The Isolation, Identification, and Antimicrobial sensitivity pattern of pathogens isolated from urinary tracts of Paraplegia and Quadriplegia patients at National Orthopaedic Hospital, Enugu was conducted on fifteen urine samples. Urine culture was done using Cysteine Lactose electrolyte deficient agar (CLED), Mac-Conkey agar, and Blood agar and incubated at 37^oC for 24 hours. The urine samples were screened for albumin presence using Combi-2 urinalysis dipsticks. Four microorganisms were isolated and identified by means of biochemical testing which included Gram stain, Oxidase test, Sugar fermentation test, IMVIC, motility test, Catalase test, Urease test and Coagulase test. Of the four (4) isolates, two were Gram-positive; one being Enterococcus Spp. with cocci shape while the other CornyebacteriumSpp. was rod shaped. The other two isolates were Gram-negative members of the Enterobacteriaceaefamily (Escherichia coli and Proteus Spp.). Enterococcus Spp.had the highest prevalence rate of 6 (37.5%); E. coli had the second highest frequency of occurrence at 5 (31.25%), CornyebacteriumSpp.had a lower rate occurrence at 3 (18.75%), followed by Proteus Spp. with the lowest rate of occurrence at 2 (12.25%). Antimicrobial susceptibility assay was carried out on the isolates. E. coli and Enterococcus Spp.had the highest resistance pattern; CornyebacteriumSpp. had a lower resistance pattern while Proteus Spp. had the lowest resistance pattern to the antibiotics. The Enterococci Spp.was susceptible to drugs like Amikacin, Chloramphenicol and Tetracycline. E. coli was susceptible to drugs like Chloramphenicol, Amikacin and Ciprofloxacin. CornyebacteriumSpp. was susceptible to Amikacin, Chloramphenicol, Ciprofloxacin and Tetracycline. Proteus Spp.was Ceftriaxone, Amikacin, Chloramphenicol, Ciprofloxacin, Sulfamethoxazoletrimethroprim and tetracycline. All isolated microorganisms were generally sensitive to Amikacin and Chloramphenicol antibiotics showing thus to be active in-vitro.

