Prevalence of Uti in Benin PDF

PREVALENCE OF URINARY TRACT INFECTION IN REPUBLIC OF BENIN.
ITS ADVERSE EFFECTS AND

CONTROLS
INTRODUCTION
Urinary Tract Infections or UTIs are very common both in the community and hospital setting
accounting for nearly 10 million doctor visits each year and they occur in all age group usually
requiring urgent treatments because they lead to more severe infections.[1]
Urinary Tract Infection, or UTI, is an infection that can affects the kidneys, bladder, ureters, or
urethra of Humans. An infection typically occurs when bacteria that live inside the bowel find their
way into the urinary tract through the urethra. Cystitis is the name for a UTI that infects the bladder,
urethritis is a UTI that infects the urethra and Pyelonephritis is the name for a UTI infecting the
kidneys, a potentially serious infection.[1]
Risk factors include female anatomy, sexual intercourse, diabetes, obesity, family history, poor
hygiene, malnutrition and low socio-economic status. Although sexual intercourse is a risk factor,
UTIs are not classified as sexually transmitted infections (STIs). Kidney infection, if it occurs,
usually follows a bladder infection but may also result from a blood-borne infection.[2]
Urinary Pathogens especially from community Patients are resistant to many of the antibiotics
used to treat this condition. In complicated cases, a longer course or intravenous antibiotics may
be needed. If symptoms do not improved in two or three days, further diagnostic testing may be
needed. In those who have bacteria or white blood cells in their urine but have no symptoms,
antibiotics are generally not needed, although pregnancy is an exception.[2]
Evaluation of an UTI requires examination of a urine specimen. The typical findings that indicate
a UTI are white blood cells (the body's infection fighters), red blood cells (a sign of extreme
irritation), and bacteria in the urine. Normal urine has none of these. The urine can be sent for a
culture to identify the causative bacteria and to determine appropriate antibiotic treatment.[8]
The aim of this research document is to highlight the severity of Urinary Tract Infection in Benin
Republic (using IRGIB Laboratories Samples collected over a Two years Period as a case study),
and recognize the clinical signs and symptoms of Urinary tract infection.
Understand epidemiology and microbiology of urinary tract infections.
Understand pathogenesis of lower and upper urinary tract infections.
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PREVALENCE OF URINARY TRACT INFECTION IN REPUBLIC OF BENIN. ITS ADVERSE EFFECTS AND
CONTROLS
CHAPTER ONE
1.0 URINARY TRACT INFECTION (UTI)
A urinary tract infection, or UTI, is an illness that occurs when bacteria infects the
urinary tract. Most UTIs involve infection of the lower urinary tract, which includes
the bladder and urethra (the tube through which urine passes out of the body). Less
often, UTIs involve the upper urinary tract, which includes the kidneys and ureters
(tubes connecting the kidneys to the bladder)[1]
The bacteria that cause urinary tract infections typically enter the bladder via the
urethra. However, infection may also occur via the blood or lymph. It is believed
that the bacteria are usually transmitted to the urethra from the bowel, with females
at greater risk due to their anatomy. After gaining entry to the bladder,bacteria are
able to attach to the bladder wall and form a biofilm that resists the body's immune
response. [2]
A urinary tract infection may involve only the lower urinary tract, in which case it
is known as a bladder infection. Alternatively, it may involve the upper urinary tract,
in which case it is known as pyelonephritis. If the urine contains significant bacteria
but there are no symptoms, the condition is known as asymptomatic bacteriuria. If a
urinary tract infection involves the upper tract, and the person has diabetes mellitus,
is pregnant, is male, or immunocompromised, it is considered complicated. If a
woman is healthy and premenopausal it is considered uncomplicated. In children
when a urinary tract infection is associated with a fever, it is deemed to be an upper
urinary tract infection. Urine may contain pus (a condition known as pyuria) as seen
from a person with sepsis due to a urinary tract infection.[3]
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The most common symptoms are burning with urination and having to urinate
frequently (or an urge to urinate) in the absence of vaginal discharge and significant
pain. These symptoms may vary from mild to severe and in healthy women last an
average of six days. Some pain above the pubic bone or in the lower back may be
present. People experiencing an upper urinary tract infection, or pyelonephritis, may
experience flank pain, fever, or nausea and vomiting in addition to the classic
symptoms of a lower urinary tract infection. Rarely the urine may appear bloody or
contain visible pus in the urine.[3]
1.1. GENDER SUSCEPTIBILITY
The Gender most susceptible to UTIs are Females. Women and girls get UTIs more
often than men and boys. This is due to differences in anatomy of male and female.
A moister environment around the urethral opening. About one in five women will
have a UTI at some point. Sexually active women are more likely to get UTIs than
women who aren't sexually active. UTIs are especially rare in young and middle-
aged adult men. For every 10,000 healthy men in this age group, only about five to
eight experience UTI symptoms each year.[4] Women get UTIs four times as often
as men, and more than 50 percent of women will get a UTI at least once in their life,
this is partly because women have a shorter urethra, making it easier for E. coli and
other bacteria to reach the bladder. Furthermore the opening of a woman's urethra is
near the anus, where bacteria live. Men and women are more likely to get a UTI if
they have: Kidney stones or other conditions that block the urinary tract, a spinal
cord injury or other nerve damage that prevents them from completely emptying
their bladder, thereby allowing bacteria to multiply, a urinary catheter (tube used to
drain the bladder). A weakened immune system.[6]
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Additionally, men with an enlarged prostate gland and women who use a
diaphragm have an increased risk of UTIs because of the extra pressure put on the
bladder, which prevents it from emptying properly. Anatomical abnormalities of the
urinary tract in men or women can also predispose people to UTIs.[6]
1.1.0 EPIDEMOLOGY
Urinary tract infections are the most frequent bacterial infection in women. They
occur most frequently between the ages of 16 and 35 years, with 10% of women
getting an infection yearly and more than 40 to 60% having an infection at some
point in their lives. Recurrences are common, with nearly half of people getting a
second infection within a year. Urinary tract infections occur four times more
frequently in females than males. Pyelonephritis occurs between 20–30 times less
frequently.[4] They are the most common cause of hospital acquired infections
accounting for approximately 40%. Rates of asymptomatic bacteria in the urine
increase with age from 2% to 7% in women of child bearing age to as high as 50%
in elderly women in care homes. Rates of asymptomatic bacteria in the urine among
men over 75 are between 7-10%. Asymptomatic bacteria in the urine occurs in 2%
to 10% of pregnancies. Urinary tract infections may affect 10% of people during
childhood. Among children urinary tract infections are the most common in
uncircumcised males less than three months of age, followed by females less than
one year. Estimates of frequency among children however vary widely. In a group
of children with a fever, ranging in age between birth and two years, two to 20%
were diagnosed with a UTI.[5]
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1.1.1 PATHOGENESIS
There are two important routes by which bacteria can invade and spread within the
urinary tract: the ascending and hematogenous pathways. There is little evidence to
support a lymphatic spread of infection to the urinary tract with any regularity.[6]
1.1.1.0 Hematogenous Route:
Infection of the renal parenchyma by blood-borne organisms occurs in humans,

albeit less commonly than by the ascending route. The kidney is frequently the site
of abscesses in patient with bacteremia or endocarditis caused by a Gram positive
organism, Staphylococcus aureus; infections of the kidney with Gram negative
bacilli rarely occur by the hematogenous route.[7]
1.1.1.1 Ascending Route:
Urinary tract infections in women develop when uropathogens from the fecal flora
colonize the vaginal introitus and displace the normal flora (diphtheroids,
lactobacilli, coagulase-negative staphylococci, and streptococcal species).
Colonization of the vaginal introitus with E.coli seems to be one of the critical initial
steps in the pathogenesis of both acute and recurrent UTI. Most uropathogens
originate in the rectal flora and enter the bladder via the urethra. The female urethra
is short and proximal to the vulvar and perineal areas, making contamination likely.
In women in whom UTIs develop, the urethra is colonized and the uropathogen gains
entry to the bladder, presumably by means of the urethral massage that accompanies
sexual intercourse. Whether infection develops depends upon the particular
organism, the size of the inoculum, and the adequacy of host defenses. Once the
bacteria ascend into the bladder, they may multiply and then pass up the ureters,
particularly if vesicoureteral reflux is present, to the renal parenchyma.[8]
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Abnormalities of the urinary tract which lead to obstruction of the urinary flow are
a major factor in the development of urinary infection. Extra-renal obstruction due
to posterior urethral valves in infant boys or urethral strictures in adult men are
uncommon but important to consider. More common is incomplete bladder
emptying due to prostatic hyperplasia. Dysfunction of the bladder due to mechanical
(prostate, pelvic floor relaxation) or neurological causes also contributes to the
development of UTI's.
1.1.1.2 HOST FACTORS IN URINARY TRACT INFECTION
The host employs several defense mechanisms to eliminate pathogenic and

