Objectives: The main objective of this study was to investigate the bacterial infections of urinary tract in patients with urolithiasis. The patients were referred to and/or visiting the Urology Department in Tikrit Teaching Hospital in Tikrit city. Methods: The present study was carried out from November 2011 until July 2012. One hundred and sixty patients with urolithiasis were included in the present study whose ages ranged from 12 to 70 years. Male to female ratio was almost 2:1. The control group consisted of two groups; group one consisted of 40 persons (20 males and 20 females) who were selected randomly from Tikrit city during the period of this study and they had no previous personal nor family history of urolithiasis, while group two consist of 40 persons (20 males and 20 females) infected with urinary tract infection. Urine culture was done for all the patients and the control group. Results: Forty five percent (45/160) of these had UTI’s. Six patients revealed mixed bacterial growth. Eighty-four percent (38/45) of patients with UTI were infected with gram negative organisms where as only 16% (7/45) of patients were infected with gram positive organisms. The majority of the gram negative bacteria isolated belonged to the family Enterobacteriaceae particularly E. coli as it was isolated from 14 (31%) cases. The urease producing bacteria were isolated from 31 cases (50%). Conclusions: UTI’s in urolithiasis was more frequent in females than males and the percentages were 28/45 and 17/45 respectively. The most effective antimicrobial agent was amikacin and the least effective one was ampicillin, whereas ciprofloxacin, cefoxitin, levofloxacin, nitrofurantoin, nalidixic acid, chloramphenicol, amoxycillin and gentamicin were effective at different levels.
Antibiotic resistance is a specific type of drug resistance when a microorganism has the ability of withstanding the effects of antibiotics. Antibiotic resistance evolves via natural selection acting upon random mutation, but it can also be engineered by applying an evolutionary stress on a population. Urinary Tract Infections (UTIs) are one of the most prevalent extra-intestinal bacterial infections. Nowadays, it represents one of the most common diseases encountered in medical practice affecting people of all ages from the neonate to the geriatric age group [
This study was conducted in the Urology Department in Tikrit Teaching Hospital as a part of research programs for higher studies in College of Medicine, University of Tikrit. The number of the patients was 160 and they were recruited from November 2011 until July 2012. All have urolithiasis including 104 males and 54 females. Patients aged between 15 to 70 years.
The control group composed of 80 subjects who were looked healthy and had comparable criteria to the patients and composed of 40 males and 40 females.
Media were prepared and sterilized according to the manufacturer’s instruction. The prepared media used for isolation, determination of the viable count, identification and susceptibility testing were carried out after being solidified [
Antibiotic sensitivity testing of all isolates was performed on Mueller-Hinton medium by the Kerby Bauer method (1996) following the definition of the National Committee of Clinical Laboratory Standard (NCCLS, 1999). The medium was allowed to cool at 45˚C and poured into Petri dishes to about 4 mm thickness of medium. The solidified plates were incubated at 37˚C for 15 - 30 minutes to let the excess moisture to evaporate (Fisher scientific, USA) [
The plates were inoculated by dipping a sterile swab into the inoculum, the excess inoculum was removed by pressing and rotating the swab firmly against the side wall of the tube above the level of fluid, then the swab was rubbed all over the surface of the medium, rotating the plate 3 times at an angle of 60 degree after each application and finally the swab passed around the edge of agar surface. The plate was left to dry at room temperature with the lid closed for few minutes. After 15 minutes of inoculation, the antibiotic discs were applied and the plates were inverted for incubation to avoid accumulation of moisture on the agar surface [
Statistical analyses in the present study were done by using Microsoft Office Excel 2007, SPSS version 12 (Statistical Package for Social Sciences). The programs used were F-test, T-test, least significant difference (LSD) and Chi-square [
Urine culture had been done for all the 160 patients who were included in this study. Only 45 patients had positive urine culture as shown in
The antibiotic sensitivity test was carried out using disc diffusion technique for all the bacterial isolates to the most commonly antibiotic agents that used in the treatment of UTI as it was shown in figures 2-12. It was found that different bacterial pathogens were highly sensitive to amikacin, ciprofloxacin and most of them were also highly sensitive to nitrofurantoin, nalidixic acid and cefotaxin. The present study also shows that the most resistant bacteria were Pseudomonas aeruginosa and almost 80% of its isolates were still sensitive to amikacin and ciprofloxacin. Almost all isolates (100%) of Escherichia coli were highly sensitive to levofluxacin, cefoxitin and chloromphenicol. E. coli isolates were resistant to nalidixic acid and almost 3% only of them were sensitive to nalidixic acid. Most of the pathogens isolated were moderately sensitive to gentamicin. Staph. aureus isolates were highly resistant to ampicillin and amoxycillin (Figures 2 and 3). The overall assessment of the most antibiotics used for UTI treatment revealed that amikacin
was the most effective and almost all the isolates were resistant to ampicillin (
Urine culture for all 160 patients was made, which was positive for 45 (28%) patients as shown in figure 1. This was almost similar to that found elsewhere l [9,10]. In contrast, the present results were almost different from those reported by Al-Jebouri [
The overall percentages of resistance of all isolates to the antimicrobial agents were 66.5 to ampicillin, 90.8 to amoxycillin, 4.3 to amikacin, 46.5 to gentamicin, 19.3 to ciprofloxacin, 63.6 to nalidixic acid, 42.8 levofloxacin, 42.2 to cefoxitin, 35 to cloromphenicol and 45 to nitrofurantoin (
The susceptibility and resistance profile of all isolates in the current study have shown that ampicillin and amoxycillin possess the lower efficacy while amikacin and ciprofloxacin possess the higher efficacy. There was a general increase in the resistance pattern of isolates to all the antibiotics used in this study. The current findings confirm that bacterial resistance would be the greatest and frightening problem in our country. A new generation of antibiotics is still locally working in a higher rate. The usage of antibiotics in our locality of the world needs to be under health assessment and control with more laboratory investigations to explore the intrinsic and extrinsic parameters led to conclude high rate of resistance occurred in the local pathogens that might be disseminated to other geographical areas.