Effective strategies for prevention and control of Gram-negative infections

Infections caused by Gram-negative bacteria such as Pseudomonas, Klebsiella, Proteus and Acinetobacter have been a major problem in healthcare settings for many years. Overlooked in government targets and unknown to patients, these infections present considerable challenges for effective infection prevention and control. Key strategies for prevention and control focus on contact precautions, the management of invasive devices and maintaining a clean, dry environment to prevent the build-up of environmental reservoirs and cross-infection.

Hospital and community isolates of uropathogens at a tertiary hospital in South Africa

AIM

To investigate the profile of common uropathogens isolated from urine specimens submitted to the diagnostic microbiology laboratory at a tertiary teaching hospital and assess their antimicrobial susceptibility patterns to commonly used antimicrobial agents.

METHODS

We conducted a retrospective analysis of laboratory reports for all urine specimens submitted for investigations over a 1-year period. Isolates were tested by means of the Kirby-Bauer disc diffusion method for susceptibility to amoxicillin, ciprofloxacin, gentamicin, co-trimoxazole and nitrofurantoin, and for extended-spectrum beta-lactamase (ESBL) production.

RESULTS

Out of the total specimens (N=2,203) received over the 1-year study period, 51.1% (1,126) of the urine samples were culture-positive, the majority (65.4%) having come from females. The most common isolate was Escherichia coli (39.0%) followed by Klebsiella species (20.8%) and Enterococcus faecalis (8.2%). The Gram-negative isolates displayed a very high level of resistance to amoxicillin (range 43 - 100%) and co-trimoxazole (range 29 - 90%), whereas resistance to gentamicin (range 0 - 50%) and ciprofloxacin (range 0 - 33%) was lower. E. coli isolates were susceptible to nitrofurantoin (94%), and ESBL production was significantly higher (p=0.01) in the hospital isolates, compared with those from the community referral sites.

CONCLUSIONS

The culture-positive rate for uropathogens was high, with a greater incidence among females. E. coli was the most common aetiological agent identified, and remained susceptible to nitrofurantoin. Resistance levels to amoxicillin and co-trimoxazole were very high for all Gram-negative isolates, and it is recommended that these antibiotics should not be used for the empiric treatment of urinary tract infections.

Incidence of multiple antibiotic resistant Gram-negative bacteria isolated from surface and underground water sources in south western region of Nigeria

In most rural and urban settlements, particularly in Nigeria, wells, spring, streams or rivers and lakes serves as major sources of water supply for drinking and other domestic purposes. Unfortunately, many of the available water sources are not potable without some form of treatment which is seldom available in most settings. The use of untreated surface water sources for drinking and for domestic purposes remains a major threat to public health as these could serve as reservoirs the for transfer of antibiotic resistant pathogens. The incidence of resistant bacteria isolated from surface and underground water in six rural settlements in Ekiti State Nigeria was thus investigated. Gram-negative bacteria were isolated from wells, streams and boreholes in six rural settlements in Ekiti State Nigeria between January and April, 2006 and the prevalence of organisms exhibiting multiple antibiotic resistance to tetracycline, amoxicillin, cotrimoxazole, nitofurantoin, gentamicin, nalidixic acid and ofloxacin was observed. Gram-negative bacterial isolates comprised Escherichia coli (22.7%), Enterobacter aerogenes (2.5%), Salmonella spp. (13.3%), Shigella spp. (19.3%), Proteus spp. (18.5%), Klebsiella spp. (19.3%) and Pseudomonas aeruginosa (4.2%). Over 10% of the bacteria were resistant to four or more antibiotic. Antibiotic resistance was highest in members of the genera Enterobacter, Pseudomonas, and Proteus. Given the prevalence of appalling sanitary facilities and inappropriate public antibiotic use, the possibility of antibiotic resistance selection, faecal dissemination and subsequent contamination of local water sources available for rural residents of the developing world is highlighted. The implication for clinical practice of infections caused by antibiotic resistant strains especially among immunodeficient individuals is also discussed.