nonpathogenic microorganisms that gain access to the bladder. Factors favoring
bacterial elimination include high urine flow rate, high voiding frequency,
bactericidal effects of bladder mucosa, secreted proteins that bind to fimbrial
adhesins on the bacterial wall, and the inflammatory response mediated by PMNs
and cytokines.
Urine osmolarity, pH, organic acids
Urine flow and micturition
Urinary inhibitors of bacterial adherence:
Bladder mucopolysaccharides
Secretory immunoglobulin A (SIgA)
Inflammatory response (PMNs, and cytokines)
Prostatic secretions
Humoral and cell-mediated immunity
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1.1.1.3 BACTERIAL FACTORS IN URINARY TRACT INFECTION
Symptomatic bacteriuria is highly correlated with the presence of bacteria that

mediate attachment to uroepithelial cells. And thus certain strains of E.coli are
selected from the fecal flora by the presence of virulence factors that enhance both
colonization and invasion of the urinary tract and the ability to produce infection.
Bacteria with enhanced adherence to vaginal and periurethral cells would be selected
to colonize the anatomic regions adjacent to the urethral orifice. Binding to the
uroepithelial surface, in turn, prevents bacterial washout during micturition and is
the first step to bacterial invasion. The adhesive properties of E.coli, for example,
are facilitated by fimbriae, filamentous surface organelle. Gram negative bacterial
uropathogens, such as Proteus mirabilis and Klebsiella species, have demonstrated
similar ability to adhere to the vaginal and periurethral cells, thereby enhancing their
pathogenicity. Among Gram positive organisms, in contrast, Staphylococcus aureus
uncommonly causes cystitis and ascending pyelonephritis, whereas Staphylococcus
saprophyticus, which adheres significantly better to uroepithelium than do
Staphylococcus aureus or Staphylococcus epidermidis, is a frequent cause of lower
urinary tract infections.[6][7][8]
1.1.2 CAUSATIVE AGENT
Bacteria are the Major cause of Urinary Tract Infections. And some of the Bacteria
include Escherichia Coli, Klebsiella pneumonia and Staphylococcus aureus to
mention a few. Escherichia coli or E. coli, is responsible for more than 85 percent
of all UTIs, according to a 2012 report in the journal Emerging Infectious Diseases.[9]
Several other common bacteria also cause UTIs, including Staphylococcus
saprophyticus, Pseudomonas aeruginosa. Sexually transmitted infections —
including herpes, gonorrhea, chlamydia, and mycoplasma — can also cause UTIs.
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Escherichia coli was the most common etiological agent of UTI, followed by
Klebsiella spp, Staphylococcus saprophyticus, and Pseudomonas aeruginosa.
Analysis of the frequency of isolated bacteria according to the age of the patients
revealed that Klebsiella infections are more prevalent in the older age groups (>10
years) and Pseudomonas infections are more prevalent in children and the elderly
(<9 years and >60 years). Results of antimicrobial susceptibility analysis for E. coli,
as the most prevalent cause of UTI.
Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia
coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract.
However, sometimes other bacteria are responsible. Sexual intercourse may lead to
cystitis, but you don't have to be sexually active to develop it. All women are at risk
of cystitis because of their anatomy — specifically, the short distance from the
urethra to the anus and the urethral opening to the bladder.
Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria
spread from the anus to the urethra. Also, because the female urethra is close to the
vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and
mycoplasma, can cause urethritis.
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TABLE 1: Pie chart showing the various uropathogens and the percentage of infection.
1.1.2.0 BACTERIA OF INTEREST

Urinary Tract Infection (UTI) is a bacterial infection, but not all Bacteria infect the
urinary tract. The Bacteria we will be focusing on are the most prevalent ones using
bio-data gathered in the laboratories
• Escherichia Coli
• Klebsiella spp. (pneumonia)
• Staphylococcus aureus
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1.1.3 BACTERIA
Bacteria are single celled microbes and thrive in diverse environment. They are
prokaryotes. They are dynamic and can be Pathogenic or Helpful. The cell structure
is simpler than that of other organisms as there is no nucleus or membrane bound
organelles. Instead their control centre containing the genetic information is a single
loop of DNA called PLASMIDS. Bacteria are different and they are classified
according to the nature of their cell wall, differences and genetic makeup.[9] The cell
walls of “Gram-positive bacteria” have a thick layer of peptidoglycan combined with
teichoic acid and lipoteichoic acid molecules. The cell walls of “Gram-negative
bacteria” have a much thinner layer of peptidoglycan, but this layer is covered with
a complex layer of lipid macromolecules, usually referred to as bacteria capsule[10]
Gram Staining is one of the most common means of classification/identification of

bacteria used in the laboratory.
Gram staining technique- fix + stain + lugol + decolorize + counter stain.

Identification of bacteria using color. GRAM STAINING.
FIGURE 1: microscopic identification.
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Gram Negative(-) stains PINK WHILE Gram Positive(+) stains

VIOLET/PURPLE.
Another means of identification is the shapes, since Bacteria are dynamic, they
present in different shapes and sizes which includes cocci, bacilli, spiral, budding
etc.
Based on the shape generally bacillus are rod shaped while coccus are ovoid or
round shape. And they are also classified based on this, diploid or cluster.[8]
Identification of bacteria using shapes
FIGURE 2: microscopic identification
Cocci are round shaped while Bacilli are rod shaped and then others as seen
in the figure above.
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1.1.3.0 LIST OF COMMON UROPATHOGENIC BACTERIA
 Escherichia Coli
 Klebsiella spp.
 Staphylococcus aureus
 Staphylococcus saprophyticus
 Pseudomonas aeruginosa
 Entrobacter cloacae
 Citrobacter species
 Serratia marcescens
 Staphylococci (coagulase-negative)
 Proteus spp.
 Providencia spp.
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1.1.4 ESCHERICHIA COLI

1.1.4.0 SCIENTIFIC CLASSIFICATION
Domain: Bacteria
Kingdom: Eubacteria
Phylum: Proteobacteria
Class: Gammaproteobacteria
Order: Enterobacteriales
Family: Enterobacteriaceae
Genus: Escherichia
Species: E. coli
Binomial name: Escherichia coli
(Migula 1895) (Castellani and Chalmers 1919)
1.1.4.1 BRIEF HISTORY
In 1885, the German-Austrian pediatrician Theodor Escherich discovered this

organism in the feces of healthy individuals. He called it Bacterium coli commune
because it is found in the colon. Early classifications of prokaryotes placed these in
a handful of genera based on their shape and motility. . Following a revision of
Bacterium, it was reclassified as Bacillus coli by Migula in 1895 and later
reclassified in the newly created genus Escherichia, named after its original
discoverer.[11]
1.1.4.2 SPECIFICATION
Escherichia coli also known as E. coli is a Gram-negative, facultative anaerobic,

rod-shaped bacterium of the genus Escherichia that is commonly found in the lower
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intestine of warm-blooded organisms (endotherms). E. coli stains Gram-negative

