Cancerbio.net

Cancer Biology 2013; 3(3) http://www.cancerbio.net Urinary Tract Infections (UTIs) in a cohort of HIV and Non-HIV-infected females in Port Harcourt, Nigeria
Frank-Peterside N, Okerentugba PO, Ndukwu J, Okonko IO Medical Microbiology Unit, Department of Microbiology, University of Port Harcourt, P.M.B. 5323, Choba, East- West Road, Port Harcourt, Rivers State, Nigeria; E-mail address: [email protected], Tel: +2348035380891

ABSTRACT: UTI is the most common problem found in all age group patients. UTI has more prevalence in HIV-
infected patients because of decreased immune status compared to Non-HIV infected individuals. The aim of this
study was to find the prevalence of UTI in a cohort of HIV and Non-HIV-infected females and planning its
treatment strategy based on etiologic agent. Clean catch midstream urine samples were collected from 100 female
subjects comprising 50 HIV-seropositive and 50 HIV-seronegative females in Port Harcourt, Nigeria. The HIV-
positive females consisted of 20 highly active retroviral therapy (HAART) – naïve females and 30 subjects on
HAART for three to six months. Most of the HIV-positive females had no signs or symptoms of UTI compared to
HIV-negative females. Urine samples were analysed using standard methods. Microbial isolates were identified in
urine and susceptibility tests were performed. The ages of the subjects ranged from 25-50 years. Of the 100 samples
analysed, 37 had significant bacteriuria representing 37.0%. Among the 50 HIV seropositive females, 17(34.0%)
had significant bacteriuria while among the HIV seronegative females (controls), 21 (42.0%) samples had
significant bacteria growth. Bacterial uropathogens were significantly prevalent (42.0 vs. 34.0, P<0.05) among HIV
seronegative females (controls) than HIV seropositive females. There was significant difference (40.0 vs. 25.0,
P<0.05) in the prevalence of significant bacteriuria between HIV seropositive females on HAART and HAART
naïve females. Generally, Staphylococcus aureus 10(26.3%) was most predominant in the urine samples. This was
followed by Klebsiella species 7(18.4%), Escherichia coli 6(15.8%), Pseudomonas aeruginosa 5(13.2%), Proteus
species 3(7.9%), Streptococcus species 3(7.9%), Enterococcus faecalis 2(5.3%) and Staphylococcus epidermidis
2(5.3%). Among the HIV seropositive females, Escherichia coli 5(29.4%) was the most predominant while among
the HIV seronegative females, Staphylococcus aureus 6(28.6%) was the most predominant. However,
Staphylococcus epidermidis was only present among the HIV seronegatives. Also, Candida albicans 10(71.4%) was
most predominant fungi isolates. This was followed by Aspergillus species 2(14.3%) and Penicillium species
2(14.3%). However, Aspergillus species 2(33.3%) was only present among the HIV seronegatives. High sensitivity
to ofloxacin (85.7%), ceprox (85.7%), ciprofloxacin (78.9%), peflacine (76.2%), gentamicin (60.5%), lincocin
(58.8%), rifampicin (58.8%), streptomycin (55.3%), augmentin (52.4%) and ampiclox (52.4%) was recorded. High
resistance to nalidixic acid (90.5%), septrin (80.9%), chloramphenicol (70.6%), floxapen (64.7%), nrobactin
(64.7%), erythromycin (58.8%), ampicillin (57.1%), ampiclox (47.6%), augmentin (47.6%), and septromycin
(44.7%) were observed. In conclusion, urinary tract infection is a significant co-morbidity in females with HIV. This
study reveals a high prevalence of urinary tract infections in a cohort of HIV seropositive females in Port Harcourt,
Nigeria. Thus, a high index of suspicion will lead to its prompt diagnosis and appropriate treatment. Of particular
importance is the sensitivity patterns of the strains of bacteria isolated, in which ofloxacin, ceprox, ciprofloxacin,
peflacine and gentamicin were the most effective. This calls for adequate planning for UTI treatment strategy based
on etiologic agent. Prospective studies are advocated to clarify whether these antibiotics confers some benefit in
protecting HIV seropositive individuals against UTI.
[Frank-Peterside N, Okerentugba PO, Ndukwu J, Okonko IO. Urinary Tract Infections (UTIs) in a cohort of HIV
and Non-HIV-infected females in Port Harcourt, Nigeria] Cancer Biology 2013;3(3):1-10]. (ISSN: 2150-1041).