Antimicrobial resistance and prevalence of canine uropathogens at the Western College of Veterinary Medicine Veterinary Teaching Hospital, 2002-2007

Between January 2002 and June 2007, uropathogens were isolated from 473 of 1557 canine urine samples submitted to Prairie Diagnostic Services from the Western College of Veterinary Medicine Veterinary Teaching Hospital. Culture and susceptibility results were analyzed, retrospectively, to estimate the prevalence of common bacterial uropathogens in dogs with urinary tract infections and to identify changes in antimicrobial resistance. The most common pathogens identified were Escherichia coli, Staphylococcus intermedius, Enterococcus spp., and Proteus spp. Antimicrobial resistance increased during the study period, particularly among recurrent E. coli isolates. Using the formula to help select rational antimicrobial therapy (FRAT), bacterial isolates were most likely to be susceptible to gentamicin, fluoroquinolones, amoxicillin-clavulanic acid, and groups 4 and 5 (third generation) cephalosporins.

Antibacterial activity of halogenated sesquiterpenes from Malaysian Laurencia spp

During our studies on Malaysian Laurencia species, brominated metabolites, tiomanene, acetylmajapolene B, and acetylmajapolene A were isolated from an unrecorded species collected at Pulau Tioman, Pahang along with known majapolene B and majapolene A. Acetylmajapolene A was a mixture of diastereomers as in the case of majapolene A. Tiomanene may be a plausible precursor for acetylmajapolenes B and A. In addition, three known halogenated sesquiterpenes and two known halogenated C(15) acetogenins were found from other two unrecorded species collected at Pulau Karah, Terengganu and Pulau Nyireh, Terengganu, respectively. Some of these halogenated metabolites showed moderate antibacterial activity against some marine bacteria.

[Quinolone resistance in Gram negative rods in Iceland and association with antibiotic use]

OBJECTIVE

Fluoroquinolones are bacteriocidal drugs that are widely used to treat severe urinary and respiratory tract infections. Studies show that resistance to fluoroquinolones is continuously increasing both in Europe and the United States. The purpose of this study was to measure the frequency of fluoroquinolone resistance in the most prevalent Gram negative rods and look at the correlation with fluoroquinolone use over the last 8 years.

MATERIALS AND METHODS

All strains of Escherichia coli, Klebsiella sp., Proteus sp. and Pseudomonas aeruginosa identified from clinical specimens at the Department of Clinical Microbiology at the Landspitali University Hospital (LUH) during the time period 1.11.2006 to 31.1.2007. Antibiotic susceptibility testing was performed by disc diffusion tests and all strains were tested for ciprofloxacin susceptibility. Antibiotic resistance data for the last years were collected from the reports of the Department of Clinical Microbiology, but ciprofloxacin susceptibility was usually only tested for specimens from hospitalised patients and when there was resistance to two or more antimicrobial agents. Data on antibiotic use/sales was obtained from the State Epidemiologist at the Directorate of Health.

RESULTS

Of the 1861 strains tested, 104 fluoroquinolone resistant strains were identified during the study period, including 91 E. coli (87%), 8 Klebsiella sp. (8%) and 5 P. aeruginosa (5%). No fluoroquinolone resistant Proteus sp. was identified. There was a significant positive correlation between fluoroquinolone use and the frequency of resistant strains of E. coli and Enterobacteriaceae. The frequency of resistant E. coli strains was 6% and it differed significantly between age groups (p >0.001) and sex, 6% for females and 11% for males (p = 0.015). The ratio of fluoroquinolone resistant E. coli was highest in the LUH and homes for the elderly.

CONCLUSION

The frequency of fluoroquinolone resistance is increasing fast in Iceland but is still one of the lowest compared to the other European countries. The frequency is highest in the oldest age groups where the use of the quinolones is the greatest and there was a significant correlation between the quinolone use and the frequency of resistance in E. coli and Enterobacteriaceae. The results highlight the importance of prudent fluoroquinolone use and the need to monitor fluoroquinolone use and resistance.

Antimicrobial susceptibility of Klebsiella spp. and Proteus spp. from various organ systems of horses, dogs and cats as determined in the BfT-GermVet monitoring program 2004-2006

