and antibiogram of symptomatic UTIs. Methods: The study was conducted at a tertiary care hospital. All the adult patients presented with symptoms of UTI were involved. As per the standard guidelines, clean catch mid-stream urine sample was collected and inoculated on MacConkey’s agar and blood agar by standard loop technique. The isolates with significant bacteriuria were subjected for Kirby-Bauers’ disk diffusion antibiotic susceptibility testing. Results: One thousand two hundred and fifty symptomatic patients were screened for UTI. A total of 358 organisms were isolated in culture with significant bacteriuria. Among 358, Escherichia coli was commonest organism with 267 (74.5%), followed by Klebsiella species accounting for 52 isolates (14.5%) and Citrobacter species 25 (7.0%), and Pseudomonas aeruginosa 14 (4%). Higher degree of sensitivity was seen with imipenem (90%), amikacin (80%), and gentamycin (78%) followed by nitrofurantoin (75%) for E. coli. Lower degree of sensitivity was noted for norfloxacin (50%), ceftriaxone (62%), cotrimoxazole (56%), and pipericillin-tazobactum (60%). Klebsiella was sensitive to amikacin (74%) and imipenem (80%). Conclusion: In the present study, E. coli was the most common organism causing UTI. Nitrofurantoin can be started as empirical treatment for lower UTI. Gentamycin was found to be equally effective as amikacin so that it can be used instead of amikacin to decrease the selective pressure on amikacin.

Prevalence and Resistance Pattern of Uropathogens in Pregnant Women- A Cross-Sectional Study

Introduction: Urinary Tract Infection (UTI) is the most common medical problems associated with pregnancy occurring in about 5-10% of pregnant women. It is attributed by various micro- organisms. As the uropathogens is usually Multidrug resistance so, timely identification of these uropathogens and their resistance pattern detection is essential. If UTI is not treated promptly, it can lead to various complications and ultimately can affect health of infant or the pregnant mother. Aim: To estimate the frequency of UTI and different micro- organisms in pregnant women as well as their antibiotic resistant pattern among them. Materials and Methods: Present study was conducted in a tertiary care hospital in rural district of Chhattisgarh. During the study period from August 2021 to October 2021, 130 urine samples were collected and processed as per standard protocol. With significant growth on culture ≥105 Colony Forming Unit (CFU)/mL of single morphotype bacteria from a clean catch midstream urine sample UTI diagnosis was established. The bacteria isolated were identified up to species level by standard biochemical tests. Results: In this study, UTI was found in n=69.2% of pregnant women. The most frequently isolated organism was E. coli (53.3%), followed by Klebsiella spp.(18.9%) and Pseudomonas spp. (3.3%). Highest prevalence rate (85.7%) was observed in the age group 21 to 25 years; most of these (77.8%) were in their 2nd trimester. The isolated pathogens mostly showed multiple drug resistance to two or more antibacterial agents tested. Conclusion: There was higher incidence of UTI in pregnancy and the most predominant organism isolated was E. coli; in 2nd trimester UTI was more common and high level of multidrug resistance was observed. In pregnancy, continuous monitoring of uropathogens including their resistance pattern is required.

Antimicrobial Potential of Syzygium aromaticium (CLOVE) Extracts on Multidrug-Resistant (MDR) Uropathogenic Bacteria Isolated from Clinical Specimens in Bauchi, Nigeria

