BACTERIOLOGICAL STUDY OF URINARY INFECTIONS FROM JUNE TO AUGUST 2019 AT THE CLINICAL BACTERIOLOGY UNIT

FROM THE PASTEUR INSTITUTE OF ABIDJAN

INTRODUCTION
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BACTERIOLOGICAL STUDY OF URINARY INFECTIONS AT THE CLINICAL BACTERIOLOGY UNIT FROM JUNE TO AUGUST 2019
AT THE PASTEUR INSTITUTE OF ABIDJAN
Infectious diseases are the result of the development of agents.
microscopic pathogens within a tissue or an organ that are
of bacterial, viral, or fungal origin, which causes diseases
infectious. Among these infections, we distinguish urinary infection which
represents the second infectious pathology. Urinary infection (UI)
is one of the most commonly encountered infections in both urban practice as well as in
hospital environment (GOBERNADO et al, 2007; SOULA et al, 1990;
ALAOUI et al, 1998). The urinary tract is a frequent source
infection at any age. They hold an important place among the
reasons for consultation.
Among healthcare-associated infections, urinary infections hold a significant place.
not negligible. Their high frequency could be explained by the
preferential proliferation of certain germs in the pathways
urinary and the multiplicity of contributing factors (age, sex, the state of
patient). UTIs are common in both community and hospital settings.
hospital environment. The interest in infections in recent years
urinary and their management in anti-infective therapy remains
still relevant.
Indeed, these infections are a real health problem.
Published as much by their frequency as by their difficulty of treatment.
Their high frequency could be explained by the proliferation.
preferential of certain germs in the urinary tract and the
multiplicity of contributing factors. [2] It remains the most common of
infections despite prevention efforts. She is fortunately a
benign infection in the majority of cases.
However, the means employed to ensure its diagnosis and its
Treatment represents a significant part of the health budget.
They are the second reason for consultation and prescription.
antibiotics at the doctor's office and in emergency services,
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after respiratory infections, but they are probably there
the primary cause of bacterial infection.
It is often associated with a urinary tract anomaly of which the
more frequent is the vesico-ureteral reflux. The signs and
symptoms of urinary infections are often nonspecific, in
particularly in infants and newborns.
In light of the resurgence and the serious consequences that this condition
could lead to issues in pregnant women, children, and the elderly,
several studies have been devoted to it.
In the United States, urinary infections rank first among
nosocomial infections.
In France, VEYSSIER found during his work that the
infections were mainly urinary after a long stay at
the hospital at 47% and occurred much more in elderly people.
Their treatment is most often probabilistic, but the emergence of
bacteria increasingly resistant to antibiotics makes these
ineffective treatments. The laboratory diagnosis of infections
urinary therefore remains an important tool for management as much on the
diagnostic point than therapeutic.
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General objective:
Determine the prevalence of urinary infections in the patients received.
Specific objectives:
1- Determine the risk factors for urinary infections
2- Identify the microorganisms potentially responsible for
urinary infections.
3- Indicate the antibiotic sensitivity of the responsible germs.
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FIRST PART:
GENERALITIES
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I. GENERALITIES ON URINARY INFECTIONS
1. DEFINITION OF A URINARY INFECTION
The term urinary infection encompasses clinical situations
heterogeneous substances that have in common the presence of
significant quantities of bacteria in the urine. It is also the
presence of numerous leukocytes in the urine.
2. CLASSIFICATION
It is common to distinguish, according to anatomical location, two
situations :
∑ Cystitis: infections localized in the bladder, most often.
of bacterial origin, benign, always of ascending origin.
∑ Pyelonephritis: bacterial urinary infections with
damage to the renal parenchyma, this is an interstitial nephritis
microbial, potentially serious, affecting the parenchyma by
ascending path, starting from the bladder then the ureter, then the
bassinet. The terms upper urinary tract infection and urinary infection
bass are also often used and refer respectively
localized infections in the kidney and bladder infections.
3. EPIDEMIOLOGY
Urinary infections are one of the most common infections in
children. The prevalence of the disease depends on multiple factors,
especially age and sex: In the first three months of life, the
the prevalence of urinary tract infections is higher in boys: thus, among the
febrile patients under three months of age, the risk of UTI is
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approximately 13% among girls, 2% among boys
circumcised, 19% among those who are not.
It is in the first year of life that the incidence of the first episode
the IU is the highest. [12] In infants, the risk of IU is
estimated a year ago at 6% for girls and 3% for boys; after the
first year of life, urinary infections are much more
more frequent among girls than among boys (8% of girls and 2% of)
boys before the age of six years)
Recurrent urinary infection often reveals an anomaly.
malformative or functional urinary tract conditions especially in the
infant, abnormalities in 40 to 50% of cases (vesicoureteral reflux)
in 80% of cases.
A urological etiological assessment should therefore be carried out from the first.
febrile urinary infection in children (variation of investigations according to the
centers: at least renal and bladder ultrasound.
4. ETIOLOGY
Bacteria involved in urinary infections: Enterobacteriaceae: 90 to
95% of cases, (including: Escherichia coli 70 to 80%; Proteus mirabilis 5 to
10%; Klebsiella pneumoniae 4 to 8%). Sometimes, Cocci +: Streptococcus D
and Staphylococcus. The share occupied by E. coli is all the more
important that this is the first episode and in the absence of uropathy
malformative, up to 88% in some series. Nevertheless, [Link] is
less frequent in case of infection occurring in a child benefiting
of an antibiotic prophylaxis.
After [Link], the three bacterial species playing a significant role
are Proteus mirabilis, enterococci, and Klebsiella spp. The
staphylococci, Pseudomonas aeruginosa, are rarely involved
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in the child without any pathological condition. Staphylococcus
saprophyticus is a cause of urinary infection mainly found in
the teenager [15].
5. ANATOMICAL REMINDER
Figure 1: Anatomy of the urinary system
The urinary system is divided into two. It indeed includes the lower
device, composed of the urethra and the bladder, and the upper urinary system,
bilateral and symmetrical, composed of the ureters and the kidneys. The urethra is the
primary obstacle to bacterial invasion. Its sphincter limits the
colonization. Its longer length in men also explains the
lower frequency of urinary infections in the male sex.
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Moreover, the anti-reflux system between the kidney and the bladder limits the
progression of bacteria upwards and therefore the risk of
pyelonephritis.
6. PATHOPHYSIOLOGY
6.1 Origin of the infection
The urinary tract is normally sterile, except for the distal urethra.
colonized by the digestive flora (enterobacteria, streptococci,
anaerobes), the skin flora (coagulase-negative staphylococci,
corynebacteria) and the genital flora (lactobacilli in women). The
the reins are protected from bacterial invasion by the vesical sphincter
ureteral and the continuous flow of urine[17].
The normal digestive flora is usually the reservoir of bacteria.
found in urinary infections. The infection is favored by the
presence of a functional or organic anomaly responsible for the
colonization of bladder urine, urinary stasis or reflux of
urines towards the upper device.
6.2 Related to the bacteria:
Bacterial virulence, in this context of uropathogenicity, is
also an important factor that has emerged in recent years.
Indeed, not all bacterial strains are capable of inducing
an infection: some strains possess specific factors of
virulence, allowing for rapid spread from fecal flora to the
renal parenchyma.
The natural history of urinary infection begins with colonization.
from the digestive tract with a uropathogenic strain that, thanks to the presence
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virulence factors, will colonize the periurethral area and migrate along
