Determination of Urinary Tract Infections aand Antibiotic Sensitivity among Non-Insulin Dependent Diabetes Mellitus Patients Visiting Kisii Teaching And Referral Hospital, Kenya
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Date
2018
Authors
Mogaka, Mageto Vincent
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
People with non-insulin dependent diabetes mellitus have been found to be
prone to urinary tract infections. There is a wide gap of information in
developing countries regarding the prevalence and antibiotic sensitivity of the
pathogens causing urinary tract infections in diabetic patients. Developed
nations also face a relatively huge burden of managing urinary tract infections
among non-insulin dependent diabetics. The objective of this study was to
determine the prevalence and antibiotic sensitivity of bacteria causing urinary
tract infections among non-insulin dependent diabetic patients as well as
determining the bacterial causative agents of urinary tract infections through
biochemical confirmatory tests. The study was carried out in Kisii Teaching
and Referral Hospital in Kisii County, Kenya. One hundred and eighty diabetic
patients were enrolled in a cross-sectional study design. Clean catch midstream
urine was collected from all participants and cultured in cysteine lactose
electrolyte deficient agar for bacteria isolation. The isolates were later cultured
in Mueller Hinton for antibiotic sensitivity testing. Classification of a positive
culture for urinary tract infection was based on more than 100,000 (≥105)
colony-forming units of a single bacterial species. All the data was extracted
and analyzed with the statistical package for the social science (SPSS) version
20. The data was analyzed using frequencies, chi square (P<0.05) and logic
regression to find the odds ratio. One hundred and seven participants were male
(59.4 %) and 73 (40.6 %) were female. Sixty-three participants (35 %) showed
symptoms of urinary tract infections. The overall prevalence of urinary tract
infections was 20.6 % with 37 participants testing positive for urinary tract
infection. The duration of diabetes mellitus was revealed to be significant
(p=0.01) while age was also found to have a significant association with
urinary tract infection (p=0.002). Out of the 37 (100 %) isolates, 35 (94.6 %)
were gram negative and the remaining 2 (5.4 %) were gram positive.
Escherichia coli was the most predominant isolate with 21 (56.8 %) isolates
followed by 10 (27 %) isolates of Klebsiella pneumonia and then 4 (10.8 %)
isolates of Proteus mirabilis. There were two (5.4 %) isolates of Enterococcus
faecalis. Out of the 21 E. coli isolates, five isolates showed resistance to
ampicillin, three isolates were resistant to nitrofurantoin and three isolates were
resistant to co-trimoxazole. Out of 10 K. pneumoniae isolates, two were
resistant to ampicillin, one was resistant to cephalexin and two were resistant to
co-trimoxazole. Out of the four P. mirabilis isolates, there were three cases
where one strain was each resistant to ampicillin, nitrofurantoin and cotrimoxazole.
All 21 isolates of E. coli (100 %) were sensitive to gentamicin and
cephalexin. All ten K. pneumoniae isolates (100 %) were sensitive to
gentamicin and nitrofurantoin. These findings suggest an increasing antibiotic
resistance among pathogenic causative agents of UTI among non-insulin
dependent diabetic patients. A longitudinal study is recommended with a
higher number of participants, in order to understand the risk factors of urinary
tract infection among diabetic patients
Description
A Thesis Submitted in Partial Fulfilment Of the Requirements for the Award of the Degree of Master of
Science in Infectious Diseases (Bacteriology) In the School of Medicine of Kenyatta University. October, 2018