Available online at [Link].

com

International Journal of Medical Research &

ISSN No: 2319-5886 Health Sciences, 2016, 5, 4:6-15

Comparative diagnosis of urinary tract infection (UTI) using urinary nitrite

and significant bacteriuria (SBU)
1
John Anuli S., 2Mboto Clement I. and *2Agbo Bassey E.
1
Department of General Studies, College of Health Technology, Calabar, Nigeria
2
Department of Microbiology, Faculty of Biological Sciences, University of Calabar,P.M.B. 1115, Calabar, Nigeria
*Corresponding Authors E-mail: profbaseadeone@[Link]
_____________________________________________________________________________________________

ABSTRACT

The clinical laboratory diagnosis of urinary tract infection was compared in two hundred (200) midstream urine
samples using bacteria culture and urinary nitrite detection technique. The comparative susceptibility of the isolates
to common antibiotics was evaluated using completely randomized design (CRD). The minimum inhibitory
concentration (MIC) and minimum bactericidal concentration (MBC) for each antibiotics test was evaluated using
standard laboratory procedures. Approximately fifty one percent (101/200) of urine samples that were culture
yielded significant bacteriuria (SBU) as compared to (32.59%, 65/200) which had positive nitrite detection. Also
eighteen percent (18%, 35/200) of the negative nitrite detection test showed evidence of significant bacteriuria.
Significant bacteriuria was significantly associated at p<0.05 with culture isolation technique. A total of nine (9)
different bacterial isolates were detected in this study. The isolates and their frequency of occurrence were
Escherichia coli 30(29.7%), Pseudomonas aeruginosa 15(14.9%), Klebsiella pneumonia 13(12.8%), Enterococcus
faecalis and Citrobacterfreundii 10(9.9), Proteus mirabilis 9(8.9), Staphylococcus aureus 8(7.7%),
Serretiamarcesens and Streptococcus specie 3(3.0%).The mean total viable count ranged from
31.50±3.15x107cfuml-1 to 262.5±1.09x108cfuml-1. The antibiotics susceptibility profile reveals a high level of
susceptibility of most isolates to Gentamycin(50%), Ciprofloxacin(83%), Tarivid(100%), Augumentin(50%) and
Levofloxacin(100%) with mean zone of inhibition ranging from 18.6mm to 20.3mm. However, high resistance
profile of hundred percent was observed with nalidixic acid, ampicillin and septrin while reflacin resistant rate was
66.7%. Intermediary susceptibility was observed with streptomycin (50%) and ceporex (66.7%). This study therefore
reveals the diagnostic superiority of culture method to urinary nitrite detection technique. In addition, it also reveals
Escherichia coli as the most frequently isolated agent of bacteriuria. Furthermore, the study shows a high level of
susceptibility of urinary isolates to Gentamycin, Ciprofloxacin Levofloxacin, Augumentin and Tarivid.

Keywords: Urinary Tract Infection (UTI), Significant Bacteriuria (SBU), Urinary Nitrite, Minimum Inhibitory
Concentration (MIC), Minimum Bactericidal Concentration (MBC)
_____________________________________________________________________________________________

INTRODUCTION

Urinary tract infections (UTIs) are infections associated with the multiplication of organisms in the urinary tract. It
is the most common diseases occurring from infant up to adulthood. They are among the most common infectious
diseases encountered by clinicians in developing countries with an estimated annual global incidence of at least 8.3
million doctor visit yearly [23]. Urinary tract infections affects both sex but occurs more frequently in women than
men, with half of women having at least one infection at some point in their lives. The incidence of UTIs also
increases during pregnancy which if not properly treated can lead to serious health issues such as low birth weight,
preterm birth and severe consequences to both mother and fetus [14]. Studies in Sweden and other parts of Europe
have shown that one in five adult women experience a UTI at some point, confirming that it is an exceedingly
common worldwide problem [23]. In 2007, approximately 3.9 percent of office visits in USA were related to
symptoms caused by UTI. According to Willey et al., (2011), UTIs occurs as a result of interactions between the
uropathogen and host and their pathogenesis involves several processes such as attachment to the epithelial surface,
colonization and dissemination through the mucosa causing tissue damage. After the initial colonization period,
pathogens can ascend into the urinary bladder resulting in symptomatic or asymptomatic bacteriuria and if not