because its cell wall is composed of a thin peptidoglycan layer and an outer
membrane. During the staining process, E. coli picks up the color of the counterstain
safranin and stains pink. The outer membrane surrounding the cell wall provides a
barrier to certain antibiotics such that E. coli is not damaged by penicillin. E. coli
can live on a wide variety of substrates and uses mixed-acid fermentation in
anaerobic conditions, producing lactate, succinate, ethanol, acetate, and carbon
dioxide. Since many pathways in mixed-acid fermentation produce hydrogen gas,
these pathways require the levels of hydrogen to be low, as is the case when E. coli
lives together with hydrogen-consuming organisms, such as methanogens or
sulphate-reducing bacteria. Most E. coli strains are harmless, but some serotypes can
cause serious food poisoning in their hosts, and are occasionally responsible for
product recalls due to food contamination.[12] The harmless strains are part of the
normal flora of the gut, and can benefit their hosts by producing vitamin K2, and
preventing colonization of the intestine with pathogenic bacteria. E. coli is expelled
into the environment within fecal matter. The bacterium grows massively in fresh
fecal matter under aerobic conditions for 3 days, but its numbers decline slowly
afterwards. E. coli and other facultative anaerobes constitute about 0.1% of gut flora,
and fecal–oral transmission is the major route through which pathogenic strains of
the bacterium cause disease. Cells are able to survive outside the body for a limited
amount of time, which makes them potential indicator organisms to test
environmental samples for fecal contamination. . The ability to be able to continue
growing in the absence of oxygen is an advantage to bacteria because their survival
is increased in environments where water predominates. [13]
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1.1.4.3 ROLE IN UTI
Uropathogenic E. coli (UPEC) is one of the main causes of urinary tract infections.
It is part of the normal flora in the gut and can be introduced in many ways. In
particular for females, the direction of wiping after defecation (wiping back to front)
can lead to fecal contamination of the urogenital orifices. Anal intercourse can also
introduce this bacterium into the male urethra, and in switching from anal to vaginal
intercourse, the male can also introduce UPEC to the female urogenital system.
Among the Gram-negative bacteria, UPEC is the pathogen most frequently
associated with UTIs. UPEC, which colonizes the urinary tract, may ascend towards
bladder to cause cystitis. Left untreated, bacteria ascend the ureters to the kidney and
establish a secondary infection, acute pyelonephritis with the possibility of causing
irreversible kidney damage leading to kidney failure and death. It is a causative
factor of community acquires UTIs and also Nosocomial UTIs. [14]
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1.1.5 KLEBSIELLA SPP. (PNEUMONIA)

Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gammaproteobacteria
Order: Enterobacteriales
Family: Enterobacteriaceae
Genus: Klebsiella
Species: K. pneumonia
Binomial name: Klebsiella pneumonia.
(Schroeter 1886) (Trevisan 1887)
1.1.5.1 BREIF HISTORY
Danish scientist Hans Christian Gram (1853–1938) developed the technique now
known as Gram staining in 1884 to discriminate between K. pneumoniae and
Streptococcus pneumonia. The genus Klebsiella was named after the German
bacteriologist Edwin Klebs (1834–1913). Also known as Friedlander's bacillum in
honor of Carl Friedlander, a German pathologist, who proposed that this bacterium
was the etiological factor for the pneumonia seen specially in immunocompromised
individuals such as sufferers of chronic diseases or alcoholics.[15]
Klebsiella species are found everywhere in nature. Klebsiella pneumoniae is a

Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultative anaerobic,
rod-shaped bacterium. Although found in the normal flora of the mouth, skin, and
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intestines, it can cause destructive changes to human and animal lungs if aspirated
(inhaled), specifically to the alveoli (in the lungs) resulting in bloody sputum. This
capsule also protects the cell from dessication. K. pneumoniae is a home-grown
microorganism in that it is resides in the microbiota of humans. In the clinical setting,
it is the most significant member of the Klebsiella genus of Enterobacteriaceae.
Klebsiella can also cause infections in the urinary tract, lower biliary tract, and
surgical wound sites.[16] The range of clinical diseases includes pneumonia,
thrombophlebitis, urinary tract infection, cholecystitis, diarrhea, upper respiratory
tract infection, wound infection, osteomyelitis, meningitis, and bacteremia and
septicemia. For patients with an invasive device in their bodies, contamination of the
device becomes a risk; for example, neonatal ward devices, respiratory support
equipment, and urinary catheters put patients at increased risk. Also, the use of
antibiotics can be a factor that increases the risk of nosocomial infection with
Klebsiella bacteria. Sepsis and septic shock can follow entry of the bacteria into the
blood .[17]
1.1.5.3 ROLE IN UTI
Klebsiella ranks second to E. coli for urinary tract infections in older people. It
infectious dose is not known. As for the incubation period, it is also not fully
understood but possibly arises within a number of days, presents as an
uncomplicated UTI and can also be asymptomatic. It is also a nosocomial UTI.
Klebsiella UTI mostly affect people with a weakened immune system. Most often,
affects infants, middle-aged and older men or people with debilitating diseases.
When dealing with hospital-acquired bacterial infections caused by K. pneumoniae,
it can arise in different parts of the body and in different forms of illness depending
on transmission. K. pneumoniae is responsible for 6-17% of UTI’s.14% of
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bacteremia cases are because by K. pneumoniae, which places it in second place

next to Escherichia coli for origins of gram-negative sepsis. [18]
FIGURE 3: Klebsiella spp. Source: Virtual Med Centre
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1.1.6 STAPHYLOCOCCUS SAPROPHYTICUS
Kingdom: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Bacillales
Family: Staphylococcaceae
Genus: Staphylococcus
Species: S. saprophyticus
Binomial name: Staphylococcus saprophyticus
(Fairbrother 1940) Shaw et al. 1951
1.1.6.1 BRIEF HISTORY.
S. saprophyticus was not recognized as a cause of urinary tract infections until the
early 1970s, more than 10 years after its original demonstration in urine specimens.
Prior to this, the presence of coagulase-negative staphylococci (CoNS) in urine
specimens was dismissed as contamination.[19]
1.1.6.2 SPECIFICATIONS.
In humans, S. saprophyticus is found in the normal flora of the female genital tract
and perineum. It has been isolated from other sources, too, including meat and
cheese products, vegetables, the environment, and human and animal
gastrointestinal tracts. S. saprophyticus causes 10–20% of urinary tract infections
(UTIs). In females 17–27 years old, it is the second-most common cause of
community-acquired UTIs, after Escherichia coli.[20] Sexual activity increases the
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risk of S. saprophyticus UTIs because bacteria are displaced from the normal flora
of the vagina and perineum into the urethra. Most cases occur within 24 hours of
sex, earning this infection the nickname "honeymoon cystitis". S. saprophyticus has
the capacity to selectively adhere to human urothelium. S. saprophyticus is
identified as belonging to the Staphylococcus genus using the Gram stain and
catalase test. It is identitified as a species of coagulase-negative staphylococci
(CoNS) using the coagulase test. Lastly, S. saprophyticus is differentiated from S.
epidermidis, another species of pathogenic CoNS, by testing for susceptibility to the
antibiotic novobiocin. S. saprophyticus is novobiocin-resistant, whereas S.
epidermidis is novobiocin-sensitive.[21]
1.1.6.3 ROLE IN UTI
Patients with urinary tract infections caused by S. saprophyticus usually present with
symptomatic cystitis. S. saprophyticus causes 10–20% of urinary tract infections
(UTIs). In females 17–27 years old, it is the second-most common cause of
community-acquired UTIs, after Escherichia coli. Symptoms include a burning
sensation when passing urine, the urge to urinate more often than usual, a 'dripping
effect' after urination, weak bladder, a bloated feeling with sharp razor pains in the
lower abdomen around the bladder and ovary areas, and razor-like pains during
sexual intercourse. The urine sediment of a patient with a S. saprophyticus urinary
tract infection has a characteristic appearance under the microscope manifesting
leukocytes, erythrocytes, and clumping due to cocci adhering to cellular elements.[50]
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1.1.7 STAPHYLOCOCCUS AUREUS

Domain: Bacteria
Kingdom: Eubacteria
Phylum: Firmicutes
Class: Coccus
Order: Bacillales
Family: Staphylococcaceae
Genus: Staphylococcus
Species: S. aureus
Binomial name: Staphylococcus aureus
(Rosenbach 1884)
1.1.7.1 BREIF HISTORY
Staphylococcus was first identified in 1880 in Aberdeen, Scotland, by the surgeon