http://www.cancerbio.net. 1
Keywords: Antibiograms, Coinfections, Gram-positive bacteria, Gram-negative bacteria, HIV, HAART
1. INTRODUCTION
(Chukwujekwu et al., 2010; Merrigan et al., 2011; Nigeria has the largest population in Africa Sanyaolu et al., 2013). with a population of over 150 million and HIV The advent of HIV/AIDS has resulted in prevalence of 4.6% in 2008 (FMOH, 2008; Sanyaolu many microbial agents becoming opportunistic et al., 2013). It is estimated that 2.95 million infections among individuals whose immune status individuals live with HIV/AIDS in Nigeria has been suppressed by the infection (Bigwan and (WHO/UNAIDS/UNICEF, 2008) and integrated Wakjissa, 2013). Bacterial infections are a common cause of morbidity and mortality in HIV positive individuals (Evans et al., 1995). HIV-positive patients Cancer Biology 2013; 3(3) http://www.cancerbio.net are liable to acquire opportunistic infections (HAART) – naïve females and 30 females on highly including urinary tract infections (UTIs) (Schönwald active antiretroviral therapy (HAART) for 3-6 et al., 1999). People living with HIV are likely to be months. Most of the HIV seropositive females had no more predisposed to urinary tract infection (UTI) due signs or symptoms of UTI compared to HIV to the suppression of their immunity and women in seronegative females. Exclusion criteria include this category tend to get them more often due to the antibiotic usage within one week and large fluid in- nature of their anatomy (Bakke and Digranes, 1991; take (in previous hour) before clinic attendance. The Kayima et al., 1996; Kumamoto et al., 2002; Bigwan HAART, regimen for HIV patients on HAART and Wakjissa, 2013). consisted of zidovudine, stavudine and nevirapine. UTI is not only common nosocomial Informed consent was obtained from all subjects infection but an important source of morbidity in before specimen collection. community as well (Acharya et al., 2011; Jai et al., 2012). It is the most frequent cause of illness in 2.2. Sample collection and processing
humans after respiratory tract infection (Jai et al., Clean–catch midstream urine (MSU) was 2012). UTI is the most common problem found in all collected from each patient into a sterile screw– age group patients. UTI has more prevalence in HIV- capped universal container. These urine samples were infected patients because of decreased immune status transported in a commercially available collection compared to Non-HIV infected individuals. Recent and transport system for urine specimens to the reports suggest that the incidence of urinary tract Medical Microbiology Laboratory, Department of infection (UTI) is increased in HIV positive patients Microbiology, University of Port Harcourt, Port (Omar de Rosa et al., 1990; Pinho et al., 1991; Evans Harcourt, Nigeria for analysis using standard et al., 1995). Furthermore, there is evidence that laboratory procedures. bacteriuria is more common as HIV disease progresses (Hoepelman et al., 1992; Bain et al., 1992; 2.3. Microbiological analysis
Evans et al., 1995). Macroscopic examination was carried out on Recent studies demonstrated a broad range the samples. A loop-full (0.002 ml) of well mixed un- of bacteria causing UTIs in HIV-infected patients, centrifuged urine was streaked onto the surface of Pseudomonas aeruginosa, blood agar and cystine lactose electrolyte deficient Streptococcus faecalis, and Staphylococcus aureus (CLED) medium. The plates were incubated and unusual microorganisms including Candida spp., aerobically at 370C for 24 hours and counts were Salmonella Acinetobacter expressed in colony forming units (CFU) per Cytomegalovirus (Schonwald et al., 1999; Lee et al., milliliter (ml). A count of up to 100,000CFU/mL was 2001; Ochei and Kolhatkar, 2007; Bansil et al., 2007; considered significant to indicate bacteriuria. Ten Bigwan and Wakjissa, 2013). Co-trimoxazole is (10) mls of each well-mixed urine sample was active against most common urinary pathogens and centrifuged at 2000g for 5 minutes. The supernatant has been widely used as prophylaxis against was discarded and a drop of the deposit was examined microscopically for urine deposits such as immunocompromised individuals (Evans et al., pus cells, red blood cells, epithelial cells, casts, crystals yeast-like cells and Trichomonas vaginalis. The aim of this study was to find the Pus cells ≥ 5 per high power field were considered prevalence of UTI in a cohort of HIV and Non-HIV- significant to indicate infection. The isolates were infected females and planning its treatment strategy identified based on gram reaction, morphology, and based on etiologic agent. The study also assesses the susceptibility of isolated uropathogens to different susceptibility carried out via the disc diffusion antibiotics commonly used in Port Harcourt, Nigeria. technique using antibiotic discs in accordance to standard microbiological methods (Cheesbrough, 2. MATERIALS AND METHODS
2000; Ochei and Kolhatkar, 2007). 2.1. Study Population
The study population focused on confirmed 2.4. Antibiotics sensitivity test