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treated it causes up to 30 percent of mothers to develop pyelonephritis and increases risk of low birth weight and
preterm birth [14]. Many different microorganisms can cause UTIs though the most common pathogens are
Escherichia coli and other Enterobacteriacae, which accounts for approximately 80-85 percent of the total isolates.
In complicated urinary tract infections and hospitalized patients, organisms such as Enterococcus faecalis and highly
resistant Gram-negative rods including Pseudomonasspp. are comparatively more common. The presence of nitrite
in urine is also an indication of bacteriuria. The diagnosis of urinary tract infection is therefore a vital tool as several
tests are required and treatment is based on information obtained from the antibiotic susceptibility testing [3]. This
study is therefore aimed at comparing the diagnosis of urinary tract infections using urinary nitrite and significant
bacteriuria.

MATERIALS AND METHODS

Collection of Samples
Two hundred (200) mid-stream urine samples were collected from different hospitals in Calabar, Nigeria which
included University of Calabar Teaching Hospital, General Hospital, Asi-Ukpo Diagnostic and Medical Centre and
College of Health Technology Medical Centre. The study sites were all located within Calabar metropolis, Nigeria.
Samples were collected following informed consent and the duration of study was within three to six months. The
age range in this study was between 15-70years. These samples were analyzed at the Microbiology Laboratory,
University of Calabar, Calabar, Nigeriausing standard procedures as described by CLSI, 2009.

Analysis of Clinical Specimen

The methods employed for the analysis of clinical samples were the dipstick urinalysis and the culture method. Both
methods were performed following the guidelines by the clinical and laboratory standard institute, 2009. All bacteria
isolates were identified and characterized using their morphological, and biochemical characteristics following
standard procedures described by Cowan and Steel (1974). Results were interpreted according to the guidelines of
Clinical and Laboratory Standards Institute [4].

Antibiotic Susceptibility Testing

Antibiotic susceptibility testing was performed using disc diffusion method on Muller Hinton agar [1]. The
commercial antibiotics discs used and the concentration for both gram positive and negative organisms were
Ciproflox 10mcg, Norfloxacin 10mcg, Gentamycin 10mcg, Amoxil 20mcg, Streptomycin 30mcg, Erythromycin
30mcg, Chloramphenicol 30mcg, Ampiclox 20mcg and Levofloxacin 20mcg (Gram positive disc) and Tarivid
10mcg, Reflacin 10mcg, Ciproflox 10mcg, Augmentin 30mcg, Gentamycin 10mcg, Streptomycin 30mcg, Ceporex
10mcg, Nalidixic acid 30mcg, Septrin 30mcg and Ampicilin 30mcg (Gram Negative disc). The medium for the test
was prepared according to manufactures directives and a 0.5 McFarland standard of the test organisms were
inoculated onthe surface of the already prepared agar plate. The plates were allowed to stand for 30minutes to allow
effective diffusion and then incubated at 37oC for 18-24hrs. Zones of growth inhibition were then measured to the
nearest millimeter and recorded. The MIC and MBC were evaluated using standard procedures. The organisms were
identified as eitherresistance, intermediary or susceptible based on CLSI standard [5]. Control strain was used to
check for the quality ofdisc and reagents.

RESULTS

Table 1 shows the prevalence of bacteriuria evaluation by culture according to gender and [Link] reveals that out
of the two hundred (200) midstream (MSU) urine samples analyzed, (28%, 56/200) were from the males while
(72%, 144/200) were from the females. It also reveals that the incidence of UTIs was high in females compared to
the males. In female, the incidence was high within the ages 26-36yrs(26.4%) and 59-70yrs (31.9%) while that of
the males was high within the ages 48-58(26.8%) and 59-70yrs (39.3%). FIG.1. shows the percentage of growth, it
was observed that (50.5%, 101/200) yielded significant growth, (35.5%, 71/200) yielded no significant growth while
(14.0%, 28/200) yielded no growth. The relationship between nitrite positivity and significant bacteriuria were
shown in Table 2 and FIG 2 respectively. Out of the two (200) hundred samples investigated, sixty five (65/200,
32.5%) were nitrite positive while (101/200, 50.5%) showed significant bacteriuria. Furthermore, all the nitrite
positive samples showed evidence of significant bacteriuria and in addition, thirty six samples (36/200, 18%) of
nitrite negative samples also showed evidence of significant bacteriuria. At p < 0.05, the result reveals that there was
statistically significant association between culture method and significant bacteriuria. The culture method was
therefore more diagnostic for detecting significant bacteriuria than using urinary nitrite technique. FIG. 3 shows the
prevalence of bacterial isolates. This reveals that Escherichia coli were the most prevalent bacteria and account for
29.7% (30/101) of the total isolate.