from the urethra to the bladder and then along the ureter to the kidney.
6.3 Related to the host:
According to gender: Short distance from urethra to anus in females,
favours a short route for bacteria to the meatus.
7. PATHOLOGICAL
Foreign body: lithiasis, catheter. - Urinary tract obstruction: malformation
or tumor.
Diabetes: Diabetes has been regularly implicated.
The latter could promote urinary infections in various ways.
mechanisms :
∑ Alteration of bladder drainage: Change in composition
of urine allowing for greater microbial growth.
- Kidney failure - Incontinence
Immunodeficiency [21]
Constipation is another contributing factor, as stagnation
prolonged retention of feces in the rectum is a source
permanent infestation.
Lack of hygiene:
∑ Washing: The act of wiping oneself from back to front after being
the pathway to the saddle promotes infections by bringing in bacteria
toward the urinary meatus.
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∑ Changing baby's diapers: our genitals
babies are constantly surrounded by diapers. Even if we
change as often as possible, these layers contain
urine that stagnates and fecal matter. The risks
ascending infections are always possible. In this case, the
microbes go from the outside of the layer to the inside of the
urinary system.
Bladder dysfunction or bladder immaturity: The small
they eliminate badly the totality of the urine contained in their bladder. Of
backward flow, urine stagnates in the bladder, which promotes multiplication
microbial.
8. BACTERIAL RESISTANCE
The level of resistance of E. coli to antibiotics varies from country to country.
to the other. It is particularly high in children. This high level
resistance is explained by the overconsumption of antibiotics in the
respiratory infections, the leading cause of prescriptions in pediatrics.
These prescriptions have contributed to the evolution of resistance of
bacteria of the intestinal ecosystem. Indeed, treatments with amino-
penicillins, cephalosporins or cotrimoxazole are strongly
acquired resistance generators[25,26].
For [Link], more than half of the strains are resistant to
penicillins A, primarily by the production of beta-lactamases and
clavulanic acid only partially restores the activity of
amoxicillin. The percentage of strains resistant to co-trimoxazole
20% and may be higher in the case of antibiotic prophylaxis.
preliminary
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These resistance rates result from therapeutic patterns.
probabilistic (before the results of the culture and the antibiogram)
proposing amoxicillin, the amoxicillin–clavulanic acid combination, the
cotrimoxazole, validated by comparative studies conducted some time ago
a few years or in countries where antibiotic resistance
is significantly lower. The resistance to cephalosporins of
third generation injectables (C3Gi) remains limited for the strains of
[Link] isolated in urinary infections in children (<2%).
The increase in resistances associated with the decrease in new ones
antibiotics put on the market year after year is a serious
problem. Sensitivity to cefixime is generally extrapolated from
that of the C3Gi. In fact, some studies show a sensitivity
lesser with cefixime compared to the latter. In the study of
Goldstein, the percentage of strains sensitive to cefixime is estimated at
83 versus nearly 99% for the C3Gi.
These differences can be explained by the fact that E. coli has in its
chromosomal heritage a chromosomal cephalosporinase
constitutively very weakly expressed, which when it is hyper expressed
decreases cefixime activity more rapidly than that of C3G
injectables[30].
This must lead to systematically testing this antibiotic in
pediatrics for E. coli isolated from urinary infection and questions
the use of cefixime as a probabilistic antibiotic therapy during the
initiation of treatment for acute pyelonephritis. The strains
E. coli isolated from urinary infections remain in the vast majority of
cases sensitive to aminoglycosides including gentamicin.
Enterococci are naturally resistant to cephalosporins and
to the aminoglycosides.
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Natural resistance is generally low, the use of
aminoglycosides in combination with an aminopenicillin remain possible
in case of severe infection due to synergy.
II. DIAGNOSIS OF URINARY INFECTIONS
1. PARA-CLINICAL DIAGNOSTIC
Remains important for making a definitive diagnosis:
1.1. Withdrawal:
∑ Sampling conditions:
The following conditions must be met:
Careful perineal toilet and drying.
The external genital organs must be carefully
cleaned with soap and then with an antiseptic, rinsed thoroughly with
sterile water then dried with a sterile compress. In the
boy, it is better to leave the glans uncovered during the
micturition.
Sample taken if possible in the morning upon waking, on the first
urines that have concentrated (if the sample is taken from the
During the day, you need to ask the subject to try not to urinate and to
do not drink for the 4 hours preceding the sample collection).
∑ Sampling techniques:
VMidstream urine collection (per-mictional):
It is a non-invasive technique. The risk of contamination by the flora
peri-urethral during urination can be reduced by disinfection
caregiver of the vulva, the foreskin, or the glans. It is the technique for
use in children with voluntary urination. This method
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it can also be offered to infants and children as well
young people to urinate on command. She asks for patience, but
these results are better than those obtained by the technique of
sampling using a pouch. It should therefore be favored in the
measure of the possible.
VCollection using a urine collector (urine bag):
It is the most commonly used technique for children under two.
three years. It exposes to contamination by the commensal flora of the tube
digestive (e.g., E. coli) commonly present on the vulva and the
foreskin.
The adhesive pouch must be removed as soon as the urine is emitted and, from
Anyway, it should not stay in place for more than 30 minutes.
rigorous disinfection technique and a short application time reduce
the risk of contamination but do not rule it out, so that very
many authors and international recommendations challenge in
because of the interest in pocket collection.
VSubpubic puncture:
It is the most reliable technique. It is a medical act that exposes to little
of serious risks, but it is invasive, painful, requires time and
resources. Finally, it is not uncommon for him to fail. Its realization under
Ultrasound improves its performance.
VSampling by catheterization:
The sampling by catheterization using a flexible probe, pre
lubricated, is also a reliable technique, but it partly shares the
same disadvantages. If the 'in-and-out' catheterization does not pose any
technical problem with girls, it is more difficult to accomplish with
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boy. The risks of iatrogenic urinary infections and urethral injuries in boys
are not encrypted, but seem weak. It is recommended to eliminate
the first drops of urine for the sample.
1.2. Transport and storage of samples:
Once collected, the urine must be examined within hours.
which follow and consequently immediately transported to
laboratory. If it is not possible, it is important to keep them at
refrigerator between 0 and +4°C, because at room temperature, the rare
normal urine bacteria multiply rapidly risking to cause
wrongly diagnose a urinary infection. Beyond 12 hours at 4°C,
it will not be modified, but the leukocytes can be altered and
group in clusters.
Another way to prevent any bacterial proliferation
is to place the urine in the presence of a bacteriostatic agent in the form of
of powder like boric acid. The system allows for preservation
urines at ambient temperature for 24 hours under significant modification of the rate
of bacteria and without alteration of the leukocytes. It is a simple system,
but rather expensive requires the filling of the bottle according to the
manufacturer's instructions to achieve the optimal concentration of
conservator. Boric acid is likely to decrease sensitivity
from the search for leukocyte esterase using urine test strips.
1.3. Information accompanying the collection:
The information is essential as it will allow
microbiologist to optimize the analysis and its interpretation.
They concern the patient's Age and Sex, the method and time of
withdrawal, the reasons for the request, the history of infection
urinary, the notion of a concomitant disease.
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2. DIAGNOSIS OF URINARY INFECTION USING STRIPS
REACTIVES
Figure 2: Reactive strips