Sir Alexander Ogston in pus from a surgical abscess in a knee joint. This name was
later appended to Staphylococcus aureus by Friedrich Julius Rosenbach, who was
credited by the official system of nomenclature at the time. [22]
Staphylococcus aureus is a gram-positive coccal bacterium. S A is a facultative

anaerobic, gram-positive coccal bacterium also known as "golden staph" and Oro
staphira. In medical literature, the bacterium is often referred to as S. aureus, Staph
aureus or Staph A. Staphylococcus should not be confused with the similarly named
and medically relevant genus Streptococcus. S. aureus appears as grape-like clusters
when viewed through a microscope, and has large, round, golden-yellow colonies,
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often with hemolysis, when grown on blood agar plates It is a member of the
Firmicutes, and is frequently found in the nose, respiratory tract, and on the skin. It
is often positive for catalase and nitrate reduction. Although S. aureus is not always
pathogenic, it is a common cause of skin infections such as abscesses, respiratory
infections such as sinusitis, and food poisoning. Pathogenic strains often promote
infections by producing potent protein toxins. An estimated 20% of the human
population are long-term carriers of S. aureus which can be found as part of the
normal skin flora and in the nostrils. S. aureus is a normal inhabitant of the healthy
lower reproductive tract of women. S. aureus can cause a range of illnesses, from
minor skin infections, such as pimples, impetigo, boils, cellulitis, folliculitis,
carbuncles, scalded skin syndrome, and abscesses, to life-threatening diseases such
as pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome,
bacteremia, and sepsis. S. aureus reproduces asexually by binary fission. The two
daughter cells do not fully separate and remain attached to one another, so the cells
are observed in clusters. [23]
1.1.7.3 ROLE IN UTI
Staphylococcus aureus accounts for only 0.5% to 6% of all positive urine cultures.
S. aureus may occur commonly in the environment. S. aureus is transmitted through
air droplets or aerosol. When an infected person coughs or sneezes, he or she releases
numerous small droplets of saliva that remain suspended in air. These contain the
bacteria and can infect others. Another common method of transmission is through
direct contact with objects that are contaminated by the bacteria or by bites from
infected persons or animals. Approximately 30% of healthy humans carry S. aureus
in their nose, back of the throat and on their skin. Traditionally, physicians have
tended to undertreat S aureus bacteriuria due to its reputation as a common
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contaminant. This might not be true, however, and delayed treatment could lead to
development of staphylococcal bacteremia, a serious life-threatening illness. Most
times it is asymptomatic. [24]
Source : kubu picutures
FIGURE 4: GRAM STAINED COCCI BACTERIA
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1.2 PRESENTATION AND SYMPTOMS

1.2.0 CLINICAL PRESENTATION
Symptoms of urinary-tract infection vary with the age of the patient and the location
of infection. Neonates and children less than 2 years old do not complain of dysuria:
fever, emesis, and failure to gain weight are the usual symptoms. Children over 3
years will complain of burning on urination and lower abdominal pain; previously
toilet-trained children may develop enuresis. Adult patients with cystitis have
dysuria, suprapubic pain, urinary frequency and urgency. The urine often is cloudy
and malodorous and may be bloody. Fever and systemic symptoms usually are
absent in infection limited to the lower tract. Acute dysuria in adult women can also
be due to acute urethritis (chlamydial, gonococcal, or herpetic) or to
vaginitis/vaginosis. While it may be difficult to distinguish upper tract infection from
lower tract infection based on clinical signs alone, systemic symptoms of fever
(usually greater than 101o F.), nausea, vomiting, and pain in the costovertebral areas,
are highly suggestive of upper urinary tract infection (pyelonephritis). This is
frequently accompanied by urinary frequency, urgency and dysuria. Rigors (shaking
chills) may indicate bacteremia. It is important to note that these symptoms may vary
greatly: flank tenderness is frequent and more intense when there is obstructive
disease (renal calculi), and severe pain with radiation to the groin suggests the
presence of renal calculus. The pain from an inflamed kidney may be felt in or near
the epigastrium and may radiate to one of the lower quadrants. Patients with urinary-
catheter associated infection often are asymptomatic, but may have fever, chills,
leukocytosis, etc.
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1.2.1 DIAGNOSIS
The diagnosis of UTI can only be proven by culture of an adequately collected urine
sample. This is essential in all suspected cases in females, males, infants and
children. In sexually active young women, in whom sexually transmitted infections
are unlikely, typical clinical features of cystitis in the presence of pyuria, hematuria
or bacteriuria are highly suggestive of UTI.
The urine is normally sterile. An infection occurs when bacteria get into the urine
and begin to grow. The infection usually starts at the opening of the urethra where
the urine leaves the body and moves upward into the urinary tract. [25]
1.2.2 SIGNS AND SYMPTOMS
A UTI can present with a range of symptoms, or may be totally asymptomatic and
diagnosed only on routine dip testing. The presenting symptoms will vary with the
age and sex of the patient and also with the severity and site of the infection but may
include:
Urinary frequency.
Painful frequent passing of only small amounts of urine.
Dysuria.
Haematuria.
Foul-smelling ± cloudy urine.
Urgency.
Itching
Urinary incontinence.
Suprapubic or loin pain.
Rigors.
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Pyrexia.
Nausea ± vomiting.
Acute confusional state - particularly elderly patients.
1.2.3 Differential diagnosis
The differential diagnosis will depend on the presenting symptoms: Many of the
symptoms of a UTI can be seen in women with urethral syndrome who have no
bacterial infection or in postmenopausal women with atrophic vaginitis and
urethritis.
Other infections of the genital tract such as with C. albicans, herpes simplex,
Chlamydia trachomatis and Gardnerella spp. may also produce similar symptoms in
some women.
In men, an enlarged or inflamed prostate may also present in a similar manner to a

UTI. In women with cervicitis (inflammation of the cervix) or vaginitis
(inflammation of the vagina) and in young men with UTI symptoms, a Chlamydia
trachomatis or Neisseria gonorrheae infection may be the cause. These infections are
typically classified as a urethritis rather than a urinary tract infection. Vaginitis may
also be due to a yeast infection. Interstitial cystitis (chronic pain in the bladder) may
be considered for people who experience multiple episodes of UTI symptoms but
urine cultures remain negative and not improved with antibiotics. Prostatitis
(inflammation of the prostate) may also be considered in the differential diagnosis.
[26]
Hemorrhagic cystitis, characterized by blood in the urine, can occur secondary to a

number of causes including: infections, radiation therapy, underlying cancer,
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medications and toxins. Medications that commonly cause this problem include the
chemotherapeutic agent cyclophosphamide with rates of 2 to 40%. Eosinophilic
cystitis is a rare condition where eosinophiles are present in the bladder wall. Signs
and symptoms are similar to a bladder infection. Its cause is not entirely clear;
however, it may be linked to food allergies, infections, and medications among
others. [27][28]
1.2.4 DIAGNOSTIC METHOD
There are different methods used for the diagnosis of UTI they include:
 Macroscopic examination
 Microscopic examination
 Chemical examination
1.2.4.1 Macroscopic examination: the laboratory analyst observes the urine's

color and clarity. These can be signs of what substances may be present in the urine.
They are interpreted in conjunction with results obtained during the chemical and
microscopic examinations to confirm what substances are present.
Color—urine can be a variety of colors, most often shades of yellow, from very pale
or colorless to very dark or amber. Unusual or abnormal urine colors can be the result
of a disease process, several medications (e.g., multivitamins can turn urine bright
yellow), or the result of eating certain foods. However, red-colored urine can also
occur when blood is present in the urine and can be an indicator of disease or damage
to some part of the urinary system. Another example is yellow-brown or greenish-
brown urine that may be a sign of bilirubin in the urine.
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Clarity—urine clarity refers to how clear the urine is. Usually, laboratories report
the clarity of the urine using one of the following terms: clear, slightly cloudy,
cloudy, or turbid. "Normal" urine can be clear or cloudy. Substances that cause
cloudiness but that are not considered unhealthy include mucus, sperm and prostatic
fluid, cells from the skin, normal urine crystals, and contaminants. Other substances
that can make urine cloudy, like red blood cells, white blood cells, or bacteria,
indicate a condition that requires attention. [28][29]
1.2.4.2 Microscopic examination: A microscopic examination may or may

not be performed as part of a routine urinalysis. It will typically be done when there
are abnormal findings on the physical or chemical examination and the results from
all will be taken into account for interpretation.
The microscopic exam is performed on urine sediment – urine that has been
centrifuged to concentrate the substances in it at the bottom of a tube. The fluid at
the top of the tube is then discarded and the drops of fluid remaining are examined
under a microscope (WET MOUNT). Cells, crystals, and other substances are
counted and reported either as the number observed "per low power field" (LPF) or
"per high power field" (HPF). In addition, some entities, if present, are estimated as
"few," "moderate," or "many," such as epithelial cells, bacteria, and crystals. Cells
and other substances that may be seen include the following:
Red Blood Cells (RBCs): Blood in the urine is not a normal finding, but it is not
uncommon and is not necessarily a cause for alarm. Hematuria is a sign or an
indicator that prompts a healthcare practitioner to investigate further to try to
determine the underlying cause of the blood
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White Blood Cells (WBCs): The number of WBCs in urine sediment is normally
low (0-5 WBCs per high power field, HPF). WBCs can be a contaminant, such as
those from vaginal secretions. An increased number of WBCs seen in the urine under
a microscope and/or positive test for leukocyte esterase may indicate an infection or
inflammation somewhere in the urinary tract if also seen with bacteria
Epithelial Cells: Epithelial cells are usually reported as "few," "moderate," or