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60

50

40
Number of occurence

30

20

10

0
NG NSG SG
FIG.1. Frequency of occurrence of culture method
NG - No growth, NSG - No significant growth, SG - Significant growth

TABLE 2 Relationship between Urinary Nitrite Positivity and Significant Bacteriuria

CR SBU PNT NSG NNT NNWSBU

(n=101, %) (n=65, %) (n=99, %) (n=135, %) (n=36, %)
0-20 0(00.0) 0(00.0) 99(100.0) 99(73.3) 0(00.0)
21-41 7(06.9) 0(00.0) 0(00.0) 7(05.2) 7(19.4)
42-62 15(14.9) 0(00.0) 0(00.0) 15(11.1) 15(41.7)
63-83 14(13.9) 1(01.5) 0(00.0) 13(09.6) 13(36.1)
84-104 0(00.0) 1(01.5) 0(00.0) 0(00.0) 0(00.0)
105-125 15(14.9) 14(21.5) 0(00.0) 1(0.74) 1(02.8)
126-146 7(06.9) 6(09.2) 0(00.0) 0(00.0) 0(00.0)
147-167 9(08.9) 9(13.8) 0(00.0) 0(00.0) 0(00.0)
168-188 8(07.9) 8(12.3) 0(00.0) 0(00.0) 0(00.0)
189-209 6(05.9) 5(07.7) 0(00.0) 0(00.0) 0(00.0)
≥ 210 20(19.8) 21(32.3) 0(00.0) 0(00.0) 0(00.0)
CR =Colonial range; SBU = Significant bacteriuria; NT = Positive nitrite test ; NSG = No significant growth; NNT = Negative nitrite test
NNWSBU =Negative nitrite with significant bacteriuria

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160

140

120

100

80 Nitrite
Urine

60

40

20

0
Positive Negative
FIG.2. Result of urinary nitrite test and urine culture test

This was followed by Pseudomonas aeruginosa 14.9% (15/101), Klebsiellapneumoniae 13.8% (13/101)
Enterococcus faecalis and Citrobacterfreundii 9.9% (10/101) Proteus mirabilis 8.9% (9/101), Staphylococcus
aureus 7.9% (8/101), Serretiamarcesens and Streptococcus spp 3.0% (3/101).