A total of 120 isolates of Klebsiella spp. and Proteus spp. collected from horses and small animals (dogs and cats) were screened for their susceptibility to 24 different antimicrobial agents. Klebsiella spp. were included from infections of the genital tract (GT) of horses (36 isolates) and the urinary/genital tract (UGT) from dogs and cats (17 isolates), while Proteus spp. were from small animal (dogs and cats) infections of the UGT (37 strains) and the skin (incl. ear/mouth) (30 isolates). In Klebsiella spp. resistance appeared most frequently to ampicillin (53-67%), sulfamethoxazole (19-29%) and potentiated sulfonamides (trimethoprim/sulfamethoxazole 1/19 combination) (19-24%). A further 29% of enrofloxacin resistant Klebsiella isolates were observed for the UGT of small animals. From the GT of horses for this antimicrobial agent there was no isolate detected with a comparably high minimum inhibitory concentration (MIC) value. In Proteus spp. highest percentages of resistance occurred against tetracycline (90-92%). Due to drug efflux proteins, high MIC values against this antimicrobial agent have been frequently reported in literature. In Proteus spp. relevant resistance percentages also occurred for potentiated sulfonamides (27-37%), sulfamethoxazole (24-37%) and chloramphenicol (24-37%).

Susceptibility of Human Pathogenic Bacteria to Antimicrobial Peptides from Sesame Kernels

Hospital infection caused by Gram-negative bacteria is a serious and common problem, especially in developing countries. Aiming to reduce these infections, this report focuses on the identification and characterization of novel antimicrobial peptides from sesame (Sesamum indicum) kernel meals. Thus, sesame flour was extracted and precipitated with ammonium sulfate (100%). After dialysis, a rich fraction was applied to affinity red-Sepharose CL-6B chromatography, followed by reversed-phase high-performance liquid chromatography. Mass spectrometry analysis indicated the presence of a major peptide with molecular mass of approximately 5.8 kDa in both cultivars. The bactericidal activities of antimicrobial peptides were evaluated against several human pathogens that had been effective only against Klebsiella sp., a Gram-negative bacterium responsible for human urinary infection. These data indicate the biotechnological potential of sesame peptides as an alternative method for hospital infection control and also the decrease of bacterial resistance to synthetic antibiotics.

Population-based laboratory surveillance for tribe Proteeae isolates in a large Canadian health region

The tribe Proteeae comprises the genera Proteus, Morganella and Providencia. Few studies have specifically investigated the epidemiology of infections caused by the Proteeae, and none has been conducted in a large non-selected population. The present study was a population-based laboratory surveillance in the Calgary Health Region (population 1.2 million), Canada during 2000-2005 that aimed to define the incidence, demographical risk-factors for acquisition and antimicrobial susceptibilities of Proteeae isolates. In total, 5047 patients were identified from whom Proteeae isolates were obtained (an annual incidence of 75.9/100 000), with females and the elderly being at highest risk. Incidence rates were 64.8, 7.7 and 3.4/100,000/year for the genera Proteus, Morganella and Providencia, respectively. Overall, 85% of infections were community-onset, and the overall rate of bacteraemic disease was 2.0/100,000. Compared with other species, Proteus mirabilis occurred at a much higher frequency, especially among females, and was less likely to be isolated from hospital-onset infections or to be part of a polymicrobial infection. Among isolates from community-onset infections, Providencia spp. were less likely to be from outpatients and more likely to be from nursing home residents. There were low overall rates of resistance to ciprofloxacin (4%) and gentamicin (5%), with Prot. mirabilis generally being the most susceptible. Members of the Proteeae were isolated frequently in both the community and hospital settings, but were infrequent causes of invasive disease. The occurrence, demographical risk-factors and microbiology of Proteeae isolates varied according to the individual species.

Detection of extended-spectrum beta-lactamases among Enterobacteriaceae by use of semiautomated microbiology systems and manual detection procedures

Three commercially available microbiology identification and susceptibility testing systems were compared with regard to their ability to detect extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae, i.e., the Phoenix Automated Microbiology System (BD Diagnostic Systems, Sparks, MD), the VITEK 2 System (bioMérieux, Marcy l'Etoile, France), and the MicroScan WalkAway-96 System (Dade Behring, Inc., West Sacramento, CA), using routine testing panels. One hundred fifty putative ESBL producers were distributed blindly to three participating laboratories. Conventional phenotypic confirmatory tests such as the disk approximation method, the CLSI double-disk synergy test, and the Etest ESBL were also evaluated. Biochemical and molecular characterization of beta-lactamases performed at an independent laboratory was used as the reference method. One hundred forty-seven isolates of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Citrobacter freundii, Serratia marcescens, Proteus mirabilis, Proteus vulgaris, and Morganella morganii were investigated. Of these isolates, 85 were identified as ESBL producers by the reference method. The remaining isolates were identified as non-ESBL producers; they were either hyperproducers of their chromosomal AmpC, Koxy, or SHV enzymes or lacked any detectable beta-lactamase activity. The system with the highest sensitivity for the detection of ESBLs was the Phoenix (99%), followed by the VITEK 2 (86%) and the MicroScan (84%); however, specificity was more variable, ranging from 52% (Phoenix) to 78% (VITEK 2). The performance of the semiautomated systems differed widely with the species investigated. The sensitivities of the conventional test methods ranged from 93 to 94%. The double-disk synergy test showed the highest specificity and positive predictive value among all test methods, i.e., 97% and 98%, respectively.

