Prevalence of Uti in Benin

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

CONTROLS
CHAPTER ONE
1.0 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 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]
Escherichia coli is known as the most predominant strain, though other Uropathogens may be
the cause. 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. Phenazopyridine may help with symptoms. 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. About 150 million people developed a urinary tract infection each
year. They occur most frequently between the ages of 16 and 35 years. Recurrences are common.
[2]
Urinary tract infections have been described since ancient times with the first documented
description in the Ebers Papyrus dated to c. 1550 BC. Effective treatment did not occur until the
development and availability of antibiotics in the 1930s.
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PREVALENCE OF URINARY TRACT INFECTION IN REP. OF BENIN. ITS ADVERSE EFFECTS AND
CONTROLS
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]
OBJECTIVE
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 to create awareness especially for ladies.
What happens when the Urinary Tract Infections is left untreated?
To recognize the clinical signs and symptoms of Urinary tract infection
What are the treatments and controls?
How do we know the causative bacteria?
At the end of this document, we should be able to know some Antibiotics that are very active
against the major dominant bacteria stated in the research as well as a concise
Susceptibility/sensitivity profile of Bacteria agents.
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CHAPTER TWO
PART ONE
2.1 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, E. Coli 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]
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
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to the classic symptoms of a lower urinary tract infection. Rarely the urine may appear bloody or
contain visible pus in the urine.[3]
2.1.1 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]
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]
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2.1.2 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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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.
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.
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.
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.
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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.
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.
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2.2 PREVALENCE OF URINARY TRACT INFECTION IN BENIN

REPUBLIC USING IRGIB LABORATORIES SAMPLES AS A CASE
STUDY.
Prevalence of 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, sexual intercourse, diabetes, obesity, family history, poor hygiene, malnutrition
and low socio-economic status.[7]
In Africa countries especially due to low socio-economic status urinary is more prevalent. The
prevalence of urinary tract infection was significantly higher in females compared to males
(female vs. male). Age had no effect on the prevalence of UTI.
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. The ratio of female to male is 9:1
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 pneumonia and Staphylococcus aureus and each isolate is unique
dynamic and react or affects Patients differently.
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PART TWO
2.3. PRESENTATION
2.3.1 CAUSATIVE AGENT
Bacteria are the Major cause of Urinary Tract Infections. And some of the Bacteria of focus
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.
TABLE 1: Pie chart showing the various uropathogens and the percentage of
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2.3.2 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.

Gram Negative(-) stains PINK WHILE Gram Positive(+) stains VIOLET/PURPLE.
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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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2.3.3 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.
2.3.4 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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2.4.0 Escherichia Coli

2.4.1 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)
2.4.2 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]
2.4.3 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 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
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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]
2.4.4 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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2.5.0 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)
2.5.2 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]
2.5.3 SPECIFICATION
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 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,
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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]
2.5.4 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 bacteremia cases are because by K.
pneumoniae, which places it in second place next to Escherichia coli for origins of gram-
negative sepsis. [18]
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2.6 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
2.6.2 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]
2.6.3 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 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
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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]
2.6.4 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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2.7.0 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)
2.7.2 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]
2.7.3 SPECIFICATION
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, 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.
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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]
2.7.4 ROLE OF 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 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]
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PART THREE
3.1 PRESENTATION AND SYMPTOMS
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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3.1.0 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]
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.
Pyrexia.
Nausea ± vomiting.
Acute confusional state - particularly elderly patients.
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3.1.1 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, 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]
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3.2 DIAGNOSTIC METHOD

There are different methods used for the diagnosis of UTI they include:
 Macroscopic examination
 Microscopic examination
 Chemical examination
3.2.1 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.
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]
3.2.2 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.
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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
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.
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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.
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]
3.2.3 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 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
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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.
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.
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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 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
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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
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 THREE
4.1 RESEARCH METHODOLOGY
4.1.1 SITE OF ANALYSIS
FORMER SITE:
This work was carried out in the Regional Laboratory of Sanitary Safety and Analytical
Expertise of IRGIB-AFRICA Cotonou established and officially launch in September 2006 in
Republic of Benin. Located at SIKECODJI, Street 218 in the 7th district of Cotonou. Having a
geographical positioning of: 6 22‟22.2 N 2 24‟57.8 E an Altitude of 39m, an elevation of 7m
from the ground on a ladder of 8m. The IRGIB-Africa laboratory is equipped with standard
technologies capable of various analyses. It is organized such that it has different department
which in turn have units and 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.
NEW SITE:
This remaining part of 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; Though the former site was Established and
officially launched in September 2006 in Republic of Benin. This new site located at
AKPAKPA, UNICOMER Site opposite Stade Rene Pleven, Cotonou was established in
February 2016.
The practical aspect and the Bio data collection of this project work was carried out in the Bio-
Medical and Bio-Technological Analysis department.
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4.1.2 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
4.2 MATERIALS
 Specimen sample
 Bio data
 Culture mediums
 Bunsen burner
 Sterile Slides
 Sterile loops
 Centrifuge
 Sterile Tubes
 Incubators
 Workspace
 Gram staining Kit
 Antibiograms/Antibiotics etc
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4.2.1 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.
4.2.2 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
 Wash your hands
 Wash your genitalia several times with a cleanser
 Void the first drops of urine
 Void your bladder in the sterile collection container until it is full enough
(Never fill completely)
 Close the container, write your name, date and time on it.
After the sample is collected, it should be transferred to the laboratory within two hours for
analysis.
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The analysis usually involves macroscopic urine examination and microscopic urine
examination.
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4.3.0 PRESENTATION OF DATA AND ANALYSIS:

Data was gathered manually, entered and analyzed using SPSS software version IBM 20 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. {This study focuses on only the positive samples}. E.coli 204(41.2%), Klebsiella
151(31%) Staphylococcus Aureus 152(30.5%).
The data is represented properly in the tables below:
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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 below table is a yearly accumulation of patients data,
represented in both negative and positive testing for different bacteria agent.
Table 2:
This table symbolizes one year representation of Ecoil, S.A. K.b.
A data 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.
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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.
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%)
Table 3:
This table symbolizes one year representation of Ecoil, S.A. K.b.
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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4.4.0 RESULTS and DISCUSSION

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
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TABLE 4: Tabular representation

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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Figure 3: 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
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
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.
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Figure 4: Comparison of S.A of year 2014-2015 with year 2015-2016
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
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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Figure 5: Comparison of klebsiella of year 2014-2015 with year 2015-2016
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
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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FIGURE 6: GRAPHICAL REPESENTATION.
Prevalence of Uropathogens between JULY 2014 - JUNE

2015 and JULY 2015 - JUNE 2016.
30
55 29 35
30
45 25
24 19
35 21 24 20
21
18
Axis Title
27
25 25
22
20 20
18
15 15 16
14
11 11 12
july aug sep oct nov dec jan feb mar apr may june
2014/2015 15 11 16 14 18 11 12 25 20 20 22 27
2015/2016 21 24 20 24 19 18 21 29 25 35 30 30
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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DISCUSSION
Effective management of UTIs caused by 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. Escherichia coli were the predominant isolate causing UTI in this study.
This agrees with previous reports on different UTI 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 all of the uropathogens were more resistant
than sensitive to the antimicrobial agents used.
Generally 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. Since 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.
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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.
Antimicrobial susceptibility profiling test which was carried out in the laboratory for the
uropathogen isolates. The results is recorded as follows in the table below.
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%)
Table 5: 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).
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FIGURE 7: 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 37 ֯C. The diameter of
the zone of inhibition around each antibiotic will be measured and isolates will be classified as
resistant, sensitive or intermediate.
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
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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.
Drugs commonly recommended for simple UTIs include:
Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
Nitrofurantoin (Macrodantin, Macrobid)
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
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.
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CONTROLS
CONCLUSION
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.
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 observe their selves to notice
notable changes in their health.
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 and developed.
ILOKA MARY O 49

Prevalence of Uti in Benin

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Prevalence of Uti in Benin

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PREVALENCE OF URINARY TRACT INFECTION IN REP. OF BENIN.

ITS ADVERSE EFFECTS AND

What happens when the Urinary Tract Infections is left untreated?

To recognize the clinical signs and symptoms of Urinary tract infection

What are the treatments and controls?

How do we know the causative bacteria?

2.1 URINARY TRACT INFECTION (UTI)

2.1.1 GENDER SUSCEPTIBILITY

The Gender most susceptible to UTIs are Females.

HOST FACTORS IN URINARY TRACT INFECTION

BACTERIAL FACTORS IN URINARY TRACT INFECTION

2.2 PREVALENCE OF URINARY TRACT INFECTION IN BENIN

2.3.1 CAUSATIVE AGENT

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

Identification of bacteria using color. GRAM STAINING.

FIGURE 1: microscopic identification.

Identification of bacteria using shapes

FIGURE 2: microscopic identification

2.3.3 LIST OF COMMON UROPATHOGENIC BACTERIA

2.3.4 BACTERIA OF INTEREST

2.4.0 Escherichia Coli

2.4.2 BRIEF HISTORY

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

2.4.4 ROLE IN UTI

2.5.0 Klebsiella spp. (pneumonia)

2.5.2 BREIF HISTORY

Klebsiella species are found everywhere in nature. Klebsiella pneumoniae is a Gram-negative,

2.5.4 ROLE IN UTI

2.6 STAPHYLOCOCCUS SAPROPHYTICUS

2.6.1 SCIENTIFIC CLASSIFICATION

2.6.2 BRIEF HISTORY.

coagulase-negative staphylococci (CoNS) using the coagulase test. Lastly, S. saprophyticus is

2.6.4 ROLE IN UTI

2.7.0 Staphylococcus aureus

2.7.2 BREIF HISTORY

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

2.7.4 ROLE OF UTI

3.1 PRESENTATION AND SYMPTOMS

SIGNS AND SYMPTOMS

3.1.1 Differential diagnosis

3.2 DIAGNOSTIC METHOD

3.2.2 Microscopic examination: A microscopic examination may or may not be

3.2.3 Chemical examination: To perform the chemical examination, most clinical

Urobilinogen: Urobilinogen is normally present in urine in low concentrations. It is formed in

4.1.1 SITE OF ANALYSIS

4.1.2 SAMPLE POPULATION AND SIZES.

4.2.2 SAMPLE COLLECTION METHOD

Mid-stream clean-catch collection

 Wash your hands

 Wash your genitalia several times with a cleanser

 Void the first drops of urine

(Never fill completely)

4.3.0 PRESENTATION OF DATA AND ANALYSIS:

The data is represented properly in the tables below:

month/year sample positive negative E.coli S.A K.B

This table symbolizes one year representation of Ecoil, S.A. K.b.

A data gathered from July 2014-june 2015.

Data’s represented in the below table is a yearly accumulation of patients data,

A data gathered from July 2015-june 2016.

4.4.0 RESULTS and DISCUSSION

TABLE 4: Tabular representation

Figure 3: Comparison of E.coli of year 2014-2015 with year 2015-2016

Figure 4: Comparison of S.A of year 2014-2015 with year 2015-2016

IPM 783(97.2%) * * 21(2.8%)