The antibiotic sensitivity testing reveals that the isolates showed high sensitivity profile to Gentamycin (50%),
Ciprofloxacin (83%), Tarivid (100%), Augumentin (50%) and Levofloxacin(100%). Intermediate susceptibility was
observed with Streptomycin (50%) and Ceporex (66.7%) while high resistance profile of 100% was observed with
Nalidixic acid, Septrin, Ampicillin, while the resistance of Reflacin was 66.7%. Almost all the Gram negative
organisms showed a high level of susceptibility to Tarivid, Ciproflox, Gentamycin and Augumentin as shown in
FIG. 4. Escherichiacoli were sensitive to Tarivid, Ciprofloxacin and Gentamycin. Intermediate susceptibility was
observed with Reflacin, Ceporex, Augumentin and Streptomycin while resistance was observed with nalidixic acid,
septrin and ampicillin. Pseudomonas spp. was sensitive to only Tarivid and Ciprofloxacin. Klebsiella spp. was
susceptible to Tarivid, Ciproflox and [Link] and Proteus [Link] the same susceptibility
profile Tarvid, Ciprofloxacin, Gentamycin and Augumentin. Serretia spp. was susceptible to Tarivid, Gentamycin
and streptomycin while resistance was observed with ampicillin, ceporex, augumentin, nalidixic acid, septrin and
reflacin. The gram positive organism were highly susceptible to Gentamycin (100%), Levofloxacin (100%), and
ciproflox (83%). As shown in FIG.5. Enterococcus spp was susceptible to Gentamycin (18.6mm) and Levofloxacin
(18.3mm).Staphylococcus [Link] susceptible to Ciprofloxacin (19.3mm), Gentamycin(18.3mm) and Levofloxacin
(18.6mm). Intermediate susceptibility was observed with Norfloxacin (16.3mm), Ampicolx (17.3mm) while
Streptomycin (14.3mm), Erythromycin (12.0mm), Chloramphenicol (7.3mm) and Amoxil (4.3mm) were resistant.
Streptococcus spp. was susceptible to almost all the antibiotics used, Ciproflox (18.3mm), Norfloxacin (18.0mm),
Gentamycin (19.3mm), Levofloxacin (18.0mm), Ampiclox (19.3mm), Erythromycin (18.6mm) and
Chloramphernicol ( 18.3mm). Intermediate susceptibility was only observed with Amoxil (16.3mm) while
streptomycin (9.3mm) was resistant. Table 3 and 4 summarize the result of the antibiotics susceptibility study of
both gram negative and positive organisms. Results were presented using their mean ± SME to show which is more
effective. Table 5 also shows the summary of the MIC and MBC result performed on the different bacterial isolates.
It was observed that the MIC for the different bacterial isolates ranged from 0.0625mcgml-1 to 0.125mcgml-1 while
the MBC ranged from 0.25mcgml-1 to 0.5mcgml-1.

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TABLE 1 Prevalence of UTI according to age and gender

Age groups Male Female Total

(n=56, %) (n=144, %) (n=200, %)
15-25 5(08.9) 15(10.4) 20(10.0)
26-36 8(14.3) 30 (26.4) 54(27.0)
37-47 6(10.7) 25(17.4) 31(15.5)
48-58 15(26.8) 20(13.9) 35(17.5)
59-70 22(39.3) 46(31.9) 60(30.0)

FIG.3. Frequency of occurrence of bacteria isolates

FIG. 4: Effect of different antibiotics tested against gram negative organisms

Tarivid(OFX), Reflacin(PEF), Ciproflox(CPX), Gentamycin(CN), Ceporex(CEP), Augumentin(AU),
Streptomycin(S), nalidixic acid(NA), septrin(SXT), ampicillin(PN)

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FIG. 5: Effect of different antibiotics on tested against gram positive organisms

Ciproflox(CPX),Norfloxacin(NB),Gentamycin(CN),Amoxil(AML),Ampiclox(APX), Levofloxacin(LEV),
Streptomycin(S), Erythromycin(E), Chloramphenicol(CH)

TABLE 3 Effect of different antibiotics tested against gram negative organism in urinary culture

PEX CPX CN CEP AU S NA SXT PN 3

Organism No of occurrence OFX 10mcg
10mcg 10mcg 10mcg 10mcg 30mcg 30mcg 30mcg 30mcg 0m/g
19.6± 16.6± 18.6± 20.3± 17.3± 16.7± 15.3± 10± 7.3± 6.3±
[Link] 30
0.33a 0.33cd 0.66ab 0.33a 0.33bc .066d 0.66d 1.15e 1.33f 0.33f
18.8± 7.0± 18.6± 17.6± 0.100± 7.6± 15.3± 0.00± 6.3± 0.00±
Peseudomonas 15
0.66a 0.82c 0.66a 0.33ab 0.00d 0.88c .066b 0.00d 0.66c .00d
19.4± 14.6± 18.6± 17.3± 16.7± 18.0± 16.7± 2.7± 0.00± 7.33±
Klebsiella spp. 13
0.66a 0.66c 0.66a 0.66b 0.33b .00ab 0.66b .033e 0.00f 0.66d
18.8± 6.66± 18.6± 18.6± 17.3± 18.6± 16.00± 10.6± 18.6± 16.7±
Citrobact spp. 10
0.66a 0.66d .066a 0.66a 0.66ab 0.66a 0.00b 0.66c 0.66a 0.66b
18.6± 6.66± 18.6± 18.6± 17.3± 18.6± 16.00± 10.6± 18.6± 16.7±
Proteus spp. 9
0.66a .066d 0.66a 0.66a 0.77ab 0.66a 0.00b 0.66c 0.66a 0.66b
18.3± 0.00± 17.3± 18.0± 0.00± 0.00± 18.6± 0.00± 0,00± 0.00±
Serretia spp. 3
0.33a 0.00a 0.00a 0.00a 0.00a 0.00a 0.66a 0.00a 0.00a 0.00a
Results are presented as mean ± standard error
≥18 Sensitive
15-17 Intermediary
≤ 15 Resistant
Mean (average) zone of inhibition with same letter superscript signifies no significant difference while those with different superscript letter
along each horizontal array differ significantly at (p<0.05) from each other, this mean they is difference on the antibiotic effect on each isolate