HIV positive female patients attending University of Antibiotic susceptibility test of antibiotics Port Harcourt Teaching Hospital (UPTH), Port and their interpretation was carried out for bacterial Harcourt City, Nigeria. The study population isolates by Kirby-Baur technique as recommended by comprised of 50 HIV seropositive and 50 apparently healthy HIV-seronegative females attending the Standards (2000). Uropathogens were identified on health facility. The HIV-seropositive females the basis of Gram's reaction, colony morphology and consisted of 20 highly active retroviral therapy standard biochemical tests. Antibiotic susceptibility Cancer Biology 2013; 3(3) http://www.cancerbio.net was tested by disc diffusion method for all 1st and 2nd bacteriuria (i.e. >105 colony forming units (CFU)/ml) line antibiotics. First line antibiotics tested were representing 37.0%. It also showed that 24(24.0%) Ampicillin (30µg), Ampiclox (10µg), Augmentin samples had no significant bacteriuria (i.e. <105 (30µg), Chloramphenicol (30µg), Co-trimoxazole colony forming units (CFU)/ml) and 39(39.0%) (Septrin, 30µg), Gentamicin (10µg), Lincocin (10µg), samples had no bacteriuria (Table 1). Among the 50 HIV seropositive females, Rifampicin (10µg) and Streptomycin (30µg). Second 17(34.0%) had significant bacteriuria, 14(28.0%) had line antibiotics tested were Ceporex (10µg), no significant bacteria growth and 19 (38.0%) Ofloxacin (10µg), Peflacine (10µg), Floxapen samples had no bacteriuria (Table 1) while among the (10µg), Nrobactin (10µg) and Ciprofloxacin (10µg). HIV seronegative females (controls), 21 (42.0%) samples had significant bacteria growth, 10 (20.0%) 2.5. Data Analysis
had no significant bacteria growth and 19 (38.0%) Data were analyzed using Chi-Square test. samples had no bacteriuria (Table 1). There was Values of P < 0.05 were considered statistically significant difference (42.0 vs. 34.0, P<0.05) in the significant while values of P > 0.05 were non- prevalence of bacterial uropathogens between HIV seropositive and HIV seronegative females. Bacterial uropathogens were more prevalent among HIV 3. RESULTS
seronegative females (controls) than HIV seropositive 3.1. Prevalence of significant bacteria in the HIV-
females (Table 1). seropositive and HIV seronegative females
One hundred (100) samples of urine 3.2. Prevalence of significant bacteria in relation
collected from 50 HIV seropositive and 50 HIV to highly active antiretroviral therapy (HAART)
seronegative females were evaluated to assess the There was significant difference (40.0 vs. prevalence of urinary tract infection in a cohort of 30.0, P<0.05) in the prevalence of significant HIV seropositive females and HIV seronegative bacteriuria between HIV seropositive females on females within age groups 25-50 years. Generally, of HAART and HAART naïve females (Table 2). the 100 samples analysed, 37 had significant

Table 1: Prevalence of significant bacteriuria in HIV seropositive and HIV seronegative females
HIV Status
No. Tested (%)
No. Positive for No
significant No
bacterial
bacteriuria (%)
growth (%)
Seronegative (controls) 50(50.0) 100(100.0)
38(38.0)
24(24.0)
38(38.0)

Table 2: Prevalence of significant bacteriuria in relation to highly active antiretroviral therapy (HAART)
stages among HIV-seropositive females
HIV Seropositives
No. Tested (%)
No. Positive for UTI (%)
50(100.0)
17(34.0)

3.3. Frequency occurrence of bacteria isolates
Pseudomonas aeruginosa Table 3 shows the frequency of occurrence Streptococcus species 1(5.9%), Enterococcus faecalis of bacteria isolates. Generally, Staphylococcus aureus 1(5.9%) and Proteus mirabilis 1(5.9%) while 10(26.3%) was the most predominant bacteria Staphylococcus saprophyticus 0(0.0%) was absent. isolated from urine samples. This was followed by Also among the HIV seronegative females, Klebsiella species 7(18.4%), Escherichia coli Staphylococcus aureus 6(28.6%) was the most Pseudomonas aeruginosa predominant. This was followed by Klebsiella species Proteus species 3(7.9%), Streptococcus species Pseudomonas aeruginosa Enterococcus Proteus mirabilis 2(9.5%) and Streptococcus species Staphylococcus saprophyticus 2(5.3%). Among the 2(9.5%), Staphylococcus saprophyticus 2(9.5%) HIV seropositive females, Escherichia coli 5(29.4%) while Enterococcus faecalis 1(4.8%) and Escherichia was the most predominant. This was followed by coli 1(4.8%) were least predominant. However, Staphylococcus aureus 4(23.5%), Klebsiella species Cancer Biology 2013; 3(3) http://www.cancerbio.net Staphylococcus saprophyticus was only present among the HIV seronegatives (Table 3).
Table 3: Frequency of occurrence of bacteria isolates
Bacteria isolates
HIV seropositives (%)
HIV negatives (%)
Staphylococcus aureus Staphylococcus saprophyticus Escherichia coli Pseudomonas aeruginosa Klebsiella species Proteus species Streptococcus species Enterococcus faecalis 38(100.0)
17(44.7)
21(55.3)

3.4. Frequency occurrence of fungi isolates
species 2(14.3%). Candida albicans was most Table 4 shows the frequency of occurrence predominant among HIV seropositive and HIV of fungi isolates. Generally, Candida albicans seronegative females. However, Aspergillus species 10(71.4%) was most predominant. This was followed 2(33.3%) was only present among the HIV by Aspergillus species 2(14.3%) and Penicillium seronegatives (Table 4).
Table 4: Frequency of occurrence of fungi isolates
Fungi isolates
Total No. (%)
HIV seropositives (%)
HIV negatives (%)
Aspergillus species Candida albicans Penicillium species 14(100.0)

3.5. Susceptibility and resistance of all bacteria
(58.8%), streptomycin (55.3%), augmentin (52.4%) isolated to different antibiotics
and ampiclox (52.4%) was recorded. High resistance Table 5 shows the results of the percentage antibiotic sensitivity and resistance of uropathogens. High sensitivity to ofloxacin (85.7%), ceprox nrobactin (64.7%), erythromycin (58.8%), ampicillin (85.7%), ciprofloxacin (78.9%), peflacine (76.2%), (57.1%), ampiclox (47.6%), augmentin (47.6%), and gentamicin (60.5%), lincocin (58.8%), rifampicin septromycin (44.7%) were observed (Table 5).
Table 5. Susceptibility and resistance of all bacteria isolated to different antibiotics
Antibiotics
No. tested
Number of isolate sensitive (%)
Number of isolate resistant (%)