In vitro activities of three carbapenems against recent bacterial isolates from severely ill patients at Swedish hospitals

To study the in vitro activity of imipenem, meropenem and ertapenem against common pathogens isolated from patients in intensive care, haematology and dialysis/nephrology units at 7 Swedish university hospitals, a total of 788 isolates were collected during 2002-2003. The distribution of the isolates was as follows: Escherichia coli (n = 140), Klebsiella spp. (n = 132), Proteus spp. (n = 97), Enterobacter spp. (n = 113), Pseudomonas aeruginosa (n = 126), Acinetobacter spp. (n = 53) and Enterococcus faecalis (n = 127). The susceptibility to the 3 carbapenems was determined by E-test, and the MICs were interpreted according to SRGA criteria. All 3 carbapenems were highly active against Enterobacteriaceae. The overall susceptibility to imipenem, meropenem and ertapenem was 90%, 98% and 93%, respectively. Against Enterobacteriaceae, Enterobacter spp. excluded, ertapenem had an equal or lower MIC(90) than meropenem. Apart from being the most active carbapenem against Enterobacteriaceae, meropenem was also the most active carbapenem against P. aeruginosa, whereas imipenem was the most active drug against Acinetobacter spp. The carbapenems are still potent antibiotics. With the introduction of ertapenem, and an expected increase in the carbapenem consumption due to an increased prevalence of strains with extended-spectrum beta-lactamases, continuous surveillance of carbapenem resistance appears to be warranted, with special attention to P. aeruginosa, Enterobacter and Proteus spp.

Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance

BACKGROUND

A high prevalence of antimicrobial resistance among urinary isolates in the Garhwal region of Uttaranchal.

AIMS

To identify the most appropriate antibiotic for empirical treatment of community-acquired acute cystitis on the basis of local antimicrobial sensitivity profile.

SETTINGS AND DESIGN

A prospective clinico-microbiological study including all clinically diagnosed patients with community acquired acute cystitis attending a tertiary care teaching hospital over a period of three years.

METHODS AND MATERIAL

Clean-catch midstream urine specimens, from 524 non-pregnant women with community-acquired acute cystitis, were subjected to semi-quantitative culture and antibiotic susceptibility by the Kirby- Bauer disc diffusion method. A survey was also conducted on 30 randomly selected local practitioners, to know the prevalent prescribing habits in this condition.

STATISTICAL ANALYSIS

The difference between the susceptibility rates of E. coli isolates to Nitrofurantoin and the other commonly prescribed antibiotics was analysed by applying the z test for proportion.

RESULTS

354 (67.5%) specimens yielded significant growth of E. coli.> 35% of the urinary E.coli isolates were resistant to the fluoroquinolones, which were found to be the most commonly used empirical antibiotics in acute cystitis. Resistance was minimum against Nitrofurantoin (9.3%, 33) and Amikacin (11.0%,39).> 80% of the fluoroquinolone-resistant strains were found to be sensitive to Nitrofurantoin.

CONCLUSION

The best in vitro susceptibility profile in our study has been shown by Nitrofurantoin and a significantly high proportion of the urinary E. coli isolates have already developed resistance to the currently prescribed empirical antibiotics, viz. the fluoroquinolones. In view of these in vitro susceptibility patterns, a transition in empirical therapy appears imminent.

[Microorganisms isolated from middle ear cultures and their antibacterial susceptibility in patients with chronic suppurative otitis media]

OBJECTIVES

This study sought to determine causative microorganisms of chronic suppurative otitis media and their antibacterial susceptibility.

