Guidelines for Antibiotic Therapy of Urinary Tract Infection in Acute Pyelonephritis, Bacteriuria in Adolescents

 

N. Sangeetha*

Assistant Professor, Department of Biochemistry, Kongu Arts and Science College, Erode- 638107,

 

ABSTRACT:

The term Urinary tract infection (UTI) encompasses a broad range of chemical entities that share are characteristics, a positive urine culture. UTI are detected by performing a urine analysis and the confirmed with a urine culture. If there are pathogenic bacteria present, these susceptibility testing is done to make sure that the antibiotic will have good activity against the micro -organism causing infections. The main objective of the present study was the various factors which influence the infection caused by bacteria, analyze the various diagnosis in the different tract infection area, the influence of microbes of media and to offer suggestions for the treatment of UTIs based on the study. Clean-Catch midstream urine of the patients was collected. Urine specimens were cultured for isolation of the microbial agents of UTI. The isolated bacteria were identified using biochemical tests. Disk diffusion susceptibility test was used to determine susceptibility of bacterial agents to antibiotics. Some non-laboratory test also proceed to detect UTIs are 1.Cystoscopy 2. Intravenous pyelogram. The structural abnormalities of GU tract showed the severity of bacterial infection. Chloramphenicol, Amikacin, Oflaxacin, Doxycycline, antibiotics were taken to test the antibiotics sensitivity in the urine samples from UTI infected patients. Among the four antibiotics Chloramphenicol and Doxycyline inhibits the most bacterial strains such as E. Coli, Klebsilla, Staphylococcus aureus and Pseudomonas were more effective. The bacteria in UTI are eradicated with the single dose of antibiotics. Combination therapy is used to treat recurrent infections to inhibit the growth of resistant strains where the effect of combination therapy of antibiotics was greater than the effect of single antibiotics. The cystocope and Pyelogram which are useful in diagnosis of UTI caused structural abnormality of recurrent UTI of bacteriauria. 

              

 

 

 

 

 

 

 

 

 

 

INTRODUCTION:

The term urinary tract infection (UTI) encompasses a broad range of clinical entities that are associated with one common finding, a positive urine culture. UTIs differ widely, degree of tissue invasion epidemiological setting requirements for successful anti -microbial therapy and propensity for recurrence. Clinical manifestations and responses to therapy are diverse when comparable of numbers of a particular bacterial species recovered from the urine culture. Therefore any evaluation of antimicrobial therapy for UTI must clearly consider as well as microbiological outcomes. The quantitative results of urine culture and urinalysis are the laboratory corner stones for establishing the presence of true infection and determining the efficacy of a particular antimicrobial regimen. In most circumstances, specimens for urine culture should be collected by the clean –catch mid-stream technique¹. The 90% of the uncomplicated infection is because of E.coli^2-3. These bacteria normally subside in the bowel and around the anus. These bacteria can move from the area around the anus to the opening at the urethra. The two most causes are poor hygiene and sexual intercourse. The infection can spread further as bacteria move up from the bladder via the uterus. If they reach kidney they can cause kidney serious infection of pyelonephritis⁴. The following bacteria that may causes UTI’s are proteussp, Klebsillasp, Pseudomonas sp, Enterococcussp and staphylococci. Acute uncomplicated UTI in men analogues to that acquiring in women is quite uncommon. In some cases it occurs in men 20-40 years of age. UTI‘s in men are also associated with such concomitant problems as prostatic hypertrophy, calculi, urinary obstruction and poor bladder. At present the usual therapy is a course of Trimethoprim sulphamethaxozole, Trimethoprim and carbenicillin are one of the newer fluoroquionolones for 2-6 weeks⁵. Eradication of infection from a prostatic focus is often particularly is difficult in patient with prostatic calculi. Long term therapy may be necessary for eradicating the prostatic source is preventing recurrent UTI. The aim of the study was to investigate microbial spe­cies isolated from patients with UTI and evaluate their in vitro susceptibility patterns to commonly used antimi­crobial agents.

 

MATERIALS AND METHODS:

Specimen Collection and Bacterial Isolates:

The container used for collection of urine should be chemically clear. First morning urine specimen bed is valuable for routine examination. Urine for bacteriological examination should be collected aseptically in the sterile container. Clean catch midstream urine samples (MSU) were collected in sterile disposable containers (4-5 ml) and transported immediately to the labora­tory. Clean catch urine sample by cleaning the genital area and midstream urine is preferred as it contains few contaminating bacteria. Urine samples were delivered to the laboratory within 1 hour of collection and processed within 2-4 hours. Urine specimens were subjected to general urine examinations using direct microscopy for white blood cell (WBC) counting.