TABLE 4 Effect of different antibiotics tested against gram positive organism in urine culture

Isolated No of 10m/g 10m/g 10m/g 20m/g 20m/g 20m/g 20m/g 30m/g 30m/g 30m/g
organism occurrence CPX NB CN AML LEV APX RD S E CH
Enterococcus 0.00± 0.00± 18.6± 17.3± 18.3± 0.00± 0.00± 15.6± 9.0± 0.00±
10
spp. 0.00d 0.00d 0.66ab 0.33ab 0.33ab 0.00d 0.00d 0.66b 1.00b 0.00d
Staphylococcus 19.3± 16.3± 18.3± 4.3± 18.6± 17.3± 12.6± 14.3± 12.0± 7.3±
8
spp. 0.66a 0.33c 0.33ab 0.66g 0.66ab 0.33bc 0.66e 0.33e 1.15e 0.66f
Streptococcus 18.3± 18.0± 19.3± 16.3± 18.0± 19.3± 9.6± 9.3± 18.6± 18.3±
3
spp. 0.33ab 0.00ab 0.66a 0.33c 0.33ab 0.66a 0.33d 0.66d 0.66ab 0.33ab
≥18 Sensitive
15-17 Intermediary
≤15 Resistant
Mean (average) zone of inhibition with same letter superscript signifies no significant difference while those with different superscript letter
along each horizontal array differ significantly at (p<0.05) from each other, this mean they is difference on the antibiotic effect on each isolate

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TABLE 5 Summary of MIC and MBC on the different bacterial isolates

CPX OFX CN LEV AU

TEST BACTERIA mcg/ml mcg/ml mcg/ml mcg/ml mcg/ml
MIC MBC MIC MBC MIC MBC MIC MBC MIC MBC
Escherichia coli 0.125 0.50 0.25 0.25 0.125 0.50 0.125 0.50 0.125 0.25
Pseudomonas aeruginosa 0.125 0.50 0.25 0.25 0.0625 0.25 0.125 0.25 0.125 0.50
Klebsiella pneumonia 0.125 0.25 0.25 0.50 0.125 0.50 0.125 0.50 0.0625 0.25
Citrobacterfreundii 0.0625 0.25 0.125 0.25 0.125 0.25 0.625 0.50 0.0625 0.50
Proteus mirabilis 0.125 0.50 0.25 0.25 0.125 0.25 0.125 0.50 0.125 0.25
Serretiamarcenses 0.125 0.25 0.125 0.25 0.125 0.25 0.125 0.50 0.125 0.25
Enterococcus faecalis 0.125 0.25 0.25 0.25 0.125 0.25 0.125 0.50 0.0625 0.25
Staphylococcus aureus 0.0625 0.25 0.125 0.50 0.125 0.25 0.125 0.25 0.0625 0.25
Streptococcus spp 0.125 0.50 0.25 0.25 0.125 0.25 0.125 0.50 0.125 0.50

DISCUSSION

Urinary tract infections are among the most common infections affecting all age groups. It is usually associated with
females and occurs mostly among women of reproductive age. However, this study was aimed at comparing the
diagnosis of urinary tract infections (UTIs) using urinary nitrite and significant bacteriuria (SBU). My finding in
this study reveals that the incidence of UTI was more prevalent in females compared to the males. This findings is in
harmony with reports of other studies which shows that they are higher prevalence of UTIs in adult women than in
men [8] [27]. This relatively high prevalence of UTIs in female is believed to be due to factors such as poor personal
hygiene, promiscuity, drug abuse, use of contraceptives and the close anatomical relationship of the female urethra
to the vagina [16]. The uropathogens identified in this study were mostly enterobacteriaceae and this is similar to
those of other studies who confirms that enterobacteriaceac especially E. coli are the most predominant organism
responsible for urinary tract infections [19]. The presence of these uropathogens in females actually calls for concern
as some of these bacteria have been reported by several researchers that when present in significant proportions are
able to cause miscarriages, prevent future conceptions, cause several complications in labour as well as risk for the
fetus [18] [12].

