Antimicrobial sensitivity pattern of organisms causing urinary tract infection in children with sickle cell anaemia in Ibadan, Nigeria

As part of a larger project on childhood urinary tract infection, antimicrobial sensitivity tests were carried out on the bacterial isolates from the urine of febrile children seen at the University College Hospital, Ibadan, Nigeria.

METHODOLOGY

Midstream urine specimens were collected from 171 sickle cell anaemia children and from an equal number of haemoglobin-A controls and cultured by standard methods. Sensitivity to eleven antimicrobials was tested using the disc-diffusion technique of Stokes.

RESULTS

Significant bacteriuria was obtained from 37 children with sickle cell anemia and 27 controls. The isolates were Escherichia coli, Klebsiella species, Non-haemolytic streptococcus, beta-haemolytic Streptococcus, Salmonella, Proteus and Pseudomonas species. Sensitivity was highest to Pefloxacin to which over 94% of the organisms were sensitive followed by Ceftriaxone (over 85%) and ceftazidime (over 85%). Sensitivities to nalidixic acid and cefuroxime were between 67.6% and 74.1%. Most of the isolates were resistant to gentamicin, amoxycillin, cotrimoxazole and ampicillin. In general the sensitivity pattern in the sickle cell anaemia group was similar to the pattern in the control group.

CONCLUSION

Aetiological agents of childhood UTI in this environment are resistant to most of the drugs commonly recommended for its treatment. Nalixidic acid and cefuroxime are recommended as first line drugs while awaiting results of sensitivity testing. Ceftriazone and ceftazidime should be reserved for cases of non-response to first line drugs and in severe cases. Pefloxacin should be considered potential drug of treatment particularly in multi-drug resistant infections.

Urinary tract infection in febrile children with sickle cell anaemia in Ibadan, Nigeria

A prospective study to determine the prevalence of bacteriuria and bacterial isolates in the urine of febrile children with sickle cell anaemia (SCA) was carried out at University College Hospital, Ibadan. Altogether, 171 febrile children (aged 1-15 years) with SCA and 171 age- and sex-matched controls were studied. After obtaining a history of the illness from the parents or guardians, each child was physically examined and a mid-stream urine specimen collected and subjected to microscopy and culture. The prevalence of bacteriuria in children with SCA was 21.6% compared with 15.8% in the controls. Escherichia coli and Klebsiella species were the predominant isolates from the urine, accounting for 64.9% and 18.9%, respectively, of the isolates from the SCA group and 63% and 22.2%, respectively, in the controls. In the SCA group, significant bacteriuria also occurred with other conditions such as pneumonia and osteomyelitis. Urinary tract infection (UTI) is common in children with SCA. Routine screening for it is therefore recommended during febrile illnesses. Children with fever from other overt causes, however, should not be exempted from the urine screening procedure in case there might be concomitant UTI.

Ureaplasma urealyticum as a cause of non-gonococcal urethritis: the Ibadan experience

Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.

Pattern of sexually transmitted diseases among commercial sex workers (CSWs) in Ibadan, Nigeria

The purpose of this study was to determine the pattern of STDs among commercial sex workers (CSWs) in Ibadan, Nigeria. The subjects were 169 CSWs randomly selected from 18 brothels, majority of who were examined and investigated in their rooms. Another 136 women without symptoms who visited the special treatment clinic, University College Hospital, Ibadan were selected as a normal control group. Vaginal candidiasis was the most common STD diagnosed in both CSWs and the control group. The other STDs in their order of frequency were HIV infection 34.3%, non-specific vaginosis 24.9%, trichomoniasis 21.9% and gonorrhoea and "genital ulcers" had an incidence of 16.6% each. Other important conditions were tinea cruris 18.9%, scabies 7.7% genital warts 6.5% and 4.1% of them had syphilis sero-positivity. All the 13 CSWs that had scabies, the 4 (36.4%) with genital warts and the 19 (67.9%) with "genital ulcers" had HIV infection. While there was no significant difference between the CSWs with vaginal candidiasis, gonorrhoea, trichomoniasis and the control group, the HIV positivity was significantly higher (P < 0.001) in CSWs than in the control subjects. These findings suggest that women who exchange sexual services for money can no longer be ignored, and should therefore be identified and made to participate in STD prevention and control programmes.

Penicillinase producing Neisseria gonnorhoeae: the review of the present situation in Ibadan, Nigeria

All the isolates of Neisseria gonorrhoeae from patients that attended special treatment Clinic, University College Hospital, Ibadan, Nigeria between 15th January 1997 and 15th December 1999 were studied so as to review the present prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) in Ibadan. Of the 214 patients that had gonococcal infections, 161 were male (75.2%) and 53 (24.8%) were female. Ninety-two (57.1%) of the male and 28(52.8%) of the female were aged between 20- 29 years while 19.9% of the male and 15.1 % of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=2.19, df=3, p=0.53). The present study revealed that PPNG strains have increased dramatically to 98.6 per cent. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Non-gonococcal urethritis due to Chlamydia trachomatis: the Ibadan experience

Using a qualitative amplified enzyme-linked immunoassay, two hundred and eighty-nine male patients with symptoms and signs suggestive of urethritis were investigated for Chlamydia trachomatis as a cause of non-gonococcal urethritis (NGU). Ninety-one (31.49%) of the 289 male patients investigated had gonococcal urethritis whilst 198 (68.51%) had NGU out of which 112 (56.60%) had chlamydial urethritis and 14 (7.1%) had Trichomonal urethritis. Two (6.7%) of the control subjects had C. trachomatis in their urethral swabs. The difference in the occurrence of C. trachomatis between the patients and the controls was highly statistically significant (P<0.001). The age range of peak incidence among the patients investigated was 20-29 years. Thirteen of the men treated for gonorrhoea still had watery urethral discharge and irritation and were diagnosed as having post-gonococcal urethritis (PGU), eleven (84.6%) of whom had C. trachomatis demonstrated in their urethral swabs. We were able to demonstrate a significant difference in clinical symptoms in men with gonorrhoea and NGU but only a slight difference between men with chlamydia-positive NGU and chlamydia-negative NGU.

Comparative in-vitro activities of commonly available quinolones and other antibiotics on bacterial isolates in Ibadan, Nigeria

The 4-quinolones, many of which are now available in Nigeria under different trade names, have a broad spectrum of activity. An evaluation is made of the comparative in-vitro activities of these quinolones and other antibiotics against 125 strains of bacteria commonly isolated from clinical specimens in University College Hospital, Ibadan, by using the Stroke's disc sensitivity method, and MIC estimation. The quinolones showed greater activity than the cephalosprins against Klebsiella spp., Proteus spp. and Escherichia coli, but were found to be equipotent against Pseudomonas spp. the MIC results revealed ciprofloxacin (Ciprotap) as the most active of the quinolones. Though some strains of Klebsiella spp. and Pseudomonas spp. were found to be resistant to all the antibiotics tested, majority of the strains of the gram-negative bacilli from clinical specimens were highly susceptible to all the quinolones. This emphasizes the need to monitor regularly the emergence of resistance associated with the use of antibiotics in the developing countries.