The urine test strip helps avoid a large number of urine cultures with a
important security level.[33]The main interest of screening by the
urinary strips intended for the detection of leukocytes,
nitrites, from the presence of sugar and proteins, lies in its
applicability at the patient's bed and in its negative predictive value.
What can help reduce the frequency of examinations
cytobacteriological. The test strips detect:
Leukocyte esterase is produced by neutrophil polymorphs.
The sensitivity threshold is 10.4leukocytes per ml.
- The nitrites that indicate the presence of bacteria,
essentially the enterobacteria, having a nitrate reductase
capable of transforming nitrates into nitrites.[32]The strip
must be soaked in freshly emitted urine, in a
clean container issued, and dry but not sterile.
2.1. Manipulation
It is simple, you need to briefly immerse the strip in such a way that
that all reactive areas are in contact with the urine.
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[Link]
It is done by bringing the strip closer to the colorimetric scale.
visually.
[Link] of results
A test strip is considered negative if neither is detected.
leukocyturia, no nitrites. When properly conducted, it allows for the exclusion of a
urinary infection with a very high probability; because the strips
reactives have a sensitivity of 90% and a specificity of 70%. There is
a very low risk (≈ 3%) of false negatives for the nitrite test in
case of:
low bacteriuria;
restricted nitrate regime;
acidic urinary pH
diuretic treatment;
bacteria non-productive nitrites: streptococci,
enterococci, acinetobacter spp, staphylococcus saprophyticus.
A strip is considered positive if a detection is made of a
leukocytes in urine and/or nitrites.
∑ Indication :
VSuspicion of simple cystitis
Only the strip is indicated. If the strip is negative, another
diagnosis (e.g.: cystalgia with clear urine) should be considered. If the
the strip is positive, a probabilistic treatment will be started.
VOther urinary infections
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The strip cannot be considered as a method.
relevant for diagnosis. A urine culture is necessary for identification and
the antibiotic sensitivity of the bacteria involved.
3. DIAGNOSIS OF URINARY INFECTION BY EXAMINATION
Cytobacteriological of Urines: Urine Culture
The diagnosis of urinary infection is based on a simple examination:
the cytobacteriological examination of urine (E.C.B.U.) with counting of
germs.
The cytobacteriological examination of urine (CBEU) aims to
collect the normally sterile bladder urine, avoiding its
contamination during urination by the commensal flora that colonizes
the urethra and the perineal region. The E.C.B.U must be performed first
antibiotic treatment that could distort the results.
The urine culture allows for a quantitative and qualitative assessment of the
presence of figurative elements (leukocyturia, hematuria, cells
epithelial) and microorganisms (bacteriuria, candiduria). To have
good results, one must respect the collection conditions,
conservation and transportation of urine.
[Link] Examination
The macroscopic examination allows for noting the main characteristics of
urines emitted, namely:
The aspect that can be clear, shady, murky.
The color that can be pale yellow, amber, hematic or
possibly colored by the medications.
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The presence of sediments and their abundance giving an appearance
fluffy, crystalline, whitish (phosphate), brick red (acid)
urique) or rose.[43]
[Link] examination
It includes a cytological examination and a bacteriological examination.
Cytological examination
It is considered a witness to an inflammatory attack on the tissues.
of the urinary tree. Among the measurement methods, the counting in
Mallassez or Thomas cell in a non-centrifuged urine but
homogenized, with quantification of leukocytes per cubic millimeter
or per millilitre, has established itself as a simple, quick and
reliable. It is also useful to recognize and quantify the red blood cells
and the cylinders.
Bacteriological examination
The practice of a Gram stain on centrifuged urine allows
to know the morphology of bacteria, while on a urine sample not
centrifuged and homogenized, it also allows for a
semi-quantitative enumeration of bacteria. This examination is highly
recommended because it allows for diagnostic orientation by facilitating the
choice of culture media and diagnostic conditions in
facilitating the selection of specific growing conditions.
[Link]
It allows for obtaining isolated colonies on poured gel media.
in a Petri dish. These isolation media are:
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Ordinary nutrient agar is suitable for the culture of germs.
not presenting any specific requirements;
Selective media: these are media used for isolation.
Gram-negative bacilli (MacConkey, Hektoen);
A blood agar or even a chocolate agar: under 10% CO2
according to the results of the microscopic observation. The culture is
done at a temperature of 37° C and an incubation time of
6 PM to 12 AM.
[Link] identification
The technique to be used is based on the morphology of the colonies.
completed if needed with a Gram stain and search for
the oxidase and catalase. The reading is done after at least
18 hours of incubation at 37° C
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Figure 3: Identification of bacteria
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Figure 4: Algorithm for identifying the main genres of bacilli
Gram-negative
3.5.
Interpretation
Classically, significant bacteriuria is referred to when there is a
minus 105bacteria per ml of urine. A leukocyturia is significant at
starting from 104leukocytes per ml. However, it has been shown that there exists
true urinary infections with a rate of 102to 103bacteria per ml
Urine. It is generally accepted that the diagnosis of urinary infection
requires a lower rate of bacteria per ml in humans (103or
104than in women (104.)[45]
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Table I: Interpretation of the results
Leukocytes Bacteria
results Interpretation
by ml
≤ 104
>104
by ml
< 103
>=105
Normal negative urines
Positive urinary infection certain
Possible urinary infection at
>104
greater than or equal to 103and <105Positive recheck (urethritis, prostatitis)
chronicle)
Decapitated urinary infection
by antibiotic. Think about the
tuberculosis, schistosomiasis,
>104
< 103
Negative an interstitial nephropathy
chronic, a urethritis,
urothelial tumor, lithiasis,
demanding germs.
Stain especially if the
species belong to
multiple germs. is done at
Positive after 24 hours
incubation at 37° C. In
function of the diameter.
<= 104
103
Recheck the urine culture
The biologist provides the following information:
The number of leukocytes: a rate greater than or equal to 105
leukocytes/ml of fresh urine is pathological. Sometimes, there are so many
of altered leukocytes (pus cells) is referred to as 'pyuria'.
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The number of microbes: for there to be an infection, it is necessary that one
find at least 105germs/ml provided that this rate does not
concerns only one and the same microbe.
Below 104germs/ml, there is no urinary infection. Between 104
and 105, the doubt remains and the examination must be restarted.
Escherichia Coli, Proteus, Klebsiella
Pyocyanic, Aerobacter, Streptococcus faecalis etc....
The antibiogram studies the sensitivity of the germ to antibacterials.
Sometimes, the urine culture reveals 'contaminations'. In this case,
from a poorly conducted urine sample, under hygienic conditions
Defective that allowed its contamination (tight phimosis in the
boy, diarrhea, vulvitis in the girl, etc.) [41]
3.6. The antibiogram:
Figure 5: Example of an antibiogram
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The antibiogram allows the study of the sensitivity of a strain.
bacterial to various antibiotics. The antibiogram can be performed
according to two methods:
The dilution method in liquid or solid media:
It is more precise but less used because it is longer and tedious.
and expensive requiring many tubes for each
antibiotic
-The agar diffusion method:
It is commonly used and faster. In this case, it
consists of depositing on the surface of the agar in a petri dish,
blotting paper discs impregnated with different antibiotics
tested. Each antibiotic diffuses within the agar from the
disk and determines concentrations. The inhibition will be
translate by a circular area devoid of cultivation around the
disk. The reading of growth inhibition around the disk
of antibiotic, it is said that the germ is sensitive (S), resistant (R) or
intermediate (I)[46,47].
4. DIFFERENTIAL DIAGNOSIS
Bacteriuria < 10 5germs/ml especially in the absence of signs