"many" present per low power field (LPF). Normally, in men and women, a few
epithelial cells can be found in the urine sediment. In urinary tract conditions such
as infections, inflammation, and malignancies, an increased number of epithelial
cells are present. Determining the kinds of cells present may sometimes help to
identify certain conditions.
Bacteria, Yeast and Parasites: If microbes are seen, they are usually reported as
"few," "moderate," or "many" present per high power field (HPF). Bacteria from the
surrounding skin can enter the urinary tract at the urethra and move up to the bladder,
causing a urinary tract infection (UTI). If the infection is not treated, it can eventually
move to the kidneys and cause kidney infection. In women (and rarely in men), yeast
can also be present in urine. They are most often present in women who have a
vaginal yeast infection because the urine has been contaminated with vaginal
secretions during collection. If yeast are observed in urine, then the person may be
treated for a yeast infection.
Trichomonas: Trichomonas vaginalis is a parasite that may be found in the urine of

women, or rarely, men. As with yeast, T. vaginalis infects the vaginal canal and their
presence in urine is due to contamination during sample collection. If these are found
during a urinalysis, then Trichomonas testing may be performed to look for a vaginal
infection.
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Casts: Casts are cylindrical particles sometimes found in urine that are formed from
coagulated protein released by kidney cells. They are formed in the long, thin,
hollow tubes of the kidneys known as tubules and usually take the shape of the
tubule. Other types of casts are associated with different kidney diseases, and the
type of casts found in the urine may give clues as to which disorder is affecting the
kidney. Cellular casts, such as red blood cell and white blood cell casts, indicate a
kidney disorder. Some other examples of types of casts include granular casts, fatty
casts, and waxy casts.
Crystals: Crystals are identified by their shape, color, and by the urine pH. They
may be small, sand-like particles with no specific shape (amorphous) or have
specific shapes, such as needle-like. Crystals are considered "normal" if they are
from solutes that are typically found in the urine; these usually form as urine cools
after collection and were not present in the body. If the crystals are from substances
that are not normally in the urine, they are considered "abnormal." Abnormal crystals
may indicate an abnormal metabolic process. Normal or abnormal crystals can form
within the kidneys as urine is being made and may group together to form kidney
"stones" or calculi. These stones can become lodged in the kidney itself or in the
ureters, tubes that pass the urine from kidney to the bladder, causing extreme
pain.[30][31][32]
1.2.4.3 Chemical examination: To perform the chemical examination, most

clinical laboratories use commercially prepared test strips with test pads that have
chemicals impregnated into them. The laboratorian dips the strip into urine, chemical
reactions change the colors of the pads within seconds to minutes, and the
laboratorian determines the result for each test. To reduce timing errors and
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eliminate variations in color interpretation, automated instruments are frequently

used to "read" the results of the test strip. The degree of color change on a test pad
can give an estimate of the amount of substance present. For example, a slight color
change in the test pad for protein may indicate a small amount of protein present in
the urine whereas a deep color change may indicate a large amount.
The most frequently performed chemical tests using reagent test strips are:
Specific Gravity (SG): Specific gravity is a measure of urine concentration. This

test simply indicates how concentrated the urine is. Specific gravity measurements
are a comparison of the amount of substances dissolved in urine as compared to pure
water.
pH: As with specific gravity, there are typical but not "abnormal" pH values. The
urine is usually slightly acidic, about pH 6, but can range from 4.5-8. The kidneys
play an important role in maintaining the acid-base balance of the body. Therefore,
any condition that produces acids or bases in the body, such as acidosis or alkalosis,
or the ingestion of acidic or basic foods can directly affect urine pH.
Protein: The protein test pad provides a rough estimate of the amount of albumin in
the urine. Albumin makes up about 60% of the total protein in the blood. Normally,
there will be no protein or a small amount of protein in the urine. When urine protein
is elevated, a person has a condition called proteinuria. Protein in the urine may be
a sign of kidney disease. Small amounts of albumin may be found in the urine when
kidney dysfunction begins to develop. A different test called a urine albumin test
detects and measures small amounts of albumin in the urine. The urine albumin test
is more sensitive than a dipstick urinalysis and is routinely used to screen people
with chronic conditions that put them at risk for kidney disease, such as diabetes and
high blood pressure.
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Glucose: Glucose is normally not present in urine. When glucose is present, the
condition is called glucosuria. It results from either: An excessively high glucose
level in the blood, such as may be seen with people who have uncontrolled diabetes.
A reduction in the "renal threshold;" when blood glucose levels reach a certain
concentration, the kidneys begin to eliminate glucose into the urine to decrease blood
concentrations. Sometimes the threshold concentration is reduced and glucose enters
the urine sooner, at a lower blood glucose concentration. Some other conditions that
can cause glucosuria include hormonal disorders, liver disease, medications, and
pregnancy.
Ketones: Ketones are not normally found in the urine. They are intermediate
products of fat metabolism. They are produced when glucose is not available to the
body's cells as an energy source. They can form when a person does not eat enough
carbohydrates. Ketones in urine may also be an early indication of insufficient
insulin. With insufficient insulin, a diabetic cannot process glucose and instead
metabolizes fat. This can cause ketones to build up in the blood, resulting first in
ketosis and then progressing to ketoacidosis, a form of metabolic acidosis. Excess
ketones and glucose are dumped into the urine by the kidneys in an effort to flush
them from the body.
Blood (hemoglobin) and Myoglobin: This test is used to detect hemoglobin in the
urine (hemoglobinuria) or myoglobin from muscle injury. Hemoglobin is an oxygen-
transporting protein found inside red blood cells (RBCs). Its presence in the urine
indicates blood in the urine (known as hematuria). Blood in the urine is not a normal
finding, but it is not uncommon and not necessarily a cause for alarm.
Leukocyte Esterase: Leukocyte esterase is an enzyme present in most white blood

cells (WBCs). A few white blood cells are normally present in urine and usually give
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a negative chemical test result. When the number of WBCs in urine increases
significantly, this screening test will become positive. Results of this test will be
considered along with a microscopic examination for WBCs in the urine. When this
test is positive and/or the WBC count in urine is high, it may indicate that there is
inflammation in the urinary tract or kidneys. The most common cause for WBCs in
urine (leukocyturia) is a bacterial urinary tract infection
Nitrite: This test detects nitrite and is based upon the fact that many bacteria can
convert nitrate (a normal substance in urine) to nitrite. Normally, the urinary tract
and urine are free of bacteria and nitrite. When bacteria enter the urinary tract, they
can cause a urinary tract infection. A positive nitrite test result can indicate a UTI.
Bilirubin: This test screens for bilirubin in the urine. Bilirubin is not present in the
urine of normal, healthy individuals. It is a waste product that is produced by the
liver from the hemoglobin of RBCs that are broken down and removed from
circulation. It becomes a component of bile, a fluid that is released into the intestines
to aid in food digestion. In certain liver diseases, such as biliary obstruction or
hepatitis, excess bilirubin can build up in the blood and is eliminated in urine. The
presence of bilirubin in urine is an early indicator of liver disease and can occur
before clinical symptoms such as jaundice develop.
Urobilinogen: Urobilinogen is normally present in urine in low concentrations. It is

formed in the intestine from bilirubin, and a portion of it is absorbed back into the
blood. Positive test results may indicate liver diseases such as viral hepatitis,
cirrhosis, liver damage due to drugs or toxic substances, or conditions associated
with increased RBC destruction (hemolytic anemia). When urine urobilinogen is low
or absent in a person with urine bilirubin and/or signs of liver dysfunction, it can
indicate the presence of hepatic or biliary obstruction
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Some reagent test strips also have a test pad for ascorbic acid (vitamin C).
Occasionally, people taking vitamin C or multivitamins may have large amounts of
ascorbic acid in their urine. When this is suspected to be the case, a laboratorian may
test the sample for ascorbic acid (vitamin C) because it has been known to interfere
with the accuracy of some of the results of the chemical test strip, causing them to
be falsely low or falsely negative. [33][34][35][36][37][36][39]
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CHAPTER TWO
2.0 RESEARCH METHODOLOGY
2.1 SITE OF ANALYSIS
This work was carried out in Biomedical Analysis section of Biomedical and
Biotechnological Analysis department of the Regional Laboratory of Sanitary Safety
and Analytical Expertise of IRGIB-AFRICA, Cotonou; Established and officially
launched in September 2006 in Republic of Benin. Located at AKPAKPA,
UNICOMER Site opposite Stade Rene Pleven, Cotonou.
The IRGIB-AFRICA laboratory is equipped with standard technologies capable of