Background: Urinary Tract Infection (UTI) is a common pathogenic inflammatory, distressing, and occasionally life-threatening condition that affects people of all ages and gender, mostly propelled by the emergence of multidrug-resistant bacteria. Cloves are used as spices in food and flavouring agent in drinks it is also used traditionally as a treatment for urinary infections.&#x0D; Aim: This study was carried out to evaluate the antimicrobial potentials of Clove extracts on multidrug-resistant (MDR) Uropathogenic bacteria.&#x0D; Design: This is a Clinical and laboratory-based study of patient with cases of UTI&#x0D; Place and Duration of study: This study was conducted in the Microbiology laboratory of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, Nigeria, from January to December, 2021.&#x0D; Methodology: Two hundred and fourty five (245) clean catch midstream urine samples were collected from patients with suspected cases of urinary tract infection attending GOPD ATBU TH. Bacteria were isolated using standard techniques and antibiotic resistant pattern was tested by Kirby Bauer Disk Diffusion method. Bioactive components of clove was extracted using diethyl ether, ethanolic and water as solvents. Phytochemical analysis of the extracts was also carried out.&#x0D; Results: Out of the samples analysed, 168 (68.6%) showed significant bacteriuria. UTI was more prevalent in women within the active age group 21-30. The isolates resistant to seven and above commonly used antibiotics are selected from each specie to test for efficacy. The extracts revealed the presence of alkaloids, glycosides, saponins, tannins, flavonoids, sterols and Triterpenes. In vitro antimicrobial activity of diethyl ether, ethanolic and aqueous extract of cloves at different concentration of: 200mg/ml, 100mg/ml, 50mg/ml, 25mg/ml, 12.5mg/ml&#x0D; and 6.25mg/ml were tested against multidrug resistant isolates. S. aureus and Klebsiella spp are the most sensitive to all clove extracts while E. coli and P. aeruginosa are less sensitive. All Three extracts showed a broad spectrum of activities at higher concentrations (200mg/ml) while no or less activity at the lower concentration of the extracts. Diethyl ether extract exerts higher activity than ethanolic and aqueous extract as revealed by the mean diameter of zone of inhibitions, MIC and, MBC values. The MIC values of the extracts were lower than their MBC values suggesting that the extracts inhibited the growth of MDR isolates while being bactericidal at higher concentrations.&#x0D; Conclusion: Staphylococcus aureus and E. coli are among the commonest uropathogens clinically encountered in this area and most of the species are resistant to commonly administered antibiotics. Clove extracts had great antimicrobial potential against these bacteria, therefore it can be used in the treatment of UTIs. However, it is necessary to determine its toxicity, pharmacokinetic properties and side effects.

Incidence and Antibiogram of Uropathogens Isolated from Pregnant Women Attending Antenatal Clinic in a Public Hospitalin Yola, Adamawa State, Nigeria

Urinary tract infection during pregnancy including asymptomatic bacteriuria has been associated with some adverse outcomes for the mother and foetus. Studies have shown that pregnant women with urinary tract infections have a significantly higher rate of intra-uterine growth restriction, pre-eclampsia, caesarean and pre-term deliveries. This study was undertaken to determine the occurrence, distribution and antibacterial susceptibility pattern of uropathogens among pregnant women attending antenatal clinic in a public hospital in Yola. A total of 200 clean catch mid-stream urine samples were collected from pregnant women and inoculated on cysteine lactose electrolyte deficient agar for bacterial count and isolation of uropathogens. The isolates were also screened for ability to form biofilms using Congo Red Agar method and antibiotic susceptibility test was done on the isolates using agar disk diffusion method. The incidence of UTI among the pregnant women was found to be 90%. The predominant uropathogens were E. coli (46.0%), S. aureus (20.0%) and Klebsiella pneumoniae (17.0%) while the least occurring uropathogen was Proteus sp. (2.0%). Women in the third and first trimester of pregnancy had the highest occurrence of UTI. A total of 47.0% of the isolates produced biofilm in vitro with the highest biofilm production observed among Proteus sp. (75.0%) and Pseudomonas aeruginosa (60.0%) isolates. The occurrence of antibiotic resistance among the isolates was high, with greater susceptibility observed to quinolone and third generation cephalosporin. The E. coli isolates demonstrated varying levels of resistance to all the antibiotics tested. Because of the gravity of problems of UTI in pregnancy and that 9 in 10 pregnant women from this study have symptomatic or asymptomatic infection, it is concluded that pregnant women should be screened for urinary tract infection during antenatal visits especially during the first and third trimesters of pregnancy.

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.