 

 

Culture test:

Aloopful 0.01ml of urine sample was cultured on Cysteine Lactose Electrolyte-Deficiency (CLED) and Macconkey  agar medium and incubated for 24 h at 37˚C aerobically. Cultures without any colony at the end of 24h incubation were further incubated for 48h. Samples with colony count equal or more than 10⁵ Cfu/ml were considered positive. The isolates were identified and confirmed using standard microbiologi­cal methods including Gram staining, colonial mor­phology on media, growth on selective media, lactose and mannitol fermentation, H₂S production, catalase, oxidase, coagulase, indole, and citrate utilization, and urease          test ⁶.

 

Antimicrobial susceptibility testing:

Antimicrobial susceptibility testing was performed on Mueller-Hinton agar (Merck, Germany) using disk diffu­sion (Kirby Bauer’s) technique. The an­tibiotic discs and their concentrations consisted of Cephalexin (CPX, 30μg, Polfa, Tarchomin, Poland), Cefazolin (CF, 30μg, Polfa, Tarchomin, Poland) Ciprofloxacin(CP, 5μg), Gentami­cin (GM, 10μg), Ampicillin (AM,10μg), Trimethoprim-sulfa­methoxazole (SXT, 30μg), Amikacin (AM, 50μg) and, Nalidixic acid (NA, 30μg) for Gram negative isolates, and Chloramphenicol (C, 30μg, Bayer, Wuppertal, Germany), Ampicillin (AM, 10μg), Norfloxa­cin (NOR, 10μg), Gentamicin(GM, 10μg), (V, 30μg), Sparfloxacin (SF, 50μg), Doxycycline (DC, 30μg),Oflaxacin (OF 10μg) and Trimethoprim-sulfamethoxazole (SXT, 30μg) for Gram positive isolates all obtained from Hi media, India. E. coli is the most common causal agent of UTI. Proteus and Pseudomonasare the most difficult to control due to their resistant nature to antibiotic therapy. Mycobacterium tuberculosis causes a rare kidney function.  UTI was due to infection by a single genus and species of bacterium that makes examination easy.

 

Study of Cystoscope:

Two main types of cystoscope are used. Flexible cystoscope was carried out using local anesthesia on both sex. Usually lidocaine gel was used as anesthetic, instilled in urethra. Rigid cystoscopy can be performed under the same condition but it is generally carried out under general anesthesia, particularly in male, due to the pain caused by probe. Endoscopy of the urinary bladder via urethra is called cystoscopy. Cystoscopy involvesinsertion of thin, flexible tube with a tiny camera on the end through the urethra into bladder. This allowed detection of abnormality inside the bladder that might contribute to infection and urethra. The patients are able to eat normally and return to normal activity after the test. Urine sample was collected before the test to check for infection. Patient should avoid urinating for an hour before this part of the test. The area urethral around opening was cleaned and local anesthesia was applied. Cystoscope was gently inserted into the urethra and slowly glides up to the bladder. The following any one of the sterile liquid like water, saline or glycine water were used. X-ray pictures were taken several times. The dye goes through the urinary tract which was for taken in several positions and it was developed. The belts were usually used to block the passage of the dye through the urethra. During fluoroscopy a continuous X-ray beam was used to display a moving image on a video monitor.

 

Pyelogram:

An intravenous pyelogram (IVP) is an X-ray test that provides the picture of the kidney, the bladder, the uterus, and the urethra.  An IVP can show size, shape and position of the urinary tract. It could be evaluate the collecting system inside the kidneys. During IVP a dye called contrast material was injected into the vein in arm. A series of X –ray picture was taken at time intervals. The patient was asked to urinate just before one hour the test begins and to lie on patient back on an X-ray table. Picture of abdomen was taken and reviewed. The contrast material dye was injected in the vein and the dye travels intravenously through the blood stream was filtered out by the kidney and passed into the urine. Then the urine flows into the urethra.

 

RESULTS AND DISCUSSION:

Culture test:

A count of 1, 00,000 or more bacteria /ml of urine which may be caused by an infection implies that culture result is positive. The urine culture test is repeated if the bacterial was between 100-1, 00,000 which may be caused by infection or contamination of sample. If the antibiotics consumed already the count may be 100 or less than 100 which was indicated by plate -1 and 2

 

Antimicrobial susceptibility testing:

The patients with acute uncomplicated pyelonephritis require intensive chemotherapy. In cases of pyelonephritis a variety of parenteral combinations (Penicillin or cephalosporin plus an amino glycoside) and single drug regimens (Third generation cephalosporin and fluoroquinolone or Trimethoprim and sulphamethoxazole) are preferred. The antibiotic susceptibility was done to test the susceptibility to chloramphenicol when the causative organism tested by Kirby- Bauer method of this susceptibility a 30 mg of chloramphenicol should give the one of inhibition of 17mm to indicate susceptibility. The structural abnormality of UTI showed the severity of bacterial infection. Chloramphenicol, Amikacin, Ofloxacin, Doxycycline were taken to test the antibiotic sensitivity in the urine sample from UTI infected persons. Among the four antibiotics Chloramphenicol and Doxycycline inhibits the most bacterial strains such as E-Coli, Klebsilla, Staphylococcus aureus and Pseudomonas. The reports were shown in antibiotic sensitivity plate 3-6 and table-1. The antibiotics described above are recommended for the treatment of complicated lower UTI in single or combinational therapy which are described for 7-10 days. A urinary analgesic phenazopyridine are prescribed the pain associated with complicated UTI. Table 1 shows determination of antibiotic sensitivity of UTI –causing microorganisms.

 

Cystoscope:

The enlarged prostate gland can be seen to the cystoscope. The inflammation in the urinary tract caused by inflammation of bacteria can be identified with the symptoms like swelling or narrowing urethra because previous infection or enlargement prostate gland there are bladder tumors, ulcers, urinary stones or inflammation of the bladder walls. There may be abnormalities in the structure of urinary tract since congenital births are seen. Genital prolapse or pelvic organ prolapse are seen in woman.

 

Pyelogram:

The observations of pyelogram are the kidneys, ureters or bladder may be abnormal in position, size or shape. The contrast material takes longer than normal to reach a kidney. Abnormal growth, more cysts, an abscess and kidney stone are seen. Injuries to the kidney, ureter or bladder are seen. The prostate glands are too large in men.

 

CONCLUSION:

The various factors which influence the infection caused by bacteria were studied. The different diagnosis in various parts of the urinary tract infections was studied. The influence of microbes on culture media and suggestions for the treatment of UTI were studied. A different set evidence based guidelines were developed for antimicrobial treatment uncomplicated acute bacterial cystitis an acute pyelonephritis in adolescent UTIs.

 

Plate 1 Microorganism like Klebsilla, proteus grown in the blood agar medium

 

Plate 2 E.coli from the urine sample grown in the nutrient medium

 

 

Plate 3 Antibiotic sensitivity plate for E.coli

 

 

 

Plate 4 Antibiotic sensitivity plate for Psudomonas

 

 

 

Plate 5 Antibiotic sensitivity plate for Staphylococcus

 

 

 Plate 6 Antibiotic sensitivity plate for Klebsillasp

 

Table-1 Determination Antibiotic Sensitivity of UTI- causing microorganisms

Bacteria antibiotics	E-coli	Klebsilla	Staphylococcus aureus	Psuedo monas
Ampicillin	R	R	S	R
Amikacin	S	S	R	R
Co- Trimoxazole	-	R	R	R
Chloram phenicol	S	S	S	R
Cephalexin	R	R	S	-
Cefazolin	R	-	S	-
Ciprofloxacin	MS	R	S	S
Doxycycline	MS	MS	S	S
Gentamycin	MS	MS	S	-
Nalidixic Acid	R	R	S	-
Norfloxacin	MS	R	S	-
Sparfloxacin	S	MS	-	-
Oflaxacin	S	R	S	MS

Chloramphenicol>Doxycycline > Gentamycin >Oflaxacin–Sensitive, others are less sensitive for UTI’s. S-Sensitive, R- Resistance, MS-Most sensitive.

 

REFERENCES:

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2.       Pollack HM. Laboratory for detection of urinary tract infection and assessment of value. Am J Med 1983; 75 (18): 79-84.

3.       Foxman B, Manning SD, Tallman P, et al; Uropathogenic Escherichia coli are more likely than commensal E.colito be shared between heterosexual sex partners, Am J Epidemiol, 2002 Dec 15; 156 (12): 156(12): 1133-40.

4.       Mulvey MA Schilling JD, Hultgren SJ 2001. Establishment of persistent E.coli reservoir during the acute phase of bladder infection. Infect Immune., 69, 4572-4579.

5.       Rubin RH. Tolkoff- Rubin NE, Cotra RS. Urinary tract infection pyelonephritis, and reflux nephropathy. In: Brenner BM, Rector FC Jr, eds. The kidney.4^th ed. Philadelphia: WB Saunders, 1991: 1369-429.

6.       Murray Patrick, EllnBaron, James Jorgensen, Michael A Pfaller, Robert H Yorken, 2003 susceptibility testing methods yeast and filamentous fungi, manual of clinical microbiology 8th ed.Vol 2 American Society Microbiology press Washington DC.

 

 

 

 

Received on 02.02.2018       Accepted on 18.04.2018

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