Microsoft word - penicillins and cephalosporins against microbic aetiologies of urinary tract infection; concern to public heal

Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 2 (1): 143-146 Scholarlink Research Institute Journals, 2011 (ISSN: 2141-7016) Jjo g Engineering and Applied Sciences (JETEAS) 2 (1): 143-146 (ISSN: 2141-7016) Penicillins and Cephalosporins Against Microbic Aetiologies
of Urinary Tract Infection; Concern to Public Health
1Ukaji, D. C., 2Eze, E. M and 3Ezeiruaku, F. C
1Department of Medical Microbiology, Madonna University Okija, Nigeria.
2Department of Haematology and Blood Transfusion Services,
3Department of Medical Laboratory Sciences, Niger Delta University, Yenagoa, Nigeria. Corresponding Author: Ukaji, D. C
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Abstract
The epidemiological survey of urinary tract infection in South-Eastern
February 2006 and April 2007. Five hundred and three (503) subjects who had signs of UTI were enlisted for this study. With regard to their state of origin; 159 samples from Rivers, 102 from Bayelsa, 64 from Delta, 39 from Edo, 68 from Akwa Ibom and 71 from Cross River State were enlisted. The isolated microorganisms from the urinary tracts were subjected to susceptibility tests. The antimicrobial action of the antibacterials – Ciprofloxacin, gentamicin, Cefuroxime and Ampicillin were compared against the isolated organisms of Escherichia coli, Staphylococci, Proteus, Pseudomonas and klebsiella sp. There was statistical difference in their resistance (P<0.001) with near uniform resistance between ampicillin and cefuroxine. The present findings revealed a relatively high prevalence of resistance to Ampicillin and Cefuroxime in the South-Eastern igeria, underlining the need for urgent policy intervention before the situation escalates beyond control. __________________________________________________________________________________________
Keywords: penicillins, cephalosporins, UTIs, public health
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I TRODUCTIO
The incidence of antibiotic resistance in community
In this work the orthodox antibacterials against acquired infections is rising. In spite of the microbic aetiologies of the urinary tract infections availability of effective drugs and vaccines, the battle against infectious diseases is far from being over. The work of Hillier et al., (2002) made strong claims in SUBJECTS A D METHOD
support of the fact that antibiotic use is a risk factor The study was carried out at Rivers State University for antibiotic resistant community acquired urinary of Science and Technology Microbiology laboratory tract infection. Urinary tract infections (UTIs) are on 812 patients from the six cosmopotitan cities of microbial infections of the urinary tract (kidneys, South-Eastern Nigeria, viz:- Port Harcourt, Yenagoa, urethra) and form a significant presentation among Asaba, Benin, Uyo and Calabar. All the patients gave patients who visit hospitals and other health centers informed consent and completed questionnaire on (Audu, 2007). It has been estimated that about two their personal data, marital status, number of sex thirds of the cases of infertility in Nigeria are partners, if any, sexual contacts with female attributable to infections (Okonofua et al., 1995). prostitutes, previous history of UTIs as well as Consequences and dangers of UTI include HIV and bringing their contacts for treatment. Urine for AIDS, sterility, infertility, emotional disturbances and microscopy and culture on Cysteine lactose electrolyte deficient medium (CLED) was taken. Pyelonephritis, if not treated especially in infants Isolates were identified by the usual techniques. Four leads to kidney damage (AAP Workgroup, 1997). classes of antibacterial drugs were used, namely; The incidence of vesicouretheral reflux (VUR) is higher in this age group than older children. Others include urosepsis, kidney abscess and hydrophrosis (Ampicillin) and Cephalosporins /zinnat) for sensitivity tests using the agar diffusion method. The emergence and spread of antimicrobial resistance The study was subjected to statistical analysis using is now threatening to undermine our ability to treat chi.square test with Yates correction (Fisher and infections and save lives (WHO, 2001).Two major mechanisms exist by which increased resistance to antibiotics and other things used in clinical practice RESULTS A D DISCUSSIO