Ampicillin (30µg) Ampiclox (10µg) Augmentin (30µg) Ciprofloxacin (10µg) Chloramphenicol (30µg) Erythromycin (10µg) Floxapen (10µg) Gentamicin (10µg) Lincocin (10µg) Nalidixic acid (30µg) Nrobactin (10µg) Ofloxacin (10µg) Peflacine (10µg) Rifampicin (10µg) Streptomycin (10µg) Cancer Biology 2013; 3(3) http://www.cancerbio.net 4. DISCUSSION
females analyzed, 17(34.0%) had UTI while of the 50 The aim of this study was to find the urine samples of HIV seronegative females, prevalence of UTI in a cohort of HIV and Non-HIV- 21(42.0%) had UTI. The study found significant infected females so as to plan its treatment strategy differences (42.0 vs. 34.0, P<0.05) in prevalence of based on etiologic agent. The study showed that significant bacteriuria among HIV seropositive and overall prevalence of significant bacteriuria was HIV seronegative females (controls). This present 38.0%. The higher incidence found in these females finding agrees favourably with the fact that may not be unconnected to the general increased risk uropathogens causing UTIs are not higher in HIV of women to acquiring urinary tract infection (Samuel seropositive individuals than HIV seronegative et al., 2012). This is due to the anatomical structure of individuals as reported in our previous study (Frank- the female genital tract that makes them susceptible to Peterside et al., 2013a). However, our present study urinary tract infections compared to their male disagrees with the fact that uropathogens causing UTIs counterparts irrespective of their HIV sero status are higher in HIV seropositive individuals (Bigwan (Najar et al., 2009; Samuel et al., 2012). Close and Wakjissa, 2013). The higher prevalence of the proximity of the female urethral meatus to the anus, bacterial pathogens in all the HIV seronegative shorter urethra, and sexual intercourse, incontinence, females (controls) may be attributed to their exposure bad toilet habits have all been reported as factors that to HIV/AIDS being the major predisposing risk factor influence the higher prevalence in females (Orrett and and probably other risk factors such as pregnancy, Davis, 2005; Ochei and Kolhatkar , 2007; Aiyegoro et diabetes, increased sexual activity and contamination al., 2007; Bigwan and Wakjissa, 2013). This figure (38.0%) reported in this study is Cunningham, 2005; Obiogbolu et al., 2009; Okonko et lower than the 50.0% reported by Obiogbolu et al. al., 2009a; Bigwan and Wakjissa, 2013; Frank- (2009) and the 47.5% reported by Okonko et al. Peterside et al., 2013a). (2009a). However, it is higher than the 28.1% reported The prevalence of significant bacteriuria by Olowu and Oyetunji (2003) in Lagos, Nigeria, the among HIV seropositive females was 34.0%. This 30.0% reported by Anochie et al. (2001) in a rural disagrees with similar studies reported previously in community in Enugu, Nigeria and the 26.0% overall Nigeria and outside Nigeria. This figure is lower than prevalence reported by Samuel et al. (2012) in Irrua, the 78.0% reported in our previous study in Port Edo State, Nigeria. UTI prevalence of 38.0% reported Harcourt, Nigeria (Frank-Peterside et al., 2013b). It is in this present study is comparable to the 39.6% also lower than the prevalence of 48.7% recorded by reported in our previous study in a cohort of HIV- Iweriebor et al. (2012) in South Africa. It is higher positive and HIV-negative males in Port Harcourt, than 23.9% reported in our previous study among HIV Nigeria. The higher prevalence found in females in seropositive males (Frank-Peterside et al., 2013a). It is this present study may not be unconnected to the also higher than the 23.5% reported in Jos, Nigeria general increased risk of women to acquiring urinary (Bigwan and Wakjissa, 2013) and the 29.1% reported tract infection (Samuel et al., 2012). According to in South Africa (Fabian et al., 2009). However, it is previous studies, this is largely due to the anatomical comparable to the 32.3% reported in Irrua, Edo State, structure of the female genital tract that makes them Nigeria (Samuel et al., 2012). susceptible to urinary tract infections compared to According to most researchers, UTIs are an their male counterparts irrespective of their HIV important health problem in HIV-infected persons, serostatus (Najar et al., 2009; Samuel et al., 2012). where the incidence is between 5% and 20 % Although definitive diagnosis is based on (Foxman, 2002; Bigwan and Wakjissa, 2013). Studies culture results but looking at the significant bacteriuria have shown that the incidence of UTIs is greater in 38.0% of samples shows good clinical co-relation among men and women infected with HIV than between clinical and microbiological diagnosis (Das et among men and women who are sero-negative for al., 2006; Jai et al., 2012; Frank-Peterside et al., HIV (Schonwald et al., 1999; Foxman, 2002; Bigwan 2013a,b). However in this present study, 24.0% of the and Wakjissa, 2013). Our present study did not samples had no significant bacteria growth (i.e. < 105 support this claim. Rather, our study showed colony forming units (CFU)/ml) and 38.0% of the significant differences (40.0 vs. 30.0, P<0.05) in the samples had no bacteria growth. In line with Jai et al. prevalence of significant bacteriuria between HIV (2012) and Frank-Peterside et al. (2013a, b) presence seropositive females on HAART and HAART naïve of insignificant growth or sterile urine may be due to females. The higher frequencies of occurrence among prior use of antibiotics or improper method of HIV-infected HAART naïve females may be due to collecting samples. several possibilities such as: advanced stage of HIV, The study also showed that of the 50 increased sexual activity, bad toilet habits or sharing midstream urine samples from HIV seropositive of bad public toilet facilities among these groups Cancer Biology 2013; 3(3) http://www.cancerbio.net (Bigwan and Wakjissa, 