clinics: Contamination: redo the sample;

Similarly, in the case of multiple germs, leukocyturia without
germs
-isolated leukocyte: contamination;
Rare urinary candidiasis;
Exceptional urinary tuberculosis.
5. EVOLUTION
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‹ Immediate:
Satisfactory under appropriate treatment with apyrexia in 36 to 48
hours. If a febrile state persists, investigate:
a resistance of germs (antibiogram).
a secondary location, not exceptional in the newborn
born and the infant (frequency of bacteremia: cerebral abscess,
arthritis ...).
‹ In the long term:
Infection on a growing organ with a risk of renal sequelae.
Parenchymal aggression can lead to the formation of scars.
cortical and manifest in the long term as hypertension, a failure
renal. This risk is correlated with the implementation delay of a
effective treatment of a UTI; it is increased during underlying uropathy
lying.
III. PROPHYLAXIS
‹ If your child is not yet potty trained, change them frequently.
layer.
‹ When teaching your daughter about potty training,
to wipe from front to back to avoid bacteria
its rectum comes into contact with its urinary tract.
‹ At bath time, avoid bubble baths and soaps.
fragranced, which can irritate the urethra.
‹ Teach your child not to hold back when they feel the urge.
urinating: regularly emptying your bladder helps to avoid the
proliferation of bacteria in the bladder.
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‹ Prevent your child's chronic constipation, as this
Condition is often associated with recurrent urinary infections.
∑ Does circumcision prevent urinary infections?
The prevention of urinary infections is one of the reasons mentioned in
favor of circumcision. Some studies indeed indicate that this
surgical intervention could reduce the frequency of infections
urinary issues in boys under 1 year old.
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SECOND PART:
OUR STUDY
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CHAPTER I :
MATERIAL AND METHODS
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I. MATERIAL
1. TYPE AND LOCATION OF THE STUDY
This is a cross-sectional descriptive study. This study is
conducted at the medical microbiology laboratory of the Pasteur Institute
Ivory Coast in Abidjan.
2. STUDY PERIOD
This study took place over a period of three months, from June to August.
2019.
3. STUDIED POPULATION
This study concerned:
Patients who presented at
laboratory of
Medical Microbiology of the Pasteur Institute of Côte d'Ivoire at
Abidjan for the submission of a urine sample and this in the
in the context of a clinical suspicion of a urinary infection. These patients
previously consulted a doctor or a general practitioner, and have
were redirected to the laboratory.
- Hospitalized patients at the Cocody University Hospital and the
urology department patients.
3.1. Inclusion criteria
The inclusion criteria selected for the study subjects:
Patients presenting signs of a urinary infection (mentioned
in the information sheet).
3.2. Exclusion Criteria
Patients whose report does not mention the urine culture.
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II. METHODS
SAMPLING
Our population consists of 265 outpatients and hospitalized patients.
for some at the CHU of Cocody and patients from the urology department, who
appeared at the microbiology laboratory of the Pasteur Institute of
Cocody.
2. DATA COLLECTION
For each patient, we reported on an information sheet.
(see appendix A) the epidemiological data concerning:
Sample number;
-Sex;
The age;
-The patient's origin *Hospitalization or not;
Aspect
Flower;
-Gram ;
-Shapes of bacteria;
The associated pathologies;
Antibiogram
Treatment received.
3. DATA ENTRY AND STATISTICAL ANALYSIS
We have established a database using Microsoft Excel where
the epidemiological data, as well as the results of the urine culture have been
postponed to conduct the statistical analysis. The entered data allowed
to establish graphical representations, comparisons of
proportions.
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4. URINARY SAMPLING MATERIAL
To carry out the urine collection, we used the equipment.
following:
∑ The sterile pot for urine culture: for children and adults
Figure 7: Sterile pot for urine culture
4.1. Samples
During the study period, we collected 265 samples.
4.2. Laboratory Equipment
For the realization of this study, we used the following materials:
Gloves;
Plateau
Display stand;
Hemolysis tubes;
Reactive strips for urinary culture;
Pasteur pipettes;
Petri dishes with agar;
Optical microscope;
- Blade (26*76 mm) ;
Automatic pipette;
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Pipette tips;
- Bec bunsen ;
Oven set to 37°C.
4.3. Culture media
The culture media used in the study are:
∑ Nutrient agar: Basic medium that allows for the cultivation of
non-demanding bacteria.
∑ MacConkey Agar
Mac Conkey agar is a selective medium for the isolation of
Enterobacteriaceae. Indeed, it contains selective agents that
inhibit the development of Gram-positive bacteria: crystal
violet and bile salts.
The identification orientation is based on the use of the Portoir
reduced from Leminor.
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5. METHODOLOGY OF THE STUDY
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6. WITHDRAWAL
∑ Preparation of the patient:
VFor the infant:
For the young child, a specific sterile collector (bag) must be used.
sterile adhesive). This single-use device tailored to the anatomy is
after careful disinfection of the baby's urogenital area and
can be left in place for no more than 30 minutes. After this time, if
the child has not urinated, the device is removed and replaced by a
new collector. Once the urination is complete, the collector is removed and the
urines are carefully transferred into a sterile bottle then