The population studied comprises of both male and females’ patients with age ranged between fifteen to seventy
years. In male, the highest frequency of occurrence was observed in the age range between 59-70years (39.3%).
The incidence is high because it is believed that most men at this age tend to develop prostate problems which are
due to loss of prostate fluid and enlargement of the prostate gland. When this happens, it impedes and slows the flow
of urine thus raising the risk of them developing UTIs [26]. In female, the highest occurrence was observed within
the age’s 26-36years (26.4%) and 59-70years (31.9%). This result is in line with other reports which identify that the
incidence of UTIs in female increases gradually with age [8]. Within the age range, 26-36years, the high incidence is
believed to be due to the fact that most females are sexually very active and most of them also use contraceptives.
This action introduces a lot of bacteria into the urinary tract. For instance, during sexual intercourse, it is believed
that bacterial are being massaged up the urethra into the bladder and this makes it liable to trauma and infection.
Also between 59-70years, the high incidence may be due to menopause and estrogen loss [11] [20].

This biological change is known to put older women at risk of developing primary and recurring UTIs. With
estrogen loss the walls of the urinary tract thin out, weakening the mucous membrane there by reducing its ability to
resist bacterial colonization. Estrogen is known to maintain the normal acidity of vaginal fluid and also preventing
bacterial colonization so loss of it can lead to serious health issues such as UTIs [24].

Escherichia coli were the most predominant organism accounting for 29.7% (30/101) of the total isolates. This
finding is in concordance with studies of other researchers [9] which reveals that E. coli was the leading agent
responsible for UTIs with 32.7% of the total isolates. This is partly so because E. coli is the most predominant
bacteria in the gastro intestinal tract of human and as such it can easily move to the bladder after a bowel movement.
Other uropathogens isolated from this study were Pseudomonas aeruginosa accounting for 14.9%,
Klebsiellapneumoniae 12.8%, Enterococcus faecalis and Citrobacterfreundii 9.9%, Proteus miribilis 8.9%,
Staphylococcusaureus 7.9%, Serretiamarcesens and Streptococousspp 3.0% respectively. These results is in line
with other reports which reveals that members of the enterobacteriaceae are the most predominant organism
responsible for urinary tract infections and that they formed a greater proportion of the microflora of gastro intestine
tract [21]. This confirmed why gram negative rods were the most isolated organisms in this study and they accounts
for 79.2% of the total isolates and gram positive organism accounts for 20.8% of the total isolates

The comparative diagnostic analysis of dipstick urinalysis and culture method evaluated shows that both methods
can be used in the diagnosis of UTI but the culture method was more effective and reliable as most times the urinary

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nitrite technique may result in false negative and positive result. This is in harmony with reports from several
investigators who concluded that the dipstick urinalysis is not specific and cannot give a reliable result in the
diagnosis of UTIs [22]. Also it was observed that 18% of the nitrite negative samples showed evidence of significant
bacteriuria and as such, using urinary nitrite alone in the diagnosis of UTI may lead to a false negative and positive
result which may lead to wrong diagnosis and exposing patients to the risk of unnecessary antibiotics. That is why
recent studies of 75 papers carried out to establish whether negative dipstick urinalysis is sensitive enough to rule
out UTI concluded that negative dipstick is insufficient to rule out UTIs [10]. At p<0.05, they was statistically
significant association between the culture method and significant bacteriuria and as such, the culture method was
more diagnostic for detecting significant bacteriuria than the use of urinary nitrite detection technique.

