1.

0 INTRODUCTION

1.1 Background of the study

In recent years, there has been an increasing interest in urinary tract infection (UTI)

research subject as it is a second common type of infection in body. According to previous

studies, Mustafa and Balingi (2012) stated that around 4500 cases of UTI have been reported

in Kota Kinabalu where it is more common in affecting women compare in men due to

anatomical predisposition and a woman’s shorter urethra (Al-Badr & Al-Shaikh, 2013).

Therefore, bacteria are easier to reach bladder from anus or genital area (Priyadharsini,

Bhardwaj, & Sheeba, 2014).

Gram negative bacteria such as E. coli, Klebsiella, Enterobacter and Proteus caused

80-85% of infections (Sharma, Verma, & Ramteke, 2014). Bacteria belong to the

Enterobacteriaceae is a good illustration of UTIs causes. Staphylococcus sp. from gram

positive is another reason to cause infection (Al-Jiffri, El-Sayed, & Al-Sharif, 2011). E.coli is

an intestinal bacterium that essential for digestion but it can cause UTIs if they grow in

bladder. Klebsiella and group B streptococcus infection are more prevalent in patient that

diagnosed with diabetes (Al-Badr & Al-Shaikh, 2013).

Recent evidence suggests that cost of antibiotics, antibiotics toxicity and resistance

phenomenon has been increasing the global concern as it complicated the UTIs treatment

(Jean-De-Dieu Tamokou et al., 2017). An example of what is meant by resistance

phenomenon is UTIs bacteria may become resistance to antibiotics overtime if a person

suffered UTIs frequently, to cure it; a complete course of treatment is needed. Thus, natural
antibacterial agent is discovered to prevent UTIs from spreading or relapse and eventually to

cure it.

Plants as traditional medicines have been studied over the latest few decades because

plant-based traditional medicines are still used for medical purpose especially in developing

country (Vu et al., 2016). There is a large volume of published studies describing a few

plants contain antibacterial properties. Different extracts of guava leaves and seeds (Psdium

guajava Linn) showed antibacterial activity against some microbes (Alsarhan, et al., 2014;

Priyadharsini et al., 2014) and a comparison on inhibitory characteristic on UTIs causing

pathogen E.coli and S.aureus were carried out.

Guava or Psidium guajava is a medicinal plant from Myrtaceae family where

originally from South America (Barbalho, Farinazzi-Machado, 2012). The whole parts of

guava for instances, barks, roots, leaves, seeds and fruits can used to medicate diarrhoea,

scurry, fever or cough worldwide as medical purpose. Moreover, studies have found that

guava possessed bacteriostatic against microbes such as Staphylococcus spp., Shigella spp.,

Salmonella spp., Bacillus spp., E. coli, and Clostridium spp. (Farhana, Hossain, & Mowlah,

2017). The seeds and leaves of guava are known to possess antimicrobial, anti-allergic, anti-

diarrheal, antipyretic and bio-antimutagenic properties where it plays an important role in

preventing the progression of diabetes and cancer (Barbalho, Farinazzi-Machado, 2012;

Alsarhan et al., 2014).

In conclusion, based on various studies they had shown that the guava leaves and

seeds contain bacteriostatic properties on human intestinal pathogen. Thus, guava leaves and
seeds is extracted using aqueous and ethanol solution to assess antimicrobial activity against

E.coli from gram negative and S. aureus from gram positive.

1.2 Problem statement

The most common human disease that lead patients seek medical care is the urinary

tract infection (UTIs), it affects human throughout their life span from neonate to elderly

(Mustafa & Balingi, 2012; Sharma et al., 2014). According to Ohio State University, UTIs is

caused by the invasion of bacteria to urinary tract due to kidney stone, poor personal hygiene,

irritation caused by tight pants or by nylon underwear and low resistance to infection due to

stress.

Escherichia coli and other gram negative organisms is the good illustration that infect

the urinary tract (Mustafa & Balingi, 2012). E.coli is bacteria can be found everywhere

including environment, food, humans and animals intestine. However, some E.coli can cause

both intestinal and extra intestinal illness. It was found that E.coli is resisted to antibiotic and

complicated the treatment of bacterial infection (Rasheed, et al., 2014). Besides, E.coli had

proven to be resistant towards β-lactams, Trimethoprim/ sulfamethoxazole, levofloxacin and

ciprofloxacin (Tirumalai et al., 2019).

It has been suggested that Staphylococcus aureus is an uncommon cause of UTIs in

general population but it co-infected UTIs with urinary tract catheterization(Flores-Mireles,

Walker, Caparon, & Hultgren, 2015). National Kidney and Urologic Disease Information

Clearinghouse has reported that S.aureus urinary tract infection can occur in urethra, bladder

or kidneys where it is infected by Staphylococcus aureus bacteria. In order to cure UTIs

infected by S.aureus, antibiotic is given over a period of several days. However, S.aureus are

reported to resistant towards methicillin (World Health Organisation, 2014).

Generally, controlling and reducing the spread of urinary tract infection is using the

antibiotic treatment (Mustafa & Balingi, 2012).Yet it was found that E.coli had increasingly

resisted to fluoroquinolones from 3% to 25%, meanwhile S.aureus resistant to methicillin

increased 23% to 38.7% (Jean-De-Dieu Tamokou et al., 2017). Several studies have revealed

that P.gujava possessed an antimicrobial properties (Alsarhan et al., 2014). Hence, my

research study will focus on the screening of antimicrobial activity of Psidium guajava Linn

plant against urinary tract infection causing pathogen; Escherichia coli and Staphylococcus

aureus.