may arise; mutation and by genetic exchange (Nester Table 1: shows the different areas in the South- Eastern Nigeria where the samples were collected and Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 2 (1): 143-146 (ISSN: 2141-7016) tested. Out of the 812 patients whose samples were of antimicrobial resistance may be due to collected, only 503 (61.9%) yielded significant spontaneous mutation that naturally occur during cell bacterial growth while 309 (38.1%) yielded no growth or may be due to DNA transfer (Nester et al., bacterial growth. The media used in culture may be a 1998). The most troublesome source of resistance is limiting factor since aetiological agents of UTI are the transfer of genes from resistant organisms to not only bacteria but include among others fungus, those that are sensitive. The resistance genes are often virus and tuberculosis. Majority of the patients found on conjugative plasmids (Resistance Plasmids). (32.6%) were in the 31-40 years age group. The This may be the way through which organism difference is due to high rate of sexual activity among simultaneously gain resistance to several completely this age group. Table 2 illustrates that more females different drugs as is the case of this study. (61.6%) than males (38.4%) had UTIs. This observation has also been made in similar Additionally, many gram negative organisms are circumstances (Brooks et al., 2002 and Longmore et inherently resistant to penicillin because the selective al., 2001). The reason may be due to the shortness of permeability of their outer membrane excludes the the female urethra as well as lying adjacent to the genital and intestinal tracts (Nester et al., 1998). This The likelihood of resistance should therefore be makes organisms to get from outside into the bladder considered before using Ampicillin for the ‘blind’ especially during sexual activity. Traders had more UTIs than any other occupational group (P < 0.001). The study has shown both drugs to be unacceptably The nature of their trade and cash at their disposal inactive in treatment of UTIs and so their use should make them indulge in amorous relationships and hence high level of infections. Students also It is also instructive that medical laboratories should recorded reasonable level of infectivity for UTIs. The stop using their discs when carrying out sensitivity reason is quite obvious. Many male and female tests as it has become a public health problem that students take care of their educational expenses. requires accelerated public health solution. More so, since they are separated from the parental care, as well as being the age of moral wash out, they Table 1: Number of samples collected from each state Growth
o of Growth
Total
Table 3 reports the history and treatment of patients who had UTI. A majority of the patients (44.8%) said this was their first experience while 37.2% had experienced it before. Many (38.1%.) visited chemist shops for treatment while others indulged in either self medication, visit herbalists, medicine vendors or hospitals. It is possible that they had been re-infected or they were improperly treated initially. *(503(61.9)
309(38.1)
812
Table 4 shows the recovery rate of organisms in urine. Five hundred and three positive cultures of Table 2: Personal data of Patients in the Sub-region. which Escherichia coli accounted for 48.3% and Staphylococcus species accounted for 27.6% of the isolates. Since E-coli is of faecal origin, sexual activity may be responsible for the contamination of the urinary tract and hence their predominance. Tables 5 and 6 indicate the resistance rates of the isolates to the antibacterials and their comparisons. Resistance of Staphylococcus aureus to Cefuroxime and Ampicillin was almost uniform (89.2 and 95.7%). The same observation was seen among E- coli, Pseudomonas, Proteus and klebsiella organisms. In all the actions of the antibacterials against the organisms, there was no significant difference in the resistance for ampicillin and cefuroxime (P > 0.001). Many studies (Hillier et al., 2002) have shown that patients on antibiotics may develop resistance to organisms and consequently become treatment failures. It has also been shown that during treatment of UTIs and other infections, faecal coliforms develop resistance (Lacey et al., 1980). Acquisition Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 2 (1): 143-146 (ISSN: 2141-7016) Table 6: Comparison of % Resistance of Organism to the Antibacterial. Organism
Occurrence
Staph Sp.
Place of Treatment of precious UTI
Pseudomonas CPX
Table 4: Rate of Isolation of microorganism from Klebsiella Sp. CPX
Table 5: Resistant Pattern of the Isolates REFERE CES
Breastfeeding and the use of Human Milk, Pediatrics, 100:1035 – 1039.
Audu, J.A. (2007). Personal Communication. Consultant Obstetrics. and Gynaecology, Military Fisher, R.A. and Yates, F. (1974). Statistical Tables CPX = Ciprofloxacin, GE Gentamicin, CXM = for Biological Agricultural and Medical Research, 6th Cefuroxime, Amp-Ampicillin, % resistance in Hillier, S.L., Magee, J.J., Howard, A.J. and Palmer, S.R. (2002): How Strong Is the Evidence That Antibiotics use is a Risk Factor for Antibiotic- Infection? Journal of Antimicrobial Chemotherapy, Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 2 (1): 143-146 (ISSN: 2141-7016) Lacey, R.W., Lord, V.L., Gunasekera, H.K.W., Leiberman, P.J. and Luxton, D.E.A. (1980). Comparison of trimethoprim alone with trimethoprim sulphamethoxzole treatment of respiratory and urinary infections with particular reference to selection Nester, E.W., Roberts, E. C., Pearsall, N.N., Anderson, Microbiology: A Human Perspective. 2nd ed. WCB/McGRAW-Hill, USA, 447-459. Okonofua, F.E., Ako-Nai, K.A and Diglitoghi, M.D. (1995). Hower Genital Tract Infections in Infertile Nigerian World Health Organization (2001). WHO Global Strategy

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