2013). This might have more predominant in the urine of their patients in increased risk of bacteriuria which correlates with the Benin and Frank-Peterside et al. (2013b) where degree of immunosuppression, as reflected by the CD4 Staphylococcus aureus (66.7%) more predominant in count (Bigwan and Wakjissa, 2013). the urine of HIV seropositive patients in Port The differences in the prevalence in these two Harcourt, Nigeria. groups may be linked to the immune status of the individuals, increased multiple sexual activities and Staphylococcus aureus accounted for the highest other possible risks factors (Bigwan and Wakjissa, bacteria isolates at 28.6%. This is also in contrast with 2013). Most studies have demonstrated increased our previous finding in a cohort of HIV seronegative susceptibility to UTIs in HIV-infected patients with Escherichia CD4 count of <200 lymphocytes/mm3 (Schonwald et predominant over other pathogens (Frank-Peterside et al., 1999; Hochreiter and Bushman, 1999; Foxman, al., 2013a). It disagrees with our previous study among 2002; Bigwan and Wakjissa, 2013). Some studies have HIV seropositive (Frank-Peterside et al., 2013b). It indicated that the risk of bacteriuria and UTI may be also disagrees with previous studies on community increased in HIV-infected patients and is inversely acquired UTI (Cheesbrough, 2000; Allan, 2001; related to CD4+ lymphocyte counts (Hoepelman et al., Fabian et al., 2009; Obiogbolu et al., 2009; Okonko et 1992; Heyns and Fisher, 2005; Bigwan and Wakjissa, al., 2009; Samuel et al., 2012; Bigwan and Wakjissa, 2013). Furthermore, the spectrum of organisms Staphylococcus aureus which is the highest causing UTI in our study are not similar to community isolate has a high propensity for causing infections acquired infections in the HIV negative population in especially in young sexually actives (Mims et al., a studies by Wilkie et al. (1992) and Evans et al., 2004; Bigwan and Wakjissa, 2013). In this study, (1999), where nearly 90.0% of UTIs are due to E. coli, Staphylococcus aureus accounted for the highest and where resistance to amoxycillin also occurred. prevalence of bacteria isolates (26.3%), followed by The presence of Enterococcus faecalis and Escherichia coli and Klebsiella species (18.4%). This Streptococcus pyogenes in this study agrees is in agreement to what Omorogbe et al. (2009) found favourably with our previous study in Port Harcourt, in Benin where Staphylococcus aureus (27.2%) was Nigeria (Frank-Peterside et al., 2013b). Also, the isolated more in the urine of their patients. In our presence of Staphylococcus saprophyticus in this previous studies, Staphylococcus aureus was reported study agrees favourably with previous study in Irrua, to be most predominant over other bacteria Edo State, Nigeria (Samuel et al., 2012). uropathogens (Frank-Peterside et al., 2013a, b). This observation disagrees with previous studies on opportunistic fungal infection (Hedayati and Shafiei, community acquired UTI (Cheesbrough, 2000; Allan, 2010; Donbraye-Emmanuel et al., 2010; Alli et al., 2001; Fabian et al., 2009; Obiogbolu et al., 2009; 2011). In this study, Candida albicans 10(71.4%) was Okonko et al., 2009a; Jai et al., 2012; Samuel et al., most predominant over other fungi isolates. This was 2012; Bigwan and Wakjissa, 2013) where Escherichia followed by Aspergillus species 2(14.3%) and coli was reported predominant over Staphylococcus Penicillium species 2(14.3%). Candida albicans was also most predominant among HIV seropositive and UTI due to Escherichia coli is a common HIV seronegative females. Candida albican and other finding (Obiogbolu et al., 2009; Fabian et al., 2009; Candida species had been isolated from several Okonko et al., 2009a; Mwaka et al., 2011; Bigwan and clinical specimens from different part of Nigeria Wakjissa, 2013). Among HIV seropositive females, (Donbraye-Emmanuel et al., 2010; Alli et al., 2011) Escherichia coli accounted for the highest bacteria and different parts of the world (Hedayati and Shafiei, isolates at 29.4% followed by Staphylococcus aureus 2010; Choudhry et al., 2010; Alli et al., 2011). McGee being isolated in 23.5%. This agrees favourably with et al. (2009) also documented Candida species among Samuel et al. (2012) who also reported Escherichia immunocompromised patients with vaginitis and coli to be predominant over Staphylococcus aureus secondary to hematogenous spread. This figure being isolated in 23.1%. This was also documented in reported for Candida albicans 10(71.4%) in this study Jos Nigeria (Jumbo et al., 2005), in Ibadan Nigeria is comparable to the 70.0% reported by Nwankwo et among asymptomatic HIV positive pregnant women al. (2010) among females of reproductive age in Kano, (Awolude et al., 2010), in Bamako Mali (Dao et al., Nigeria. It is lower than the 78.0% reported by Rizvi 2007; Minta et al., 2007) where Escherichia coli was and Luby (2004) among Nepalese women; the 77.0% isolated in 46.7% and 28.57% of their studied cohort reported by Oyewole et al. (2010) among HIV- of patients respectively. However, this is also in infected women in Sagamu, Ogun state, Nigeria and contrast to what was reported by Omorogbe et al. the 88.3 % prevalence reported by Nikolov et al. (2009) who found Staphylococcus aureus (27.2%) Cancer Biology 2013; 3(3) http://www.cancerbio.net This figure is also higher than the 40.0% Nitrofurantoin was found to be the most sensitive reported by Oyewole et al. (2010) among non HIV- antibiotic to uropthogens. infected women in Sagamu, Ogun state, Nigeria; the The percentage sensitivity recorded for most 29.7% reported by Hedayati and Shafiei (2010) in isolates to some of the antibiotics used in this study is their study; the 65.4% reported by