Urinary Tract Infections Caused by Enteric Bacteria and Antibiotic Sensitivity among Symptomatic Males Visiting Special Treatment Center, Nairobi City County, Kenya

Abstract

Urinary tract infections are not as common in men as they are in women. However, when present, they are considered to be indicative of serious urological abnormalities and thus considered to be complicated infection in men. They can either be typical or atypical. Typical irritative lower urinary tract infection can be presented by most men with clinical symptoms such as frequency or urgency in micturition, nocturia, dysuria, and hematuria. The less common atypical urinary tract infection presents with clinical symptoms such as confusion, urine incontinence and is highly associated with elderly men. Due to the stigma and denial associated with urinary tract infections, male patients with urinary tract infections self-diagnose and use over the counter antibiotics leading to the mismanagement of disease and increase in antibiotics resistance. The study aimed at investigating the prevalence of urinary tract infections caused by enteric bacteria and antibiotic sensitivity among symptomatic male patients visiting special treatment center, in Nairobi, Kenya. A cross-sectional study was carried out among three hundred and eighty-four (384) male patients attending the special treatment center. The male participants were selected using systematic random sampling technique. Aseptic procedure of urine collection was explained to the patient and 10-15ml mid-stream urine sample collected. Urinalysis using dipstick was done, followed by culture on CLED and blood Agar. Kirby Bauer disc diffusion technique for antibiotic sensitivity was done using Ofloxacin, cefaclor, nitrofurantoin, Nalidixic acid, Augmentin, cefuroxime, minocycline, ciprofloxacin and gentamicin. Data was cleaned, coded and entered into the computer and analyzed using Statistical Package for Social Science software version 23. Both descriptive and inferential statistical test techniques were used and the output presented using tables and charts. The prevalence was 65.6% calculated based on the proportion of participants with UTI during the study period. The Gram negative bacteria isolated were: Escherichia coli, Klebsiella pneumonia, Proteus mirabilis and Pseudomonas aeruginosa while Gram positive were Staphylococcus aureus and Staphylococcus saprophyticus. The most frequent bacteria isolated was Escherichia coli (42%) and the least was P. aeuruginosa (4.7%). The occurrence of urinary tract infections was noted to be most common between the ages of 20-29 years. There was moderate relationship between P. mirabilis, S. saprophyticus and age (r= 0.698, r=0.85). There was also a slight statistical significance between age and S. aureus (p=0.046). The most effective antibiotic to all bacteria was ofloxacin and the isolates exhibited resistance to nitrofurantoin, augmentin and nitrofurantoin. Sensitivity of P. mirabilis was 100% to cefaclor while P. aeruginosa was 100% resistance to all the drugs. All isolates demonstrated multidrug resistance to more than two drugs. The study therefore recommends a regular surveillance and research of antibiotic use in the management of UTI to avoid multidrug resistance which would otherwise impact on the increasing cost of care.