various analyses. It is organized such that it has different departments which in turn
have sections. All these are managed by engineers and researchers who work under
the supervision of: Director of laboratory, technical director, interns‟ supervisor and
a personnel in charge of quality control.
The Biomedical and Biotechnological Analysis department, which sections include:
Hematological section, Serological section, Biochemical section, Microbiological

section (bacteriology and parasitology), Biotechnological section.
In all these section various biomedical analysis are carried out by the Technicians
and Engineers.
There is also Production department and Agro Analysis Department and these
departments are also subdivided into various sections.
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2.2 SAMPLE POPULATION AND SIZES.
The sample population of this particular research is focused on a two years sample
collection from various individuals in Benin Republic (case study of IRGIB-
AFRICA LABORATORIES). Samples collected and analyzed
2.3 MATERIALS
 Specimen sample
 Bio data
 Culture mediums
 Bunsen burner
 Sterile Slides
 Sterile loops
 Centrifuge
 Sterile Tubes
 Incubators
 Workspace
 Gram staining Kit
 Antibiograms/Antibiotics etc
2.4 METHODOLOGY
The method used for this research is a Quantitative and Qualitative Approach as
well as a detailed research on the different effects of UTIs. Microbiological
(bacteriology) Parameters analysis as well as a macroscopic and microscopic
examination on the samples.
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2.4.1 SAMPLE COLLECTION METHOD
When collecting samples for bacteriological urinalysis, it is important to make sure

that some basic safety measures are followed, and that the correct collection
procedure is used. The method commonly used is the mid-stream clean-catch
method, detailed below:
Mid-stream clean-catch collection
(Never fill completely)
ime on it.
After the sample is collected, it should be transferred to the laboratory within two
hours for analysis.
The analysis usually involves macroscopic urine examination and microscopic

urine examination.
Macroscopic examination: the laboratory analyst observes the urine's color and
clarity. These can be signs of what substances may be present in the urine. They are
interpreted in conjunction with results obtained during the chemical and microscopic
examinations to confirm what substances are present.
The microscopic exam is performed on urine sediment – urine that has been
centrifuged to concentrate the substances in it at the bottom of a tube. The fluid at
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the top of the tube is then discarded and the drops of fluid remaining are examined
under a microscope (WET MOUNT). Cells, crystals, and other substances are
counted and reported either as the number observed "per low power field" (LPF) or
"per high power field" (HPF). In addition, some entities, if present, are estimated as
"few," "moderate," or "many," such as epithelial cells, bacteria, and crystals.
Gram stain is a technique commonly used in bacteriology to classify bacteria into

two basic groups: Gram positive (+) and Gram negative (-) bacteria.
Culture media are nutritive sources prepared specifically to sustain bacterial growth.
The nutrients they contain vary depending on the bacteria that need to be grown on
them. Indeed, different bacteria can have different feeding requirements.
The culture media used for bacteriological urinalysis include: Chapman (MSA –
Mannitol Salt Agar), EMB (Eosin Methylene Blue) and Mueller Hinton Agar. Each
of these is specific for a bacterial type.
A urine culture is a test that can detect bacteria in urine. This test can find and
identify the germs that cause a urinary tract infection (UTI). Bacteria, which
typically cause UTIs, can enter the urinary tract through the urethra. In the sterile
environment of your urinary tract, these bacteria can grow rapidly and develop into
an infection. Antibiotic susceptibility test is to provide a medical practitioner with a
range of possibilities as far as treatment of urinary tract infections is concerned.
During the test, the efficacy of various antibiotics will be tested on the bacteria
isolated from a patient’s sample in order to decide what antibiotics would be best
given as treatment to the patient.
By using Bergery’s Manual of determinative Bacteriology the isolates were

characterized and identified.
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2.5 PRESENTATION OF DATA AND ANALYSIS:

Data was gathered manually, entered and analyzed using SPSS software IBM 20
version 24 and Microsoft excel 2013. Statistical significance differences were
considered and compared. Data recorded were 759 samples data, which was
collected for the laboratory of IRGIB AFICA REPUBLIC OF BENIN. About
495(65.2%) 0f the samples data were positive while 264(34.8%) were negative.
E.coli 204(41.2%), Klebsiella 151(31%) Staphylococcus Aureus 152(30.5%). The
data is represented properly in the tables below:
Table 2: This table symbolizes one year representation of Ecoil, S.A. K.b.
month/year sample positive negative E.coli S.A K.B
size
July-14 27 15 12 7 3 5
Aug-14 21 11 10 2 5 4
Sep-14 37 16 21 7 4 5
Oct-14 32 14 18 4 5 5
Nov-14 29 18 11 9 6 3
Dec-14 15 9 6 4 3 4
Jan-15 17 12 5 3 7 2
Feb-15 29 24 5 9 8 8
Mar-15 33 19 14 11 5 4
Apr-15 36 20 16 9 4 7
May-15 31 22 9 7 10 5
Jun-15 39 26 13 11 7 9
total=12 346 206(59.5%) 140(40.5%) 83(40.3%) 67(32.5%) 61(30%)
Data’s represented in the above table is a years’ accumulation of patients data,

represented in both negative and positive testing for different bacteria agent. A data
ILOKA MARY O 39
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gathered from July 2014-june 2015. This tables show the amount of positive and
negative samples as well as the amount of each bacteria agent present each month in
the samples gathered.
Table 3: This table symbolizes one year representation of E.coil, S.A. K.b.
sample
month/year positive negative E.coli S.A K.B
size
Jul-15 34 21 13 11 7 3
Aug 2015 39 24 15 9 3 12
Sep-15 37 20 17 12 5 3
Oct-15 35 24 11 9 12 3
Nov-15 27 19 8 9 6 4
Dec-15 22 18 4 6 4 8
Jan-16 25 16 9 6 7 8
Feb-16 37 29 8 12 9 8
Mar-16 38 25 13 10 7 8
Apr-16 42 35 7 13 9 13
May-16 39 30 9 12 8 10
Jun-16 38 28 10 12 8 10
total =12 413 289(70%) 124(30%) 121(42%) 85(29%) 90(31%)
Data’s represented in the below table is a yearly accumulation of patients data, represented in
both negative and positive testing for different bacteria agent. A data gathered from July 2015-
june 2016. This tables show the amount of positive and negative samples as well as the amount of
each bacteria agent present each month in the samples gathered.
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CHAPTER THREE
3.0 RESULTS and DISCUSSION
3.1 RESULT
TABLE 4: Tabular representation of the result
month/year 2014/2015 2015/2016
July 15 21
August 11 24
September 16 20
October 14 24
November 18 19
December 11 18
January 12 21
February 25 29
March 20 25
April 20 35
May 22 30
June 27 30
This table represents the results from the tables (table 2 and table 3) above. It is the
addition of the Uropathogens(E.coli, S.A, KB) which show that 2015/2016
uropathogens are more prevalent then 2014/2015. While there are significant
differences in some of the months in other the differences are not so much. The
figures highlighted in the tables are the figures that have a significant difference (ie
>.5).
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14
13
12 12 12 12
12
11 11 11
10
10
9 9 9 9 9 9
8
7 7 7
6 6
6
4 4
4
3
2
2
0
Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16
july-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15
E.coli 2014/2015 E.Coli 2015/2016
Figure 5: Comparison of E.coli of year 2014-2015 with year 2015-2016
This figure is a Multiple Bar Chart of 2years (2014-2015 and 2015-2016) E.coli. It
is the comparison of E. coli for two year based on the data gathered and
represented in tables (2 and 3) above. Its show that the amount of E.coli the next
year (2015-2016) is more than that of the previous year (2014-2015). {Though in
Nov there is no difference, and in Mar E.coli of 2014/2015 is slightly more}.
Generally studying the Chart, it shows that 2015/2016 is significantly higher than
2014/2015.
ILOKA MARY O 42
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14
12
12
10
10
9 9
8 8 8
8
7 7 7 7 7
6 6
6
5 5 5 5
4 4 4
4
3 3 3
0
S.A 2014/2015 S.A 2015/2016
Figure 6: Comparison of S.A of year 2014-2015 with year 2015-2016
This figure is a Multiple Bar Chart of 2years (2014-2015 and 2015-2016) S.A It is
the comparison of S.A for two year based on the data gathered and represented in
tables (2 and 3) above. Its show that S.A of 2015/2016 is more than that of
2014/2015. {Aug, Nov, Jan and May are more in these months of 2014/2015}.
Generally studying the Chart, it shows that 2015/2016 is significantly higher than
2014/2015.
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14
13
12
12
10 10
10
9
8 8 8 8 8
8
7
6
5 5 5 5
4 4 4 4
4
3 3 3 3
2
2
0
Eith2014/2015 Eith 2015/2016
Figure 7: Comparison of klebsiella of year 2014-2015 with year 2015-2016
This figure is a Multiple Bar Chart of 2years (2014-2015 and 2015-2016) Klebsiella.
It is the comparison of klebsiella for two year based on the data gathered and
represented in tables (2 and 3) above. Its show that the amount of klebsiella the next
year 2015/2016 is more than that of the previous year 2014/2015. {July, Sep, Oct
and Feb of 2014/2015 is more than that of 2015/2016}. But the later year months
still have a significant different.
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Prevalence of Uropathogens between JULY 2014 - JUNE