Donbraye- comparable to our previous findings (Frank-Peterside Emmanuel et al. (2010) in their study; the 33.6% et al., 2013b). Dao et al. (2007) that found the reported by Adeoye and Akande (2007) among fluoroquinolones sensitive to 90.9% of the isolates. women at LUTH and Military Hospital, Lagos; the Manfredi et al. (2001) also observed a similar 22.1% reported by Anorlu et al. (2004) among women sensitivity pattern among their cohort of patients. The in Lagos University Teaching Hospital, Lagos, observed contrast with the antibiotic sensitivity pattern Nigeria; and the 21.5% and 21.3% reported by Usanga with previous studies may not be unconnected with the et al. (2010) among pregnant women and non- different uropathogens isolated (Manfredi et al., 2001; pregnant women in Calabar, Nigeria. This was also Dao et al., 2007; Omorogbe et al., 2009; Samuel et al., higher than the findings published by some other 2012; Frank-Peterside et al., 2013b). workers (Nwokedi and Aniyam, 2003; Khan et al., In this study, highest resistance to nalidixic 2009; Muvunyi and Hernandez, 2009) who reported a acid (90.5%), septrin (80.9%), chloramphenicol prevalence rate of 12, 28, and 52.5% respectively. (70.6%), floxapen (647%), nrobactin (64.7%), This 71.4% reported for Candida albicans in erythromycin (58.8%), ampicillin (57.1%), ampiclox this study is also higher than the findings published by (47.6%), augmentin (47.6%), and septromycin some other workers (Nwokedi and Aniyam, 2003; (44.7%) were observed. Resistance to ampicillin, Donbraye-Emmanuel et al., 2010; Nwadioha et al., amoxicllin, augmentin and penicillin was also reported 2010; Alli et al. 2011) who reported a prevalence rate in our previous study (Frank-Peterside et al., 2013a,b). of 12, 28, and 52.5% respectively. It is higher than the This is also similar to what was observed by Jai et al. 60.0% reported for Candida albican by Alli et al. (2012) who reported 100.0% resistance of their E. coli (2011). It is also higher than what was reported by isolates to ampicillin. Furthermore, in a study by Choudhry et al. (2010), who reported Candida to be Wilkie et al. (1992) and Evans et al. (1999) nearly 2.0% in their study. It is also higher than the 26.0% 90.0% of UTIs were due to E. coli and were also reported for overall candida colonization and/or resistance to amoxycillin. infection among pregnant women by Donbraye- Emmanuel et al. (2010). This agrees with the reports (80.9%) was reported in this study. This agrees with of Nwadioha et al. (2010) from Jos, Nigeria. Samuel et previous findings (Jai et al., 2012; Frank-Peterside et al. (2012) also reported the presence of Candida al., 2013b). Jai et al. (2012) reported 69.0% of their E. albicans in 7.7% of urine samples analysed. coli isolates were resistant cotrimoxazole. Frank- This study also assessed the susceptibility of Peterside et al. (2013b) reported 52.9% resistance to Cotrimoxazole in our previous study. Most studies commonly used in Port Harcourt, Nigeria. UTI in however found their isolates resistant to cotrimoxazole HIV-positive patients tends to recur, requiring longer and penicillins perhaps due to the formers use treatment and it is suggested that treatment should be prophylactically in the HIV clinic for the prophylactic culture-specific (Heyns and Fisher, 2005; Bigwan and treatment of several opportunistic bacterial and Wakjissa, 2013). However, our study revealed that parasitic infections (Evans et al., 1995; van ofloxacin, ceporex, ciprofloxacin, peflacine, lincocin, Dooyeweert et al., 1996; Maynart et al., 2001; Samuel rifampicin, streptomycin, augmentin and ampiclox et al., 2012), widespread and indiscriminate use in our were the commonest antibiotics sensitive to the environment (Jai et al., 2012; Frank-Peterside et al., uropathogens. Our findings are however in agreement 2013a,b), self-medication, use of fake, adulterated and to that of several other workers. Samuel et al. (2012) substandard drugs and drug abuse (Bigwan and reported the commonest antibiotic sensitive to the Wakjissa, 2013; Frank-Peterside et al., 2013a,b). isolated organism to be ciprofloxacin, pefloxacin and ofloxacin. This also disagrees with the findings of 5. Conclusion
In conclusion, urinary tract infection is a Gentamicin, Nitrofurantoin and Augmentin more significant co-morbidity in females with HIV. This effective against most of the urinary isolates. It also study reveals a high prevalence of urinary tract disagrees with the findings of Okonko et al. (2009b) infections in a cohort of HIV seropositive females in who reported that Nitrofurantoin and Nalidixic acid Port Harcourt, Nigeria. Thus, a high index of suspicion remains the effective drug of choice against will lead to its prompt diagnosis and appropriate uropathogens. It is also in contrast to the findings of treatment. Of particular importance is the sensitivity Omorogbe et al. (2009) in Benin Nigeria where patterns of the strains of bacteria isolated, in which Cancer Biology 2013; 3(3) http://www.cancerbio.net ofloxacin, ceprox, ciprofloxacin, peflacine and 10. Bakke A, Digranes A.Bacteriuria in patients gentamicin were the most effective. Prospective treated with clean intermittent catheterization. studies are advocated to clarify whether these Scand J Infect Dis 1991; 23:577- 82. antibiotics confers some benefit in protecting HIV 11. Bansil P, Jamicson DJ, Posner SF, Kourtis AP. seropositive individuals against UTI. Hospitalization of pregnant HIV-infected women in the United States in the era of highly active Correspondence to:
antiretroviral therapy (HAART). J Women Iheanyi O. Okonko