quickly routed to the laboratory.
VFor the child and the adult:
Ask him to perform a genital-urinary wash with water and soap.
and to rinse well, explaining to him how to do it:
Ask him to wash his hands
Ask him to do a thorough intimate wash going from the
pubis towards the anus.
Ask him to discard the first few drops of urine and to collect
the midstream of the first morning urine, in the bottle
sterile without putting fingers inside and doing
be careful not to contact the bottle with the area
genital.
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∑ Transport to the laboratory:
VTransport to the laboratory as quickly as possible possible, or
keep at 4°C in a cooler if the time exceeds 1 hour.
Identify the sample and place it on the metal tray.
provided for this purpose.
Fill in the patient information: the information sheet
must be filled out to better guide the course of the ECBU
especially if we have a negative cytology.
7. MACROSCOPIC EXAMINATION
During this exam, we will note the following data:
Couleur : jaune clair, jaune citrin, rouge ...
Aspect: presence of trouble or not
Scent: so special
• Biochemical test:
This test is conducted to test the following parameters:
PH
Presence of albumin
Presence of acetone
Presence of nitrite
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Figure 8: Urine biochemical test (reactive strip)
8. MICROSCOPIC EXAMINATION
It is both a qualitative and quantitative examination; the sample is examined.
in optical microscopy for :
8.1 The quantitative examination
∑ Direct examination in the fresh state
This test is done by placing two drops of urine spread between
a blade and a slide without staining, then examine under a microscope at
the goal 40. It allows to specify the existence of microorganisms in
urine: red blood cells; leukocytes; casts; crystals, their mobility, and
estimate their number and isolate those responsible.
But this test must obviously be complemented by the staining of smears.
(Gram).
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Figure 9: Microscopic examination of urine
8.2 The qualitative examination
∑ Gram staining
This examination remains essential by providing information.
immediate information to the clinician about the type of bacteria involved enabling
to adapt the treatment. This staining allows for the study of the
morphology of germs and differential Gram followed by culture
systematic on appropriate medium.
Figure 10: Gram Staining
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9. CULTURE
Cultivation must meet a dual objective: isolation and
numbering of bacterial species. It is the only method that
allows for the exact identification of microorganisms that
colonize urine. A very large majority of bacteria
urinary infection agents are not demanding and
are cultivated on ordinary agar, nutrient agar (NA). In
At first, the seeding is done by taking a
drop of the sample that is deposited on the surface of the GN at
to sow. It allows:
∑ Bacterial identification
∑ The counting of germs
∑ Production of the antibiogram
Procedure: Culturing the sample by spreading a volume
urine sample (10 µl) on a Petri dish containing agar
nutrient and a MacConkey agar, then we must place them in
incubate at 37°C for 24 or even 48 hours if necessary, the continuation of
the analysis
microbiological
depends
of
the interpretation
cytobacteriological.
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Figure 11: Urine Seeding
10. IDENTIFICATION
It involves performing biochemical tests by a method
specific to each germ family.
For identification, the technique to be used derives from the morphology of
colonies (size, pigmentation), completed if necessary with a staining of
Gram and the search for biochemical characters (the oxidase and of the
catalase.
The limited number of microbial species involved simplifies the choice of
the shopping gallery to use. The counting of colonies is done afterwards
24h of incubation at 37°C, following the same principle as figure 11:
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Figure 12: Bacterial counting on urinary culture
Note: The absence of culture when bacteria have been seen in the examination.
directly, in a patient not treated with antibiotics must
to require a redo of the urine culture.
11. ANTIBIOGRAM
∑ Seeding:
From a 24-hour culture on non-selective agar medium, prepare a
suspension in Mueller-Hinton broth.
Seeding is done by: The reference method and the most widely used
is the method by diffusion in gelled medium.
It relies on swab seeding of a suspension
bacterial density known and standardized (0.5 Mcfarland), we
then dispose of the disks loaded with antibiotics and we incubate this
box in an incubator at 37°C.
After 24 hours, we read the various inhibition diameters and we can
to conclude by comparing these to the reading charts.
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Figure 13: Antibiogram
∑ Interpretation of the antibiogram:
The reading abacuses are presented in the form of bands showing
two data points that delimit the areas:
VThe bacteria is destroyed by the antibiotic at concentration
elevated.
VIntermediate: the bacteria are sensitive to the tested antibiotic but to
a low concentration.
VResistant: The tested antibiotic has no effect on the strain.
bacterial.
A report of the measured diameter on the box allows us to conclude
quickly.
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∑ Here is an example of the antibiogram reading table for
enterobacteria (Concentrations and critical diameters for
the various classes of antibiotics) :
Figure 14: Concentrations and critical diameters for various
classes of antibiotics for enterobacteria.
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CHAPTER II:
RESULTS
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I. CHARACTERISTICS OF THE GENERAL POPULATION
1. DISTRIBUTION OF TOPICS BASED ON GENDER