TABLE OF CONTENT

Title page - - - - - - - - - i

Approval page - - - - - - - - - ii

Dedication - - - - - - - - - iii

Acknowledgement - - - - - - - - - - iv

Table of content - - - - - - - - - - v

List of tables - - - - - - - - - vii

List of figures - - - - - - - - - viii

Abstract - - - - - - - - - ix

Chapter One

1.0 Introduction - - - - - - - - - 1

1.1 Aim - - - - - - - - - 3

1.2 Objective - - - - - - - - - - 3

Chapter Two

2.0 Literature review - - - - - - - - - 4

2.1 Antimicrobial resistance - - - - - - - - 5

2.2 The mechanism for Antimicrobial resistance - - - - - 6

2.3 Urinary tract infection - - - - - - - - 7

2.4 Aetiology of UTI - - - - - - - - - 9

2.5 Types of UTI - - - - - - - - - - 10

2.6 Pathogenesis of Urinary tract infection - - - - - - 12

2.7 Long-stay hospitalized and catheterized patients with spinal cord injury - - 13

2.8 In a study by - - - - - - - - - - 14

Chapter Three

3.1 Sample collection - - - - - - - - - 19

3.2 Preparation of culture - - - - - - - - - 19

3.3 Urinalysis - - - - - - - - - - 19

3.4 Isolation and identification of bacteria - - - - - - 20

3.5 Biochemical Tests - - - - - - - - - 20

3.6 Antibiotic susceptibility testing - - - - - - - 22

Chapter Four

4.1 Result - - - - - - - - - 24

Chapter Five

5.1 Discussion/Conclusion - - - - - - - - 32

References - - - - - - - - - 34

Appendices - - - - - - - - - 40

CHAPTER ONE

1.0 INTRODUCTION

Drugs are substances that when inhaled, injected, consumed, absorbed, or dissolved under the tongue causes a temporary physiological change in a body. In pharmacology, a pharmaceutical drug also called a medicine is a chemical substance used to treat, cure, present, or diagnose a disease or to promote well-being. Traditionally, drugs has been produced through extraction from medicinal plants, but more recently also by organic synthesis. (Atanasovet al., 2015). The use of medicine may be as preventive medicine that has benefits but does not treat any existing or pre-existing diseases as symptoms.Pharmaceutical drugs are usually categorized into drug classes. A group of drugs well share a similar chemical structure, or have the same mechanism of action, the same related mode of action or target the same illness or related illness (Mahoney and Evans, 2008;WHO, 2003). The Anatomical therapeutic chemical classification system, assigns drugs a unique ATC code, which is an alphanumeric code. Another system of classification is the Biopharmaceutics classification system.These groups of drugs were classified according to their solubility and permeability or absorption properties (Bergstrom et al., 2014).Drug resistance is the reduction in the effectiveness of a medication such as an antimicrobial in curing a disease or condition. The term is used in the context of resistance that pathogens or cancers have “acquired”, that is resistance has evolved. Antimicrobial resistance challenges clinical case and drives research. When an organism is resistant to more than one drug, it is said to be multi-drug resistant. The development of antibiotic resistant in particular stems from the drugs targeting only specific bacterial molecules (almost always proteins). Because the drug is also specific, any mutation in these molecules will interface with or negate its destruction effect resulting in antibiotic resistance (Pitman, 2004). Bacteria arecapable of not only altering the enzymes targeted by antibiotics, but also by the use of enzymes to modify the antibiotic itself and thus neutralize it. Drug resistant traitsare accordingly inherited by subsequent offspring, resulting in a population that is more drug resistant.In domestic environment, drug-resistant strains of organism may arise from seemingly safe activities such as the use of bleach, the use of antibiotics, disinfectants and detergent, soaps etc.Urinary tract infection (UTI) is one of the most common diseases in human societies which occur in women more than men (Al-Badr and Al-Shaikl, 2013;Mody and Juthani, 2014, Zone and Guide, 2017). The urinary tract infection occurrence depends on several factors provide the presence of bacteria (more than 10⁵/ml) in urine (Zone and Guide, 2017).UTI treatment with antibiotics is carried out usually before receiving culture and sensitivity test results. This therapy without drug prescription occasionally leads to antibiotic resistance and treatment failure has result (Zone and Guide, 2017; Gupta et al., 2001).Antimicrobial drug resistance is increasing around the world, especially in developing countries (Sadeghabadiet al., 2014).According to the World Health Organization in 2014, antimicrobial resistance is increasingly a global threat for public health and all countries have focused on this problem which is a threat to modern medicine (WHO, 2014).

Quadriplegic and paraplegic patients are generally patients with spinal cord injuries that have lost the use of all or part of their limbs. Patients with spinal cord injuries (SCI) are prone to repeated UTIs.Symptomatic UTIs continue to prove a significant problem for these patients. They may include fever, foul smelling urine, haematuria (Cardenas and Mayo, 1987). Nosocomial urinary tract infections (UTIs) are often associated with significant morbidity, mortality and health care cost (Saint and Lipsky, 1999;Lauplandet al., 2005).Patients with spinal cord injury (SCIs) often have indwelling or intermittent urinary catheters and are prone to have asymptomatic bacteria and UTIs. As a result, they frequently receive antimicrobial therapy and have a higher prevalence of antibiotic resistant urinary tract isolates compound to patients without SCI (Girard et al., 2006; Salomon et al., 2007). Many studies have evaluated patient propensity for development of antibiotic resistance in UTIS. Age, use of a urinary catheter, previously hospitalization and prior antimicrobial use have been identified as common risk factors (Enaet al., 1995; De Meuyet al., 1999).

1.1 Aim

To Isolate, Identify, and test the antimicrobial sensitivity pattern of pathogens isolated from urinary tracts of Paraplegic and Quadriplegic patients.

1.2 Objectives

ToIsolate and determine the type of micro-organisms causing urinary tract infection in paraplegia and quadriplegia patients.
To assay the sensitivity pattern of the isolated microorganisms to antibiotics