Health 2007; 16:159- 62. Department of Microbiology, 12. Bigwan E. I. and Wakjissa F. D. 2013. University of Port Harcourt, Prevalence of Urinary Tract Infections among PMB 5323 Uniport Post Office, Choba, HIV Patients Attending a Non- Governmental East-West Road, Port Harcourt, Nigeria; Health Facility in Jos, Plateau State, Nigeria. International Journal of Biomedical And Advance Research 04(08): 528-533 Tel.: +234 803 538 0891 13. Cheesbrough M. Examination of urine and antimicrobial sensitivity testing. In: District REFERENCES
Laboratory Practice in Tropical Countries. Part 2 1. Acharya A, Gautam R, Subedee L. Uropathogens and their antimicrobial susceptibility pattern in University Press; 2000 p.105 – 143. Bharatpur, Nepal. Nepal Med Coll J 2011;13:30- 14. Choudhry S, Ramachandran VG, Das S, Bhattacharya SN, Mogha NS. Pattern of sexually 2. Adeoye GO, Akande AH. 2007. Epidemiology transmitted infections and performance of of Trichomonas vaginalis among women in Lagos Metropolis, Nigeria. Pak. J. Biol. Sci., 10: diagnosis in patients attending the sexually transmitted infection clinic of a tertiary care 3. Aiyegoro OA, Igbinosa OO, Ogunmwonyi IN, hospital. Indian J Sex Transm Dis. 31:104-108 Odjadjaro E, Igbinosa OE, Okoh AI. Incidence of 15. Chukwujekwu O, Chabikuli NO, Merrigan M, urinary tract infections (UTI) among children and Awi D, Hamelmann C. Integrating reproductive adolescents in Ile–Ife, Nigeria. Afr J Microbiol health and HIV indicators into the Nigerian Res 2007; 1:13 – 19 health system—building an evidence base for 4. Allan RR. Urologic symptoms. In: Guerrant action. African Journal of Reproductive Health RL,Walker HD, Weller FP ,editors. Essentials of 16. Dao S, Oumar AA, Dembele JP, Noutache JL, Livingstone; 2001.p. 98 – 100. Fongoro S, Maiga I, Bougoudogo F. 2007. 5. Alli JAO, Okonko IO, Odu NN, Kolade AF, Clinical and bacteriological profiles of the Nwanze JC. 2011. Detection and prevalence of urinary infections associated the VIH/AIDS in Candida isolates among patients in Ibadan, hospital area of Bamako, Mali. Mali Med. Southwestern Nigeria. Journal of Microbiology 2007;22(1):10-3. and Biotechnology Research 1(3): 176-184 17. Das RN, Chandrashekhar TS, Joshi HS, Gurung 6. Anochie IC, Nkanginieme KEO, Eke FU. The M, Shreshtha N, Shivananda PG. Frequency and influence of instruction about the method of susceptibility profile of pathogens causing urine collections and storage on the prevalence of urinary tract infections at tertiary care hospital. urinary tract infection. Niger J Paediatr 2001; Singapore Med J 2006;47:281 18. Donbraye-Emmanuel 7. Anorlu R, Imosemi D, Odunukwe N, Abudu O, Okonko IO, Alli JA, Ojezele MO, Nwanze JC. Otuonye M. 2004. Prevalence of HIV among 2010. Detection and prevalence of Candida women with vaginal discharge in a gynecological among pregnant women in Ibadan, Nigeria. clinic. Natl Med Assoc. 96(3): 367–371. World Applied Science Journal 10(9): 986-991 8. Awolude OA, Adesina OA, Oladokun A, Mutiu 19. Evans JK, A McOwan, R J Hillman, G E Forster. WB, Adewole IF. Virulence. 2010 May- 1995. Incidence of symptomatic urinary tract Jun;1(3):130-133. infections in HIV seropositive patients and the 9. Bain M, Emmanuel FXS, Willocks L, Cowan F, use of cotrimoxazole as prophylaxis against Brettle RP. Value of bacteriological screening of Pneumocystis carznn pneumonia. Genitourin urine samples from HIV infected patients. Med.; 71:120-122 Internet STD AIDS 1992; 3:360-361. Cancer Biology 2013; 3(3) http://www.cancerbio.net 20. Fabian J, Naicker S, Venter WD, Baker L, Naidoo S, Paget G, Wadee S. Ethn Dis. 2009 causative organisms isolated from patients with Spring;19(1 Suppl 1):S1-80-85. urinary tract infections (2000). I susceptibility 21. FMOH. Nigeria Federal Ministry of Health. distribution. Jap J Antibiot 2002;57:246-74. National HIV Sentinel Survey. A Technical 36. Lee LK, Dinneen MD, Ahmad S. The Urologist Report Abuja. 2008. 22. Foxman B .Epidemiology of Urinary Tract immunodeficiency virus or with acquired Infections. Incidence, morbidity, and economic immune deficiency syndrome. Br J of Urol costs. Am J Med 2002; 113:55-135. Intern 2001; 88:500- 10. 23. Frank-Peterside N, Chukwugozim-Umejuru R, 37. Manfredi R, Nanetti A, Ferri M, Chiodo F. J Okerentugba PO, Okonko IO. 2013b. HIV-1 & - Chemother. 2001 Apr;13(2):195-201. 2 Co-Infections with Multi-Drug Resistant 38. Maynart M, Lièvre L, Sow PS, Kony S, Gueye (MDR) Uropathogens in Port Harcourt, Nigeria. NF, Bassène E, Metro A, Ndoye I, Ba DS, Nat Sci;11(11):11-20 Coulaud JP, Costagliola D; J Acquir Immune 24. Frank-Peterside N, Okerentugba PO, Nwodo CR, Defic Syndr. 2001 Feb 1;26(2):130-136. Okonko IO. 2013a. Prevalence of Bacterial 39. McGee SM, Thompson CA, Granberg CF, Uropathogens in a cohort of HIV-Positive Males Hutcheson JC, Vandersteen DR, Reinberg Y, et in Port Harcourt, Nigeria. Cancer Biology 3(in al. 2009. Acute renal infarction due to fungal 25. Hedayati, T. and G. Shafiei, 2010. Candidiasis. candidiasis. Urology 73(3):535-537 eMedicine Specialties. 40. Merrigan M, Azeez A, Afolabi B, Chabikuli ON, 26. Hochreiter WW, Bushman W. Urinary tract Onyekwena O, Eluwa G, Aiyenigba B, Kawu I, infection: a moving target. World J Urol 1999; Ogungbemi K, Hamelmann C. HIV prevalence and risk behaviours among men having sex with 27. Heyns CF, Fisher M. The urological management men in Nigeria. Sexually Transmitted Infections of the patient with acquired immunodeficiency syndrome. Br J of Urol Intern 2005; 95: 709-16 41. Mims C, Dockrell HM, Gowering VR, Roith I, 28. Hochreiter WW, Bushman W. Urinary tract infection: a moving target. World J Urol 1999; Microbiology 3rd ed., Elsevier publishing company; 2004. p. 241 29. Hoepelman AIM, Buren MV, Brock JVD, et al. 42. Minta DK, Dembele M, Diarra AS, Sidibe AT, Bacteriuria in men with HIV-1 is related to their Cisse IA, Aldiouma H, Fongoro S, Maiga II, immune status (CD4+ cell count). AIDS 1992; Pichard E, Traore HA. 2007. Association of urinary tract infections and HIV infection in an internal medicine ward of Hospital of Point G- Bamako-Mali. Mali Med. 22(2):23-7. 