Figure 15: Distribution of subjects by sex

According to sex, 160 patients or 60% are male, and 105 patients or
40% are female, with a male-to-female sex ratio of
0.64
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2. DISTRIBUTION OF TOPICS BY AGE GROUP

Figure 16: Distribution of subjects based on age range

5% of our population consists of children and 95% of adults.
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II. DISTRIBUTION OF SAMPLES ACCORDING TO CULTURE RESULTS

Figure 17 :
Distribution of samples according to the culture result.
After inoculation on nutrient agar, 21% of the samples have
positive results, 67% of samples were negative. The samples
soiled 10% (contaminated) contained a polymicrobial flora, so a
new samples were necessary, and 2% of the isolated germs could not be
highlighted.
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III. CHARACTERISTICS OF THE POPULATION WITH URINARY INFECTION

Figure 18: Prevalence rate of urinary infection

Among the 265 patients included in our study, 56 developed an infection.
urinary confirmed by direct examination and culture, with a prevalence rate of
24%.
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1. DISTRIBUTION OF URINARY INFECTION CASES BY GENDER

Figure 19: Distribution of patients with a urinary infection based on

sex
For urinary infections, 61% are female and 39% are male.
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2. DISTRIBUTION OF PATIENTS WITH URINARY INFECTION ACCORDING TO
THE AGE

Figure 20: Distribution of patients with a urinary infection based on

age group
7% of children and 93% of adults are affected by urinary infections.
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3. DISTRIBUTION OF PATIENTS WITH URINARY INFECTION BY
AGE AND GENDER

Figure 21: Distribution of patients with a urinary infection based on

age and gender
This distribution shows a male predominance among children,
unlike adults, there is a female predominance. This
The predominance of females is explained by the anatomy of the female urinary system.
which is composed of a short urethra that measures about 5 cm in length and
opens between the clitoris and the opening of the vagina in its vestibule. Its
the opening is insufficient to protect against vaginal contamination and of
rectum; as a result, there are often microbial contaminations with
inflammatory irritations. Unlike that of man, which measures about
20 to 25 cm which decreases the risk of urinary infection. The effect of secretions
prostate-related provides additional protection for men.
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[Link] OF GERMS RESPONSIBLE FOR URINARY INFECTION

Figure 22: Distribution of urinary infections in children and adults

There is a predominance of [Link] with a rate of 27%.
This can be explained by the fact that this species is the most dominant in the flora.
intestinal and that it can migrate to the intestine and then to the urinary tract.
Furthermore, [Link] is part of fecal coliforms, so a poor cleaning of
The intimate area can easily cause the entry of bacteria into the bladder.
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5. THE RESISTANCE OF ENTEROBACTERIA TO ANTIBIOTICS
When a bacterium is isolated from a sample, its sensitivity to
antibiotics should be sought. This test is crucial, it allows for the selection of a
appropriate antibiotic for treatment. The determination of the activity of
antibiotics is performed by the diffusion method on agar (Mueller
Hinton), and the interpretation was made according to the standards of the Committee of
the antibiogram of the French Society of Microbiology (CASFM).
During our study, we sought to determine the sensitivity and resistance.
microorganisms identified with different antibiotics.

Figure 23: The resistance of enterobacteria to antibiotics

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5.1 The resistance of E. coli to antibiotics

Figure 24: The resistance of [Link] to antibiotics

In our study, we found E. coli resistance to Amoxicillin (94%), sensitive to
Ciprofloxacin
lmipeneme (100%), and Fosfomycin at 97%. Regarding Cefoxitin,
bacteria express the same value of 94% sensitivity.
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5.2 The resistance of Klebsiella pneumoniae to antibiotics

Figure 25: The resistance of Klebsiella pneumoniae to antibiotics

The strains were resistant to Amoxicillin and Ticarcillin however they
are sensitive to 87% to Gentamicin, and to Cefazolin at 75%.
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5.3 The resistance of Staphylococcus aureus to antibiotics

Figure 26: The resistance of Staphylococcus aureus to antibiotics

The isolated strains were resistant but also sensitive to
cotrimoxazole
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5.4 The resistance of Pseudomonas aeruginosa to antibiotics

Figure 27: The resistance of Pseudomonas aeruginosa to antibiotics

The strains were resistant to Ceftazidime, Ticarcillin at 100%, and sensitive to
Tobramycin, and Gentamicin at 100%.
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5.5 The resistance of coagulase-negative Staphylococcus to
antibiotics

Figure 28: The resistance of coagulase-negative staphylococcus to

antibiotics
The strains were resistant to Cefoxitin and Fosfomycin (100%) by
they were sensitive to other antibiotics such as the
Rifampicin,
and Ciprofloxacin (100 %).
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5.6 The resistance of Enterobacter aerogenes to antibiotics

Figure 29: The resistance of Enterobacter aerogenes to antibiotics

The bacterium was resistant to Amoxicillin and Cephalotin at 100% and by
she is sensitive to Ticarcillin (57%) and Piperacillin (
55 %).
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5.7 The resistance of Group B Streptococcus to antibiotics

Figure 30: The resistance of Streptococcus B to antibiotics

The strain was resistant to Penicillin, Rifampicin, Tetracycline, and
Clindamycin (100%) but sensitive to Ampicillin and Cefotaxime (100%).
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5.8 The resistance of Enterococcus faecalis to antibiotics