60 2015 and JULY 2015 - JUNE 2016.
30
29 35
30
50
25
40
24 19
21 24 20
Axis Title
21
30
18
27
25
22
20 20 20
18
15 16
14
11 11 12
10
0
july aug sep oct nov dec jan feb mar apr may june
2015/2016 21 24 20 24 19 18 21 29 25 35 30 30
2014/2015 15 11 16 14 18 11 12 25 20 20 22 27
FIGURE 8: GRAPHICAL REPESENTATION OF RESULTS
This result show that 2015/2016 UTIs is more prevalent then 2015/2016.
This result is same as the table above (table4) but here better emphasis of the
prevalent is clearly shown using a line graph to represent both years. The red line
represents the year 2015/2016 while the blue line represents 2014/2015. Studying
the graphs clearly we see the different comparison of the uropathogens monthly.
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3.2 DISCUSSION
The study focuses on the frequency of uropathogens and their antibiotics

susceptibility profile which was carried out within a two years periods resulting in a
total of 759 samples data. The analysis has already been carried out so the sample
data’s recorded with their sensitivity pattern was processed and used.
Urinary tract infection is not racial or geographically limited, it affects all

geographical area, but it is more prevalent in some area due to some factors which
include female anatomy, family health history, poor personal hygiene, malnutrition
and low socio-economic status[40]
In Africa countries especially due to low socio-economic status urinary tract

infections is more prevalent. The prevalence of urinary tract infection was
significantly higher in females compared to males (female vs. male). The ratio of
female to male is 9:1.
E. coli is the cause of 80–85% of community-acquired urinary tract infections, with

Staphylococcus saprophyticus being the cause in 5–10%. Rarely they may be due to
viral or fungal infections. Healthcare-associated urinary tract infections involve a
much broader range of pathogens including: E. coli (27%), Klebsiella (11%),
Pseudomonas (11%), the fungal pathogen Candida albicans (9%), and Enterococcus
(7%) among others. Urinary tract infections due to Staphylococcus aureus typically
occur secondary to blood-borne infections.
Escherichia coli was the most prevalent isolate generally and especially in females,
while Staphylococcus aureus was the predominant isolate causing urinary tract
infection in males based on data collected in the laboratory.
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Data gathered in the laboratory using a two years period july2014-june2015 and
july2015-june2016 shows that in Benin republic (IRGIB laboratories) the three
common uropathogens are Escherichia Coli, Klebsiella spp and Staphylococcus
aureus and each isolate is unique and react or affects Patients differently.
Effective management of UTIs caused by these uropathogen depends on proper

identification of the bacteria. In this Study document E.coli is the major bacterial
agent causing UTI resulting in up to 50% of the infection. This agrees with previous
reports on different UTIs which has been carried out.
Resistance to antimicrobial agent has been noted since the introduction of these
agents and it is becoming a cause for concern. This study shows that most of the
uropathogens were more resistant than sensitive to the antimicrobial agents used.
UTIs can be common both in the community and hospital setting, antibiotic
treatment is a very vital part in the effective treatment of UTI though other measures
can also be employed. Urinary pathogens especially from community patients have
been known to include strains that are resistant to many of the commonly used
antibiotics. Therefore there is need for periodic monitoring of etiologic agents of
urinary tract infection, and their susceptibility pattern especially in a rural setting.
There is need however for re-evaluation of the empiric treatment of UTIs as people
generally abuse antibiotics (antimicrobial agents). This causes more drug resistance
among uropathogen and makes antibiotics profiling difficult[41].
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3.3 ANTIBIOTICS SUSCEPTIBILITY TEST

The antibiotic susceptibility pattern of all isolates was determined by the modified
Kirby – Bauer diffusion techniques. The inoculated plates carrying the antibiotic
discs were incubated at 37֯C overnight. The diameter of the zone of inhibition around
each antibiotic was measured and isolates were classified as resistant or sensitive
based on the standard intermediate chart updated according to the current
NCCLS(CLSI) AST standard and Fluke zone interpretative chart in accordance with
WHO requirements[41][42]
Antimicrobial susceptibility profiling test which was carried out in the laboratory
for the uropathogen isolates of the samples used. The results is recorded as follows
in the table below.
TABLE 5: Antimicrobial Sensitivity Testing Table
Antibiotics Sensitivity Intermediate Resistance Absent
AMC 100(13.2%) 128(16.9%) 349(46.0%) 182(25.9%)
AMX 148(19.5%) 109(14.4%) 296(39.0%) 206(27.1%)
CTX 345(45.5%) 98(12.9%) 123(16.2%) 193(25.4%)
CIP 211(28%) 80(10.5%) 246(32.4%) 222(29.2%)
CEF 148(19.5%) 70(9.2%) 220(29%) 321(42.3%)
CF 256(34%) 46(6.0%) 206(27.1%) 251(33.0%)
IPM 783(97.2%) *** *** 21(2.8%)
GEN 156(20.5%) 121(15.9%) 96(12.6%) 386(50.9%)
NET 359(47.3%) *** 40(5.3%) 363(47.8%)
OFX 212(28%) 65(8.6%) 271(35.7%) 211(27.8%)
ERY 12(1.6%) *** 341(45%) 406(53.5%)
LIN 56(7.4%) 115(15.1%) 212(27.9%) 376(49.5%)
ILOKA MARY O 48
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The table shows the percentage of each antimicrobial agent used. (Amoxicillin
AMC, Amoxicillin AMX, Cefotaxim CTX, Ciprofloxacin CIP, Cefalotin CEF,
Cefixime CFM, Imepenem IPM, Gentamycin GEN, Nethilimicin NET, Ofloxacin
OFX, Erythromycin ERY, Lincomycin LIN).
FIGURE 9: Antibiotic Susceptibility Testing
This figure shows an inoculated plates carrying the antibiotic discs.

