Abstract

Introduction։ Urinary tract infections are considered as one of the most common diseases encountered in medical practice. In resource poor settings, treatment is usually empiric due to the high cost and long duration required for reporting diagnosis by culture and antibiotic susceptibility testing. With the growing problem of drug resistance knowledge of antibiotic susceptibility pattern is pertinent for successful eradication of invading pathogens.

This study aimed at determining the prevalence, type of microorganisms causing UTI and antibiotic susceptibility of the bacteria responsible for UTI among women of reproductive age attending the Douala General Hospital.

Methodology։ A cross sectional study was conducted at the Douala general hospital, Cameroon. Sociodemographic and clinical information were taken from 152 women and documented. This was followed by collection of midstream urine samples for bacteriological examination and antibiotic susceptibility test.

Results։ Out of the 152 women, 53(34.9%) had UTI. The age group >32 were the most infected 29(40.3%), married women 23(36.5%) and non-pregnant women 30(38.8%) were the most infected. Escherichia coli 32(62.3%) and Klebsiella pneumoniae 11(22.6%) were the most isolated bacteria. Among the eleven (11) antibiotics tested, Gentamicin 29(54.7%), Nitrofurantoin 30(56.6%) and Ceftazidime 30(56.6%) were the most sensitive drugs. The most resistant antibiotics were Nalidixic acid 34(66.0%), Cotrimoxazole 32(60.4%) and Pefloxacin 32(60.4%).

Conclusion։ This study revealed that 1 in 3 women of reproductive age group attending the Douala General hospital have a UTI and E coli is the most implicated causative agent of the disease. Pregnancy is significantly associated with having a UTI. There is a high bacterial resistance to commonly prescribed empiric antibiotics.

CHAPTER ONE

INTRODUCTION

1.1 Background  of the Study

Urinary tract infections (UTI) have plagued mankind long before bacteria were recognized as the causative agents of disease and before urology became an established medical specialty [1]. Urinary tract infection is defined as an infection in any part of the urinary system that is the urethra, bladder, ureter and kidneys.

The infection of the bladder and urethra is referred to as a lower urinary tract infection or cystitis whereas the kidneys and ureter infection is an indication of an upper urinary tract infection or pyelonephritis [2]. UTIs usually arise from an ascending infection from the urethra to the bladder, but occasionally it develops through haematogenous or lymphatic spread.

Specific group of people are at risk of developing a UTI including women of the reproductive age group who are the most vulnerable population.

Urinary tract infections are the second most common bacterial infections after respiratory tract infections in community health practice [3]. Urinary tract infections (UTI) are more common in women with approximately half of all women experiencing at least one during their lifetime [4]. Of the women infected, pregnant women are more vulnerable due to their compromised immune system and 25-30% develop recurrent infections unrelated to any functional or anatomical abnormality of the urinary tract [5]. Most UTIs in women are episodes of acute uncomplicated cystitis which occur in women of childbearing age [4].

The common microorganisms that cause UTI include enterobacteriacae like Escherichia coli which account for 80-90%, Klebsiella pneumoniae, as well as Gram positive organisms like Staphylococci and enterococci which are rare [6], [7], [8].

Bacterial isolates found in Sub-Saharan Africa include Klebsiella pneumonia, Proteus mirabilis, Staphylococcus aureus, Pseudomas aeruginosa and Enteroeaseus feacalis [9], [10], [11]. Uropathogens have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract therefore, studies aimed at increasing knowledge of local etiologic agents of UTIs and their resistance patterns to antibiotics are necessary to guide clinicians in empiric treatment. [12].

Recent studies show a growing problem of antibiotic resistance in Cameroon, thereby establishing a need for continuous surveillance of antibiotic susceptibility of uropathogens [13], [14].

Depending on underlying host factors and on underlying uropathogens UTIs can be classified as either complicated or uncomplicated [15]

Complicated UTIs are defined as UTIs associated with factors that compromise the urinary tract or host defense, including urinary obstruction and urinary retention caused by neurological disease, immunosuppression, renal failure, renal transplantation, pregnancy and the presence of foreign bodies such as calculi, indwelling catheters or other drainage devices [16].

UTI is commonly treated with oral antibiotics like amoxicillin-clavulante, nitrofurantoin, cephalosporins, fluoroquinolones and trimethropin/sulfamethoxazole [17]. Unfortunately, a number of more recent studies have demonstrated increasing antimicrobial resistance among uropathogens causing uncomplicated cystitis and traditional antibiotic regimens have been questioned [18].

A study carried out by Nickel et al investigated antimicrobial resistance among 4000 female patients with UTI isolates over a 5year experimental period. Results from this study demonstrated an increase in antimicrobial (E. coli) resistance from 9% to 18% in patients treated with trimethoprim-sulfamethoxazole [18].

In addition, resistance to cephalothin (a first-generation cephalosporin) increased from 20% to 28% and resistance to ampicillin increased from 26% to 34%. Notably, resistance to nitrofurantoin and ciprofloxacin remained <1% after the 5year period.

This increase in bacterial resistance has been attributed to recent administration of trimethoprim/sulfamethoxazole, diabetes mellitus, recent hospitalisation and recent administration of any other antibiotic [19].

Treatments for UTI until the discovery of antibiotics were largely symptomatic because the bacterial origin of UTIs was not recognized and no specific antimicrobial therapies were available [1].

Previously, female patients with uncomplicated UTIs generally remained sensitive to a trimethoprim/sulfamethoxazole combination and the traditional approach to therapy had been an empirical short-course treatment with this antibiotic regimen [20].

1.2 Problem Statement

UTIs are a common infection and are neglected in some African countries, they are more prevalent in women, even more in pregnant women. If not well managed, UTIs could cause serious complications.

1.3 Research Questions 

1. Are Urinary Tract Infections prevalent in women of reproductive age attending the Douala General Hospital?
2. What are the microorganisms responsible for UTIs in women of reproductive age attending the Douala General Hospital?
3. What is the antibiotic susceptibility profile for common antibiotics used in treating UTIs in women of reproductive age attending the Douala General Hospital?

1.4 OBJECTIVES

1.4.1 General Objective

To study UTIs among women of reproductive age attending the Douala General Hospital.

1.4.2 Specific Objectives

1. To determine the prevalence of urinary tract infections in women of reproductive age attending the Douala General Hospital.
2. To identify the microorganisms causing urinary tract infections among women of reproductive age attending the Douala General Hospital
3. To determine the antibiotic susceptibility profile of the common antibiotics used in treating UTIs in women of reproductive age attending the Douala General Hospital.