The antibiotic susceptibility study reveals that almost all the gram negative organisms were sensitive to
Ciproflox(83%), Tarivid(100%), Augumentin (50%) and Gentamycin(50%). Their mean values ranged between
18.6-20.3 mm. This shows a high level of sensitivity as the result is in line with other reports [15] [25] who reported
that quinolones and aminoglycoside were very effective in treating urinary tract infections. Nalidixic acid, reflacin,
ampicillin and septrin showed 100% resistance among the gram negative organism with mean value ranging from
1.0-14.6mm. Nalidixic acid belongs to the first generation antibiotics and the oldest and as such they are more
susceptible to the development of resistance. Also the resistant rate of these antibiotics may be due to the widespread
use of this drug in hospitals when treating UTIs [2].

The gram positive cocci were also susceptible to Ciprofloxacin (83%), Levofloxacin (100%) and Gentamycin
(100%). The high susceptibility of these organisms to quinolones is believed to be due to the fact that quinolones are
broad spectrum and as such they exhibit excellent activity against a wide range of organisms both gram positive and
negative organisms. This makes quinolones have unmatched safety profile. However, intermediary susceptibility
was observed with ceporex (66.7%) and streptomycin (50%). This intermediary profile may be due to certain
variables in the susceptibility test that may not have been properly controlled thereby altering the values which
makes them becomes buffer zones separating susceptible from resistant strains.

Escherichia coli, Pseudomonas aeruginasa, Klebsiellapneumoniae, Citrobacterfreundii, Proteus mirbilis and

Serretiamarcesens was observed to be highly resistant (100%) to Septrin which belongs to the group
sulfamethoxazole. Formally, this was the drug of choice for treatment of UTIs but suddenly it has become so
resistant that it can no longer be effectively used to treat UTIs. This high resistance is believed to be due to it over
usage which is due its low cost. This observation is in line with that made by these researchers [17] that bacterial
resistance to sulfonamides are now common and that sulphonamide resistant strains of E. coli and other
enterobacteriaceac are common particularly in hospitals. Other gram positive organisms were resistant to
erythromycin but shows a high susceptibility profile against Streptococci spp with mean value of 18.6mm. This
result is in line with other reports from scholars like [13] which reports that erythromycin when used to treat UTI
caused by Streptococci is highly effective and that strains resistant to erythromycin are rare among the sensitive
streptococci. Staphylococcus spp shows a high susceptibility profile to Ciprofloxacin, Gentamycin and
Levofloxacin, however, resistance was observed with Amoxil, Erythromycin, Chloramphenicol and Streptomycin.
The resistant drugs in this study must therefore be selectively used when treating UTI and periodic monitoring and
evaluation must be carried out before they are used. Recent studies in Europe and North America demonstrated an
increasing resistance among uropathogens. In Spain, they were reports that 22-27% of E. coli was resistant to
Ciproflox (Dazaet al., 2001). This report is in contrast to this study as it recorded high sensitivity profile of
Ciprofloxacin to E. coli and other bacteria isolated in this study. The use of antibiotics has been of immense benefits
in controlling the spread of many infectious diseases but this greatly depends on its careful usage to minimize the
emergence spread of resistant strains as antibiotic susceptibility patterns to organisms changes rapidly due to over
usage [28].

CONCLUSION

In conclusion, the results from this study reveals a high prevalence of urinary tract infection among the population
studied and the data evaluation reveals that culture method is more diagnostic for detecting bacteriuria than using
urinary nitrite technique which reliability is most times doubtful. More so, the use of antibiotics has been of
immense benefit in controlling the spread of many infectious diseases but this greatly depends on its careful usage.
Therefore antibiotic therapy should only be used after a thorough culture and antibiotic sensitivity test have been
carried out to avoid the emergence and spread of antibiotic resistance strains. Also antibiotic therapy for the
treatment of UTI should be based on sensitivity, tolerability and resistance as this will serve as a guide to clinicians
for its prompt intervention.

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Acknowledgement
We sincerely acknowledge our volunteers for willingly giving us the samples used for this research work. We also
acknowledge the technical staff of the Department of Microbiology, University of Calabar, Nigeria, most especially
Mr. Bernard BasseyUbifor their support and encouragement throughout the period of this research work. I also
appreciate the effort of the staff of microbiology unit, General Hospital Calabar, Nigeria, University of Calabar
Teaching Hospital, College of Health Technology Medical Center and Asi-Ukpo diagnostic and Medical Centre for
their immense assistance in the provision of clinical samples.

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