Figure 31: The resistance of Enterococcus faecalis to antibiotics

The strain was 100% resistant to Oxacillin, Lincomycin, and Colistin.
most sensitive to Amoxicillin at 94%.
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CHAPTER III:
DISCUSSION
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The presence of leukocyturia equal to or greater than 1000/ml with or
without hematuria and a bacteriuria allowed us to make the diagnosis
of a urinary infection. The isolation of germs on media of
appropriate cultures were made after Gram staining.
We have identified the germs isolated by their characteristics
morphological, cultural and biochemical
The study of the sensitivity of isolated bacteria was conducted by the technique
gel diffusion.
After carefully conducting the analysis of the patients
included in our study, as well as in the antibiogram results obtained, it
It is now a matter of discussing the results in order to understand the
complexity of UIs in these.
‹ In our study, the prevalence of urinary infections among the
the child rate is 7%. This rate is a bit lower than the one found
in a study conducted by SIBY F.B in 1992 in Mali with a
prevalence of 9.5%.
Our study shows that the prevalence of urinary infections in
The percentage of adults is 93%. This rate is higher than that of children at 7%.
Among male children, the percentage of infection is 5%
On the other hand, the female sex accounts for 2%; but is predominant among the
male patients (5%) than female patients
(2%), these results are contrary to those found by the Dr
BELARMAIN in his study conducted in Kongo in 2010 or the
The predominance was at the level of female children (73.5%)
This predominant rate of infection in male children
(22.90%) could be explained by non-circumcision or circumcision.
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late as well as the lack of care for the children, and a poorly managed foreskin
cleaned risk factor of UTI.
‹ The urine analysis showed a positive culture with presence
of leukocyturia (24%) in patients, the presence of a reaction
inflammatory without bacteriuria can be explained either by:
Concentrated urines by dehydration.
During an irritation related to the presence of a catheter.
The presence of stones or foreign bodies in the ducts
urinary.
During a non-bacterial infection (Candida).
A urethritis.
A urinary infection decapitated by prior antibiotic therapy.
An erratic and repeated antibiotic treatment can be responsible.
an imbalance of the digestive flora and lead to:
Often the chronicity and repetition of urinary infections
(recurrent urinary infection), this is explained by the fact that
this anarchic taking leads to a destruction of the flora
commensal microbe by promoting colonization by
pathogenic germs.
Antibiotic resistance
‹ Finally, on the contrary, we received samples for which
the cytology was negative, but the culture positive, these cases
could be explained:
By an initial contamination of the sample
Due to poor transportation conditions
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The urinary collection of a infant: indeed, in the
in infants, an active urinary infection can often be found,
which is in no way accompanied by the inflammatory reaction
habitual, this is explained by the immaturity of the immune system
of a newborn.
From a diabetic subject: indeed, in diabetic individuals, in
more likely to be much more sensitive to urinary infections because
the latter are favored by the presence of glucose in the
urines, these often present infections without reaction
associated inflammatory.
Kidney failure can be a factor during a urinary infection.
risk, or a consequence:
‹ Kidney failure leads to a significant alteration of
volume of urine eliminated, and therefore promotes proliferation
microbial.
‹ Untreated UTI causes long-term kidney failure.
The results of the predominance of enterobacteria in this study
with [Link] at 27% are in agreement with those of Guenifi and Keghouche
but at lower rates that only found enterobacteria
in the hospital-health establishment of Sidi Mabrouk in Constantine,
with 80% of women infected by E. coli. This is the result of the
strong colonization of the perineum by bacteria from the flora
digestive but also by the ability that these bacteria have to
colonize the urinary tree thanks to the presence of specific factors
uro-pathogenicity (adhesins, ureases…). But what must be retained
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from our study, it is indeed the rate of antibiotic resistance of
isolated strains.
Indeed, in Ivory Coast as in other countries, the resistance of
germs continue to increase, which is a real problem
of public health.
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CONCLUSION
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Urinary infections are extremely common in the community.
hospital and community. They come after the infections
respiratory, to second rank of reasons for consultation and
prescription for antibiotics.
They can often become complicated by pyelonephritis and septicemia.
The work we have done consisted of determining the
paraclinical, epidemiological, and biological characteristics of
urinary infection in children and adults. As well as sensitivity to
antibiotics with a view to contributing to the improvement of care management
of this pathology and to avoid the consequences on the kidney which is a
noble organ and in full growth.
The cytobacterial examination of urine remains the most
important in the diagnosis of urinary infections as it allows
to adjust the antibiotic therapy.
Prevention is the best way to avoid these infections, limit
especially their complications and their economic impact, while respecting the
hygiene measures and reducing high consumption of
antibiotics.
In perspective, our study remains preliminary and the theme remains open.
for future studies, we suggest:
‹ Conduct a large-scale study and even at the national level.
‹ Take into account the risk factors of a UTI above all.
antibiotic therapy although the probability of UTI is extremely
weak.
‹ Study of the resistance of the strains involved in the urinary tract infection.
antibiotics.
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BACTERIOLOGICAL STUDY OF URINARY INFECTIONS FROM JUNE TO AUGUST 2019 AT THE CLINICAL BACTERIOLOGY UNIT
FROM THE PASTEUR INSTITUTE OF ABIDJAN
RECOMMENDATION
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BACTERIOLOGICAL STUDY OF URINARY INFECTIONS AT THE CLINICAL BACTERIOLOGY UNIT FROM JUNE - AUGUST 2019
At the PASTEUR INSTITUTE OF ABIDJAN
In light of what has been gathered on the ground, it seems wise to us
to make certain recommendations aimed at improving the work of
medical biology technician
At the Ministry of Health and Public Hygiene:
Organize campaigns to raise public awareness
on urinary infections.
To the directors of the hospital centers:
Emphasize awareness on hygiene in health centers;
Recruit competent personnel for the sanitation of centers
Strictly adhere to hygiene measures (hand washing,
wearing sterile gloves).
To the technicians:
Working in time;
Respect the conditions for receiving samples;
Follow the procedure scrupulously.
To the parents:
Emphasize the monitoring of children's property;
Avoid the anarchic use of antibiotics.
To the population:
Consult in case of any urinary trouble;
Drink plenty of water in anticipation of potential prevention.
constipation, a contributing factor to urinary stasis;
Clean the intimate area of the genitals towards the anus (for the
women, especially), urinate with every sexual intercourse.
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BACTERIOLOGICAL STUDY OF URINARY INFECTIONS AT THE CLINICAL BACTERIOLOGY UNIT FROM JUNE TO AUGUST 2019
At the PASTEUR INSTITUTE OF ABIDJAN
REFERENCES
BIBLIOGRAPHIC
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BACTERIOLOGICAL STUDY OF URINARY INFECTIONS FROM JUNE TO AUGUST 2019 AT THE CLINICAL BACTERIOLOGY UNIT
FROM THE PASTEUR INSTITUTE OF ABIDJAN
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Medical Biology Technician Thesis Class of 2016-2019
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AT THE PASTEUR INSTITUTE OF ABIDJAN
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At the PASTEUR INSTITUTE OF ABIDJAN
Consensus Conference co-organized by SPILF and AFU.
Nosocomial urinary infections in adults. Nov 2002. p.6. [18] Mariani-
Kurkdjian P. Physiopathology of urinary infections. Mt
Pediatrics 2004; 7: 167-72.
Véronique Chaouat: Doctissimo, according to the source of Tarek Msadek,
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pathogens, Department of Microbiology Pasteur Institute Created on the 18
August 2014.
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BingenE. Comparative prevalence of virulence factors in
Escherichia coli causing urinary tract infection in male infants with and
without bacteremia. J Clin Microbiol 2006;44:1156–8.
FERRY S., BURMAN L.G., HOLM S.E.: Clinical and bacteriological
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At the PASTEUR INSTITUTE OF ABIDJAN
[24] Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA,
Palatnik LP, et al. Antibiotic resistance in outpatient urinary isolates: final
results from the North American Urinary Tract Infection Collaborative
Alliance (NAUTICA). Int J Antimicrob Agents 2005;26:380–8.
[25] Edlund C, Nord CE. Effect on the human normal microflora of oral
antibiotics for treatment of urinary tract infections.
Antimicrobial Chemotherapy 2000;46 Suppl 1:41–8.
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associated with antibiotic resistance in coliform organisms from
community urinary tract infection in Wales. J AntimicrobChemother