PATIENTS AND METHODS

Bacteriologic results of middle ear swabs, agent microorganisms, and their susceptibility to antibiotics were evaluated in 70 patients (65 males, 5 females; mean age 21.1+/-1.3 years; range 19 to 25 years) with chronic suppurative otitis media.

RESULTS

No bacteria were isolated in 14% of the patients. Of 60 patients in whom bacteria were isolated, the most common bacteria was Pseudomonas aeruginosa (23%), followed by Staphylococcus aureus (18%), and Proteus spp. (17%). P. aeruginosa strains were susceptible to ceftazidime and imipenem (100%), ciprofloxacin (92%), and amikacin and gentamycin (85%); S. aureus strains were susceptible to methicillin and vancomycin (100%), ciprofloxacin (91%), sulbactam-ampicillin (73%), and gentamycin and trimethoprim-sulfamethoxazole (63%). Proteus strains were susceptible to ciprofloxacin (100%), ceftazidime (90%), and imipenem and gentamycin (70%).

CONCLUSION

Appropriate knowledge of antibacterial susceptibility of microorganisms will contribute to rational antibiotic usage and the success of treatment for chronic suppurative otitis media.

Quantitative bacterial micro-assay for rapid detection of serum phenylalanine on dry blood-spots: application in phenylketonuria screening

Phenylketonuria is an inherited metabolic disease, which is characterized by an increased level of serum phenylalanine. Quantitative measurement of phenylalanine in the serum of phenylketonuria patients is necessary to confirm the disease, and to distinguish phenylketonuria from other forms of hyperphenylalaninemia. In this study, we report a rapid and inexpensive micro-assay for simultaneous detection and quantitative measurement of serum phenylalanine on dry blood-spots. Analysis of the standard curve showed a broad linear range for phenylalanine from 120 to 1800μmol/L. Application of this method, the standard Guthrie bacterial inhibition assay and a high-performance liquid chromatography (HPLC) method for analysis of 34 samples from phenylketonuria patients and control samples produced comparable results, with the regression equation Y=0.994X+0.996. The advantage of this method over the Guthrie bacterial inhibition assay is its ability to measure serum phenylalanine quantitatively without false positive results. The method was successfully applied to dried blood-spots, serum and whole blood. The cost per sample is approximately 20–50 US cents, which is much less than for HPLC and commercial enzyme kits. The method can be automated, and is thus suitable for neonatal and mass screening for phenylketonuria, especially in developing countries where funding is a limiting factor.

Antimicrobial activity of flavonoids from Pelargonium radula (Cav.) L'Hérit

Flavonoids from Pelargonium radula (Cav.) L'Hérit were purified by column chromatography. Two fractions were obtained: F1 (main flavonoid isoquercitrin) and F2 (main flavonoid rutin). In vitro antimicrobial activity of F1 and F2 were tested against eleven species of bacteria and eleven species of fungi. Both fractions demonstrated strong inhibitory activity against Staphylococcus aureus, Proteus rettgeri, Candida tropicalis and Microsporum gypseum. Staphylococcus sp. (coagulase-negative) and Candida lusitaniae were strongly inhibited only by fraction F1 and Fusarium graminearum only by fraction F2.

Characterization and biological activities of two copper(II) complexes with diethylenetriamine and 2,2'-bipyridine or 1,10-phenanthroline as ligands

Two new mixed ligand copper(II) complexes with diethylenetriamine, 2,2'-bipyridine and 1,10-phenanthroline have been synthesized. The crystal and molecular structures of [Cu(dien)(phen)](ClO(4))(2) and [Cu(dien)(bipy)](BF(4))(2) (dien=diethylenetriamine, phen=1,10-phenanthroline, bipy=2,2'-bipyridine) were determined by X-ray crystallography from single crystal data. These two complexes have similar structures. The EPR spectral data also suggest that these complexes have distorted square pyramidal geometry about copper(II). Anti-microbial and superoxide dismutase activities of these complexes have also been measured. They show the higher SOD activity than the corresponding simple Cu(II)-dien/Cu(II)-PMDT (PMDT=N,N,N',N',N''-pentamethyldiethylenetriamine) complexes because of a strong axial bond of one of the nitrogen atoms of the alpha-diimine. Both the complexes have been found to cleave plasmid DNA in the presence of co-reductants such as ascorbic acid and glutathione.

