Asymptomatic Bacteriuria in Patients with Diabetes Mellitus in South Western Nigeria.
Omosigho O.P., Ogedengbe S. O, Umar M. A
Medical Microbiology Department, Federal Medical Centre Bida.Niger State .Nigeria.
Medical Microbiology Department.University College Hospital Ibadan.Oyo State .Nigeria.
Omueti E A.
Medical Microbiology Depertment, Umaru Ndayako General Hospital Bida Niger State Nigeria
I B B .Specialized Hospital Minna. Niger State .Nigeria.
Otojareri K .A
Public Health ,Federal Medical Centre. Bida.Niger State.Nigeria.
All Correspondence to: Omosigho Omoruyi Pius; Medical Microbiology Department, Federal Medical Centre Bida. Niger State .Nigeria
Email –firstname.lastname@example.org. Phone +234 8030676 973
Bacteriuria is often asymptomatic but almost always accompany symptomatic infection of the upper and lower urinary tract among predisposed individuals such as diabetics. This study was carried out to investigate the pattern of asymptomatic bacteriuria among diabetics to.determine the prevalence, aetiologic agents and their antibiotic susceptibility pattern.
A total of one hundred and seventy four (174) diabetics submitted midstream urine specimen for culture (86 females and 88 males). Thirty seven (21%) showed significant bacteriuria out of which 23 (61.9%) were obtained from female and 14 (38.1%) were from male. Our finding from the study revealed that the most prevalent aetiologic agent responsible for bacteriuria in diabetic patients in Ibadan were found to be Klebsiella species (46%), Escherichia coli (30%), Candida albicans (11%), Proteus species.(5%), Staphylococcus aureus (5%) and Pseudomonas aerugenosa (3%). The antibiotic susceptibility pattern showed that most of the isolates were susceptible to Ofloxacin, Ceftriazone, Gentamycin, Nitrofurantoin, Nalidixic acid and Cotrimaxizole. While they are commonly resistance to Tetracycline , Ampicillin, Cefuroxine and Ceftazidine. From this study it is clearly shown that the incidence of bacteriuria in patients with diabetes mellitus is on the increase and with the changing pattern in the bacteriology of urinary tract infection among diabetics continuous surveillance is advocated.
Key words – Bacteriuria ,Diabetes melitus, Antibiotic suscestability, Nigeria.
Diabetes Mellitus is defined as a chronic condition in which a malfunction of the pancreas causes inadequate secretion of Insulin leading to impired metabolism of carbohydrate , fats and protein(Ganog, 1985). It has a number of long term effects on the genetourinary system which predisposes to bacteria urinary tract infection (UTI) (Nicolle, 2003). The term bacteriuria means the presence of bacteria in urine and it is taking to be significant if 105 organism per milliliter of a fresh “clean catch” urine specimen are present in any patient (Alebiosu et al., 2003). Untreated asymptomatic bacteriuria predisposes the individual to recurrent UTI which can cause renal disease. Patients with diabetes mellitus have been reported to have increased rates of UTI (Baqai et al., 2008). Serious complications of UTI such as emphysematous cystitis, pyelonephritis, renal or perinephric abscess, bacteraemia and renal papillary necrosis occur more commonly in diabetic patients(Ankel et al., 1990). Most bacterial aetiological agent in
asymptomatic bacteriuria have been reported to include; Klebsiella pneumoniae, Escherichia coli, Streptococcus agalactiae, Enterococcus faecalis, coagulase negative staphylococcus Streptococcus pyogenase (Assel et al., 2009). Significant bacteriuria on evidence of UTI has been found more frequently in diabetic patients than in the general population, however in recent years other workers have demonstrated higher ( two-to-four fold increase) prevalence of bacteriuria in diabetic subjects.
The study was designed to determine the prevelence of bacteriuria, the aetiologic agents and antibiotic sensitivity pattern among isolates in diabetic out patients attending the Medical out patient (MOP) clinic in University College Hospital Ibadan(UCH).
MATERIALS AND METHODS.
This work was a dissertation, a prospective cross sectional study carried out in the department of Medical Microbiology and Parasitology U. C. H. Ibadan. The study group consists of consecutive known diabetic patients presenting at the medical out patient department (MOPD) of the hospital which covered a period of four months. A total of one hundred and seventy four (174) diabetics patients urine samples were collected, eighty six (86) of the diabetic patients investigated were females of which non was pregnant, while eighty- eight (88) were male. Age bracket of between Twenty –two (22) and sixty –five (65) years old, with a predominance of over fifty years old. The duration of the disease in the patients were between one and twelve years. All the patients have been attending the clinic regularly and their blood sugar level were thus under control.
Clean mid-stream urine sample were collected from patients into sterile disposible screw capped universal bottles. The containers were adequately labelled immediately after collection and were transported to the laboratory for analysis. Samples were innoculated on Blood agar, Macconkey agar and Cystein Lactose Electrolyte Deficient (CLED) agar media using a calibrated loop to determined colony forming unit. The plates were incubated at 370C aerobically for 24 hours. Cultures with colony count =105 cfu/ml were considered as significant bacteriuria( Flower et al., 1991, Harding et al., 2002). The organism were identified using standard cultural, morphological and biochemical techniques (Bucchana and Gibbon,1974). Antimicrobial sensitivity was determined by the agar diffusion method using multidiscs (Kirby-Bauer method ,1966).
One hundred and seventy four diabetics formed the study group (88 males and 86 females). Thirty seven (21%) had significant bacteriuria (14 males and 23 females). Their ages ranges from 20-70 years with a mean of 54 ±3.4.
Table 1. Shows the ages and sex distribution of diabetics with asymptomatic bacteriuria, with the highest incidence in age group 46-55 years (12) followed by above 65 years (11), 56-65 years (4) while age group 20-35 and 36-45 had incidence of 3 each. Higher incidence were found in female.
Table 2. Shows the microorganism isolated from the urine specimens of the study population. out of the 37 urine samples that shows significant bacteriuria, 17(46%) were identified to be Klebsiella species. (10 females and 7males), Escherichia coli 11(30%) (9 females and 2 males), Candida albicans 4(11%) (3 female and 1 male), Proteus spp.2(5%) all males. Staphylococcus aureus 2(5%) (1 male and 1 female) and 1(3%) Pseudomonas aureginosa which was from a male patient.
Table 3. Shows the antibiogram pattern to the aetiological agents. Most of the isolates were sensitive to Ofloxacin, Ceftriazone, Nitrofurantoin, Nalidixic acid, Cotrimaxizole and Gentamycin and are least sensitive to Ampicillin, Tetracycline, Ceftazidine and Cefaroxime.
The study shows that the prevalence of bacteriuria in diabetic patient in Ibadan was Twenty one percent (21%). A total of 174 diabetic patients mid-stream urine were examined during the course of this study in which 37(21%)