2001;47:305–13.
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to third-generation cephalosporins at the Armand hospital
Trousseau. Parisian Days of Pediatrics: October 9 and 10. Paris:
Flammarion Medicine-Sciences 2004 p. Abstract.
Loirat C, Mariani-Kurkdjian P, Bingen E. Treatment of
acute pyelonephritis. Parisian pediatric days: October 7 and 8.
Paris: Flammarion Medicine-Sciences 2000 pp. 303-13.
Goldstein FW. Antibiotic susceptibility of bacterial strains isolated.
from patients with community-acquired urinary tract infections in France.
Multicentre Study Group. Eur J Clin Microbiol Infect Dis 2000;19:112–7.
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At the PASTEUR INSTITUTE OF ABIDJAN
[30] Philippon A, Jarlier V, Legrand P, Fournier G, Nicolas MH, Duval J.
Antibacterial activity of cefixime according to the type of beta-lactamase
Enterobacteria. Presse Med. 1989;18:1560–6.
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of antimicrobial-resistant urinary Escherichia coli isolates to
fluoroquinolones and nitrofurantoin. Clin Infect Dis 2003;36:183–7.
Consensus conference co-organized by the Society of
French Language Infectious Pathology (SPLIF) and the Association
French Association of Urology (AFU). Nosocomial urinary infections. Paris
Institut Pasteur, 2002.
The 2008 recommendations of the AFSSAPS (French Agency for Health Safety of Health Products)
health product safety): Diagnosis and antibiotic therapy
community-acquired bacterial infections in adults.
The recommendations of the SPILF (French Society of Infectious Pathology)
French Agency for the Safety of Health Products
Nosocomial urinary infections in adults, 2002.
Practice parameter: the diagnosis, treatment, and evaluation of the
initial urinary tract infection in febrile infants and young children. American
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Royal Children’s Hospital. Urinary Tract Infection Guideline. 2004.
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AT THE PASTEUR INSTITUTE OF ABIDJAN
Urine culture from
Bag specimens in young children: are the risks too high? J
Pediatr2000;137:221–6.
Dr. Marrhich: Chartier E. Urinary infections (Generalities). Med-Line,
2nd edition, 31-36, 2001.
Thesis of DR. TIOUIT * Urinary infection * in Algeria 2007
Dr. Bouchra Marrhich "antibiotics"
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Author Pierre Cochat - (Edouard-Herriot Hospital - Lyon) Campus
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[43] KOUADIO K. Nosocomial urinary infections: studies
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Cavallo J., Garrabé E. Tools for the biological diagnosis of infections
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CHAMPETIER D. Urinary tract infections. International Impact
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At the Institut Pasteur of Abidjan
Bacterial and fungal urinary infections
the subject HIV positive. Med Thesis. Abidjan, 1996; 1778.
KOUAKOU K A. Studies on urine cultures conducted in Abidjan
1978 to 1982: the germs encountered and their sensitivity to antibiotics
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Dr. Jean Turgeon, pediatrician, Team Born and Grow, March 2015
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VEYSSIER P. Infection in the elderly. Med Press 1997; 26:
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Guenifi S. and Keghouche N., 2014. Urinary tract infections in the
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At the PASTEUR INSTITUTE OF ABIDJAN
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AT THE PASTEUR INSTITUTE OF ABIDJAN
TABLE OF CONTENTS
I. GENERAL INFORMATION ON URINARY INFECTIONS...................... 6
1. Definition of a Urinary Infection ................................................ 6
2. Classification.............................................................. 6
3. Epidémiologie.............................................................................. 6
4. Etiology
5. Anatomical rappel: .................................................................... 8
6. Pathophysiology......................................................................... 9
6.1 Origin of the infection .............................................................. 9
6.2 Related to the bacteria:.................................................................. 9
6.3 Related to the host:........................................................................ 10
7. Pathological
8. Bacterial Resistance............................................................. 11
II. DIAGNOSIS OF URINARY INFECTIONS............................ 13
1. Paraclinical diagnosis: ................................. 13
1.1. Withdrawal:.................................................................... 13
1.2. Transport and storage of samples: ...................... 15
1.3. Information accompanying the collection:............... 15
2. Diagnosis of urinary infection using reactive strips: 16
3. Diagnosis of urinary infection by cytobacterial examination
urine tests: ECBU .......................................................................... 18
4. Differential diagnosis: .............................................................. 25
5. Evolution : ................................................................................. 25
III. PROPHYLAXIS......................................................................... 26
I. MATERIAL................................................................................... 30
1. Type and location of the study .............................................................. 30
2. STUDY PERIOD ............................................................ 30
3. Study population............................................................ 30
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II. METHODS................................................................................. 31
1. Sampling......................................................................... 31
2. Data Collection................................................................. 31
3. Data Entry and Statistical Analysis ............................... 31
4. Urine collection materials ................................. 32
5. Study Methodology ............................................................ 34
6. Collection: ............................................................................ 35
7. Macroscopic examination:.......................................................... 36
8. Microscopic examination: ........................................................... 37
9. culture : ..............................................Error! Bookmark not defined.
10. Identification : ......................................................................... 40
11. Antibiogram: ..................................................................... 41
I. GENERAL CHARACTERISTICS OF THE POPULATION
GENERAL .................................................................................... 45
1. Distribution of subjects by gender ................................ 45
2. Distribution of subjects by age range .................. 46
3. Distribution of subjects according to hospitalized/outpatient status..Error!
Undefined sign.
4. The taking of antibiotics...................Error! Undefined bookmark.
II. CHARACTERISTICS OF THE POPULATION WITH INFECTION
URINARY ......................................................................................... 48
1. Distribution of urinary infection cases by gender ................ 49
2. Distribution of patients with urinary infection by age. 50
3. Distribution of patients with urinary infection according to age and
the sex : .......................................................................................... 51
4. Distribution of patients with urinary tract infection according to status
hospitalized/outpatient...................................Error! Bookmark not defined.
5. The results of cytology and culture Error! Bookmark not defined
defined.
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CHAPTER III: DISCUSSION
CONCLUSION ..........................................................................................61
RECOMMENDATION................................................................................63
BIBLIOGRAPHIC REFERENCES......................................................65
TABLE OF CONTENTS .........................................................................73
ANNEXES.................................................................................................76
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ANNEXES
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BACTERIOLOGICAL STUDY OF URINARY INFECTIONS AT THE CLINICAL BACTERIOLOGY UNIT FROM JUNE TO AUGUST 2019
At the Pasteur Institute of Abidjan
ANNEX 1
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AT THE PASTEUR INSTITUTE OF ABIDJAN
ANNEX 2
INVESTIGATION FORM
THEME: BACTERIOLOGICAL STUDY OF URINARY INFECTIONS
AT THE CLINICAL BACTERIOLOGY UNIT FROM JUNE TO AUGUST
2019 AT THE PASTEUR INSTITUTE OF ABIDJAN
patient_number
External internal service:
Sexe
FemininecMasculinec
..............
Change frequency of the layer:
Type of infection:
Nosocomial
Community
He has already had this infection:
Clinical sign:
Yesc Noc
Fever
c
c
c
Burning urination c
Pelvic
Abdominal painc
Diarrhea
Paleness
c
Vomitingc
Lower back pain
Polyurethane
c
c
Hematuria
Pain
c
c
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AT THE PASTEUR INSTITUTE OF ABIDJAN
Associated pathologies:
What treatment did he receive?
Sequel:
Result
NocYesc
Macroscopic aspect:
Cytology:
Culture :
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