This plates are usually incubated overnight or 18hours at a temperature of 37֯C. The
diameter of the zone of inhibition around each antibiotic will be measured and
isolates will be classified as resistant, sensitive or intermediate.
ILOKA MARY O 49
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3.4 TREATMENT
Treatment of urinary-tract infection is based on its location (in the upper or the
lower tract), and on patient characteristics. Lower-urinary-tract infection in the
healthy, young female with symptoms of recent onset (< 48 hours) can be treated
with a brief course (3 days) of oral antibiotics. All other women with lower tract
infections should receive a 5-7 day course. It is important to identify diabetic patients
who are at risk for recurrent infections, pyelonephritis and perinephric abscesses. In
the case of acute pyelonephritis, initial therapy is often given intravenously with
completion of therapy orally after the patient is afebrile. Total duration of therapy is
10-14 days. All patients with pyelonephritis should have a repeat urine culture 5-9
days after completing therapy, since a percentage of patients will have symptomatic
or asymptomatic relapse; the repeat urine culture will detect this. Such patients
should have 2-4 more weeks of therapy. Treatment of patients who are found to have
asymptomatic bacteriuria is still controversial. Cultures should first be repeated to
establish the diagnosis. Asymptomatic bacteriuria in a patient with an indwelling
urethral catheter should not be treated, since the only result will be selection of
resistant bacteria. In many situations, removal of the catheter will eliminate the
bacteria. If organisms are present 48 hours after removal of a catheter, a short course
of antibiotic therapy is indicated[43][44].
Drugs commonly recommended for simple UTIs include:
Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
Nitrofurantoin (Macrodantin, Macrobid)
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
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Ceftriaxone (Rocephin)
Azithromycin (Zithromax, Zmax)
Doxycycline (Monodox, Vibramycin, others)
The antimicrobial agents selected should inhibit E. coli, since it accounts for 80% of
uncomplicated lower urinary-tract infections.
Non-Medicinal Treatment
A high fluid intake is recommended to help treat UTIs. Fluids have several important
functions, including promoting complete dissolving of the antibiotic, which enable
you to get full benefit of the drug. Fluids decrease drug precipitation, which can
cause kidney stones and increase urine production, which promotes removal of
bacteria by "flushing" it out. Fluids also decrease the opportunity for bacteria to
travel up the ureters to the kidneys. Water is one of the best fluids to drink. Cranberry
juice is also often recommended for its ability to acidify urine, which discourages
multiplication of bacteria.
Frequent infections
If you have frequent UTIs, your doctor may make certain treatment
recommendations, such as: Low dose antibiotics, initially for six months but
sometimes longer Self-diagnosis and treatment, if you stay in touch with your doctor
A single dose of antibiotic after sexual intercourse if your infections are related to
sexual activity Vaginal estrogen therapy if you're postmenopausal
Other risk factors for UTIs include:
ILOKA MARY O 51
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Urinary tract abnormalities. Babies born with urinary tract abnormalities that don't
allow urine to leave the body normally or cause urine to back up in the urethra have
an increased risk of UTIs.
Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine
in the bladder and increase the risk of UTIs.
A suppressed immune system. Diabetes and other diseases that impair the immune
system — the body's defense against germs — can increase the risk of UTIs.
Catheter use. People who can't urinate on their own and use a tube (catheter) to
urinate have an increased risk of UTIs. This may include people who are
hospitalized, people with neurological problems that make it difficult to control their
ability to urinate and people who are paralyzed.
A recent urinary procedure. Urinary surgery or an exam of your urinary tract that
involves medical instruments can both increase your risk of developing a urinary
tract infection.[47][48]
ILOKA MARY O 52
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3.5 CONCLUSION AND RECOMMENDATION

Amongst the bacterial uropathogen E.coli is noted to be the most frequently
associated to UTI. Pathogens colonizes the urinary tract and ascends towards the
bladder to cause cystitis, When left untreated the bacterial migrates to the kidney
and establish a secondary Infection(Acute pyelonephritis) with possibility of causing
irreversible kidney damage leading to kidney failure and Possible Death.
Uropathogen binds and invades host cells and tissues within the urinary tract using
a specific host-pathogen interaction to activate inflammation based on production of
cytokines and chemokines by the epithelial cells of the urinary tract. A significant
bacteriuria in the present of constellation of symptoms such as dysuria, haematuria,
frequency urgency suprapubic discomfort and costovertebral tenderness is a
common manifestation of UTI.[49]
Urinary Tract Infection is a growing complication and should not be disregarded

or viewed as unimportant. Sometimes UTIs are Asymptomatic so regular doctors
visit is advised. Urinary tract infection is a common contagion among both genders
with higher prevalence among women due to their physiology and anatomy.
Individuals can prevent this potentially serious infection by good personal hygiene,
Proper Utilization of Antibiotics and proper emptying of bladder and observing their
selves to notice notable changes in their health.
Additional research is needed to advance this field of study. Further work needs to
be done on expanded populations that cover a wider geographic area; Increasing the
geographic area to include more areas would make the results more generalizable.
Additionally, future studies that include specific group of people should be done to
provide more evidence of the adverse effect of Urinary tract infection. And studies
ILOKA MARY O 53
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should also be done to relate the association of the severity of this infection and
precautionary steps that can be taken.
Finally this study shows an increasing susceptibility to Urinary tract infection

over the year and it can be linked with poor personal hygiene, low socio-economic
status and poor nutritional habits. The relevance of this study is to show that UTI is
an increasing risk in Benin Republic. Measures of awareness should be put in place,
more research should be carried out and funds should be allocated so that more
Antimicrobial agents can be researched on and developed.
ILOKA MARY O 54

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PREVALENCE OF URINARY TRACT INFECTION IN REPUBLIC OF BENIN.

ITS ADVERSE EFFECTS AND

Understand epidemiology and microbiology of urinary tract infections.

Understand pathogenesis of lower and upper urinary tract infections.

1.0 URINARY TRACT INFECTION (UTI)

1.1. GENDER SUSCEPTIBILITY

1.1.1.0 Hematogenous Route:

Infection of the renal parenchyma by blood-borne organisms occurs in humans,

1.1.1.1 Ascending Route:

1.1.1.2 HOST FACTORS IN URINARY TRACT INFECTION

The host employs several defense mechanisms to eliminate pathogenic and

Urine osmolarity, pH, organic acids

Urine flow and micturition

Urinary inhibitors of bacterial adherence:

Secretory immunoglobulin A (SIgA)

Inflammatory response (PMNs, and cytokines)

Humoral and cell-mediated immunity

1.1.1.3 BACTERIAL FACTORS IN URINARY TRACT INFECTION

Symptomatic bacteriuria is highly correlated with the presence of bacteria that

1.1.2 CAUSATIVE AGENT

1.1.2.0 BACTERIA OF INTEREST

Gram Staining is one of the most common means of classification/identification of

Gram staining technique- fix + stain + lugol + decolorize + counter stain.

FIGURE 1: microscopic identification.

Gram Negative(-) stains PINK WHILE Gram Positive(+) stains

Identification of bacteria using shapes

FIGURE 2: microscopic identification

1.1.3.0 LIST OF COMMON UROPATHOGENIC BACTERIA

1.1.4 ESCHERICHIA COLI

1.1.4.1 BRIEF HISTORY

In 1885, the German-Austrian pediatrician Theodor Escherich discovered this

Escherichia coli also known as E. coli is a Gram-negative, facultative anaerobic,

intestine of warm-blooded organisms (endotherms). E. coli stains Gram-negative

1.1.4.3 ROLE IN UTI

1.1.5 KLEBSIELLA SPP. (PNEUMONIA)

1.1.5.1 BREIF HISTORY

Klebsiella species are found everywhere in nature. Klebsiella pneumoniae is a

1.1.5.3 ROLE IN UTI

bacteremia cases are because by K. pneumoniae, which places it in second place

FIGURE 3: Klebsiella spp. Source: Virtual Med Centre

1.1.6 STAPHYLOCOCCUS SAPROPHYTICUS

1.1.6.0 SCIENTIFIC CLASSIFICATION

1.1.6.1 BRIEF HISTORY.

1.1.6.3 ROLE IN UTI

1.1.7 STAPHYLOCOCCUS AUREUS

1.1.7.1 BREIF HISTORY

Staphylococcus was first identified in 1880 in Aberdeen, Scotland, by the surgeon

Staphylococcus aureus is a gram-positive coccal bacterium. S A is a facultative

1.1.7.3 ROLE IN UTI

Source : kubu picutures

FIGURE 4: GRAM STAINED COCCI BACTERIA

1.2 PRESENTATION AND SYMPTOMS

1.2.2 SIGNS AND SYMPTOMS

1.2.3 Differential diagnosis

In men, an enlarged or inflamed prostate may also present in a similar manner to a

Hemorrhagic cystitis, characterized by blood in the urine, can occur secondary to a

1.2.4 DIAGNOSTIC METHOD

1.2.4.1 Macroscopic examination: the laboratory analyst observes the urine's

1.2.4.2 Microscopic examination: A microscopic examination may or may

Epithelial Cells: Epithelial cells are usually reported as "few," "moderate," or

Trichomonas: Trichomonas vaginalis is a parasite that may be found in the urine of

1.2.4.3 Chemical examination: To perform the chemical examination, most

eliminate variations in color interpretation, automated instruments are frequently