Straightforward representation of antimicrobial chemotherapeutics susceptibility profiles in a private tertiary care hospital

Culture-based values for antimicrobial susceptibility of 28 antimicrobials against different bacteria isolated from clinical material in a tertiary care hospital were used to pick the most promising antimicrobials. Isolates originating from urinary tract, blood and pyogenic foci, enteric fever and enteritis were grouped. Antimicrobials, systemic or oral, exhibiting a 75% or more susceptibility were compartmentalized in relation to divergent clinical disorders. Retrospective categorized culture-based susceptibility values should help a rational prospective chemotherapeutic intervention against infectious syndromes encountered in hospital practice.

[Enzymatic resistance to beta lactam antibiotics within the genus Proteus and evaluation of Proteus mirabilis phenotypes and genotypes for resistance to third- and fourth-generation cephalosporins]

INTRODUCTION

The aim of this study was to evaluate betalactam resistance within the genus Proteus and characterize the betalactamases responsible for this resistance.

METHODS

We analyzed 99 strains (87, P. mirabilis; 10 P. vulgaris, and 2, P. penneri) isolated from patients at one University Hospital. Antibiotic susceptibility tests were performed according to NCCLS recommendations. Presence of extended spectrum betalactamases (ESBL) was inferred by both double disk diffusion tests and minimum inhibitory concentration (MIC) of third and fourth generation cephalosporins alone and in the presence of clavulanic acid. Isoelectric points (pI) of the enzymes were estimated by isoelectrofocusing and the presence of the encoding genes was confirmed by polymerase chain reaction (PCR).

RESULTS

A broad spectrum betalactamase could be detected in those isolates (28%) resistant to penicillin and first generation cephalosporins while CTX-M-2 enzyme could be detected in P. mirabilis isolates resistant to third and fourth generation cephalosporins (18%). One of the P. vulgaris displayed reduced susceptibility to cefotaxime due to an enzyme of pI 7.4, while resistance to cefotaxime in one P. penneri was related to an enzyme of pI 6.8. Both enzymes were active on cefotaxime (1,000 mg/l) in the iodometric assay.

CONCLUSION

The broad extended spectrum betalactamase within genus Proteus was TEM-1, while CTX-M-2 was the ESBL responsible for the third and fourth generation cephalosporins in P. mirabilis. In P. vulgaris and P. penneri this resistance was associated with the hyperproduction of the chromosomal encoded betalactamase.

Synergy between cephalosporin and aminoglycoside antibiotics against Providencia and Proteus

Clinical isolates of Providencia and Proteus with relative aminoglycoside resistance were tested for susceptibility to combinations of gentamicin or tobramycin with cephalothin or cefazolin. The minimal bactericidal concentration of aminoglycoside for one-third of the strains was reduced by fourfold or more in the presence of one-fourth of the minimal bactericidal concentration of either cephalosporin. This effect was achieved by clinically attainable concentrations of cephalothin or cefazolin.

A potent sperm motility-inhibiting activity of bioflavonoids from an ethnomedicine of Onge, Alstonia macrophylla Wall ex A. DC, leaf extract

The methanol extract (ME) and the n-butanol fractions of methanolic extract of Alstonia macrophylla Wall ex A. DC leaves were investigated on the forward motility (FM) of mammalian (goat and human) spermatozoa. The ME at 600 microg mL-1 as well as fraction B at 100 microg mL-1 concentrations showed marked inhibition of sperm FM in both goat and human species when tested by microscopic and spectrophotometric methods. Approximately 60-80% of the goat spermatozoa lost their FM when treated with 600 microg mL-1 of ME and 100 microg mL-1 of fraction B. At 100 microg mL-1 concentration, fraction B showed 90% loss of FM in human spermatozoa, while fraction B at 400 microg mL-1 concentration showed complete inhibition of sperm FM at 0 min. The inhibitory activity of fraction B increases with increasing concentration in a dose-dependent manner. Phytochemical study of the extract revealed that the leaf contains tannins, flavonoids, sterols, triterpenes, alkaloids and reducing sugars. Further fractionation and purification of the bioactive n-butanol part of ME showed the presence of ursolic acid (fraction B), beta-sitosterol (fraction A), beta-sitosterol glucoside and a mixture of minor compounds (fraction C, detected on thin-layer chromatography). The results reveal that fraction B (ursolic acid), a pentacyclic triterpene, has the potential of sperm motility inhibition and can serve as a topical vaginal contraceptive.