43. Muvunyi C.M. and C.T. Hernandez. 2009. patients from Limpopo Province, South Africa. Prevalence of Bacterial Vaginosis in women with Afri J of Biotechnol 2012; 11(46): 10598-10604. vaginal symptoms in south province, Rwanda. 31. Jai Pal Paryani, Shafique-ur-Rehman Memon, Afr. J. Clin. Exper. Microbiol. 10(3):156-153. Zakir Hussain Rajpar, Syed Azhar Shah. 2012. 44. Mwaka AD, Mayanja-Kizza H, Kigonya E, Pattern and Sensitivity of Microorganisms Kaddu-Mulindwa D. Bacteriuria among adult Causing Urinary Tract Infection at Teaching non-pregnant women attending Mulago hospital Hospital. JLUMHS 11(02): 97-100 assessment centre in Uganda. Afri Health Sci 32. Jombo GT, Egah DZ, Ayeni JA. Niger J Med. 2011; 11(2):182 – 89. 2005 Oct-Dec;14(4):422-424. 45. Najar MS, Saldanha CL, Banday KA. Indian J 33. Kayima JK, Otieno LS, Twahir A, Njenga E. Nephrol. 2009 Oct;19(4):129-139. Asymptomatic bacteriuria among diabetics 46. Nikolov A, Shopora E, Museva A, Dinitrov A. attending Kenyatta National Hospital. East Afr 2006. Vaginal candida infections in the third Med J 1996; 73:524-26. trimester of pregnancy, Akush Ginekol (Sofia); 34. Khan A.S., F. Amir, S. Altaf, and R. Tanveer. 2009. Evaluation of common organisms causing 47. Nwadioha S, Egesie JO, Emejuo H, Iheanacho E. vaginal discharge. J. Ayub. Med. Coll. 2010. Prevalence of pathogens of abnormal Abbottabad 21(2): 90-93. vaginal discharges in a Nigerian tertiary hospital. 35. Kumamoto Y,TsukamotoT,Ogihara M,Ishibashi Asian Pacific Journal of Tropical Medicine 3(6): K, Hirose T, et al. Comparative studies on Cancer Biology 2013; 3(3) http://www.cancerbio.net Kandakai-Olukemi for Acquisition and Transmission of HIV in Shuaibu SA. 2010. Aetiologic Agents of Nigeria. Asian Journal of Medical Sciences 2(3): Abnormal Vaginal Discharge among Females of Reproductive Age in Kano, Nigeria. Journal of 59. Pinho AMF, Maranconi DV, Moriera BM, et al. Medicine and Biomedical Sciences, pp12-16 Bacteriuria in patients with CDC group IV 49. Nwokedi EE, Aniyam NN. 2003. A study of high manifestations: a prospective study (letter) .AIDS vaginal swabs in Kano teaching hospital. A preliminary report, Highland Medical Research 60. Pinho AMF, Maranconi DV, Moriera BM, et al. Journal 1: 57-61. Bacteriuria in patients with CDC group IV 50. Obiogbolu CH, IO Okonko, CO Anyamere, AO manifestations: a prospective study (letter) .AIDS Adedeji, AO Akanbi, AA Ogun, J. Ejembi, TOC Faleye. 2009. Incidence of Urinary Tract 61. Rizvi N, and S. Luby. 2004. Vaginal discharge: Infections (UTIs) among Pregnant Women in preparations and health Seeking behavior among Nepalese women. JPMA 54: 620 Scientific Research and Essay, 4(8):820-824 62. Samuel SO, Salami TAT, Adewuyi GM, 51. Ochei J, Kolhatkar A.Diagnosis of infection by Babatope E, Ekozien M.I. Prevalence of Urinary Specific Anatomic Sites. Medical Laboratory Tract Infections among a cohort of HIV Positive Science Theory and Practice.6th reprint. Tata Patients accessing care in a rural health centre in McGraw-Hill New Delhi; 2007. p.615-643. Nigeria. J Microbiol Biotech Res 2012; 2 52. Okonko IO, Donbraye-Emmanuel OB, Ijandipe LA, Ogun AA, Adedeji AO, Udeze AO. 2009b. 63. Sanyaolu AO, Fagbenro-Beyioku AF, Oyibo Antibiotics Sensitivity and Resistance Patterns of WA, Badaru OS, Onyeabor OS, Nnaemeka CI. Uropathogens to Nitrofurantoin and Nalidixic 2013. Malaria and HIV co-infection and their Acid in Pregnant Women with Urinary Tract effect on haemoglobin levels from three Infections in Ibadan, Nigeria. Middle-East J. Sci. healthcare institutions in Lagos, southwest Res. 4(2):105-109 Nigeria. African Health Sciences 2013; 13(2): 53. Okonko IO, Ijandipe LA, Ilusanya AO, Donbraye-Emmanuel OB, Ejembi J, Udeze AO, 64. Schonwald S, Begovac J, Skerk V. Urinary tract Egun OC, Fowotade A, Nkang AO. 2009a. infections in HIV disease. Int J Antimicrob. Incidence of Urinary Tract Infection (UTI) Agents 1999; 11:309-11. among Pregnant Women in Ibadan, South- 65. Sheffield JS, Cunningham FG. Urinary tract infection in women. Obstet Gynecol 2005; 106 (5 Biotechnology, 8(23):6649-6657 54. Olowu WA, Oyetunji TG (2003). Nosocomial 66. Usanga VU, Abia-Bassey L, Inyang-etoh PC, significant bacteriuria prevalence and pattern of Udoh S, Ani F, Archibong E. 2010. Prevalence bacterial pathogens among children hospitalized Of Sexually Transmitted Diseases In Pregnant for non-infective urinary tract disorders. West And Non-Pregnant Women In Calabar, Cross Afr. J. Med. 22(1): 72-75. River State, Nigeria. The Internet Journal of 55. Omar de Rosa S, Lopes GS, Da Costa JLF, Gynecology and Obstetrics 14(2). Lacerda MR, Haringer J, Faria RB Urinary tract 67. van Dooyeweert DA, Schneider MM, Borleffs infections in men with HIV infection. VI JC, Hoepelman AI. Neth J Med. 1996 International Conference on AIDS June 1990 Dec;49(6):225-227. (Abstract FB535). 68. Wilkie ME, Almond MK, Marsh FP. Diagnosis 56. Omoregie R, Eghafona NO. Br J Biomed Sci. and management of urinary tract infection in 2009;66(4):190-193. adults. BMJ3 1992; 305:1137-1141. 57. Orrett FA, Davis GK. A comparison of the 69. WHO/UNAIDS/UNICEF. Epidemiological fact antimicrobial susceptibility profile of urinary sheet on HIV and AIDS. Core data on pathogens for the years, 1999 and 2003. West epidemiology and response Nigeria 2008 update. Indian Med J 2005; 55: 95-99. 58. Oyewole IO, Anyasor GN, Michael-Chikezie EC. 2010. Prevalence of STI Pathogens in HIV- s/EFS2008/full/EFS2008_NG.pdf) 2008. Infected and Non-Infected Women: Implications

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