Dipstick urinalysis and antibiogram of bacteria isolates from asymptomatic undergraduate male students

INTRODUCTION

Asymptomatic bacteriuria (ASB) is the presence of a significant quantity of bacteria in the urine, typically above 10⁵ colony-forming units per milliliter, without the clinical symptoms associated with urinary tract infections (UTIs).^[1] Although ASB often remains benign, it can pose a risk for progression to symptomatic UTIs or even more severe complications, such as pyelonephritis or sepsis, if left untreated in vulnerable populations.^[2] Young male adults are generally considered to be at a lower risk for UTIs compared to females, due to anatomical and physiological factors. However, recent studies have suggested that the prevalence of ASB in asymptomatic males, particularly in institutional settings such as universities, may be higher than previously thought.^[3] This population is often subjected to a range of stressors and lifestyle habits, including inadequate hydration, irregular personal hygiene, and prolonged sitting periods, all of which may predispose them to urinary stasis and subsequent bacteriuria.^[4] Early detection and appropriate management of ASB in young, healthy individuals are crucial for preventing the potential spread of drug-resistant bacterial strains within the community. Dipstick urinalysis is a rapid, non-invasive, critical initial step, and cost-effective tool used to detect indicators of infection and other urological conditions, including nitrites, leukocyte esterase, glucose, ketones, and protein in the urine.^[1,5] This test can serve as an initial step in the identification of potential ASB cases, allowing for timely interventions to be made. However, despite its convenience and affordability, dipstick urinalysis has limitations, particularly regarding sensitivity and specificity, making it essential to confirm results with culture-based techniques. An antibiogram, which tests the susceptibility of bacterial isolates to a range of antibiotics, is another essential tool in the management of ASB. The growing threat of antibiotic resistance underscores the importance of conducting regular antibiogram assessments to guide effective treatment protocols.^[6] In cases of ASB, understanding the resistance profile of uropathogens is critical, as the overuse or misuse of antibiotics can lead to the development of multidrug-resistant organisms (MDROs). Recent reports suggest that antibiotic resistance, particularly to commonly used agents such as ciprofloxacin (CIP), trimethoprimsulfamethoxazole (SXT), and amoxicillin-clavulanate, is rising among uropathogens isolated from ASB cases in young adults.^[7]

MATERIAL AND METHODS

RESULTS

Table 1 summarizes the demographics of the participants across the various level of study with different age groups, lacking statistically significant results, with P-values exceeding 0.05 across all categories. Thus, this indicates no strong association between these demographics and the presence of isolates, while Table 2 summarizes the relationship between age groups and year of study with the presence or absence of bacteriuria. No significant correlation was observed, with P-values exceeding 0.05 across all categories.

Multiple antibiotic resistance (MAR) index S. aureus

Figure 1 below provides an overview of the MAR index patterns observed among the isolate S. aureus calculated by dividing the number of antibiotics to which the strain is resistant by the total number of antibiotics tested with indices ranging from 0.08 to 0.83.

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Figure 1:

Graph showing multiple antibiotic resistance index Staphylococcus aureus.

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MAR index E. coli

Figure 2 below provides an overview of the MAR index patterns observed among the isolate E. coli with indices ranging from 0.00 to 0.33.

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Figure 2:

Graph showing multiple antibiotic resistance index Escherichia coli.

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MAR index Salmonella typhi

Figure 3 below provides an overview of the MAR index patterns observed among the isolate (Salmonella typhi ) with indices ranging from 0.08 to 0.58.

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Figure 3:

Graph showing multiple antibiotic resistance index Salmonella typhi.

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MAR index S. dysenteriae

Figure 4 below provides an overview of the MAR index patterns observed among the isolate (S. dysenteriae) with indices ranging from 0.25 to 0.58.

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Figure 4:

Graph showing multiple antibiotic resistance Index Shigella dysenteriae.

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DISCUSSION

Bacteriuria has been discovered to pave the way for colonizing specific species of bacteria that produce UTIs. ASB is known to promote the significant spread of multi-drug-resistant pathogens. However, different microbes are known to infect and cause bacteriuria.^[10-12] The prevalence of ASB in the study was 89.4% with S. aureus being the most prevalent organism, comprising 54.87% of the total isolates, followed by Salmonella typhi at 23.78%, E. coli at 17.07%, and S. dysenteriae at 4.26%. The most prevalent organism reported in this study is known to be a commensal organism found commonly in skin microflora and mucous membranes. It is known to cause opportunistic infections mostly among immunocompromised individuals. It has been reported to cause bloodstream, skin, and soft-tissue infections including UTI.^[13-15] A similar, high prevalence rate of S. aureus has been reported in previous studies.^[16-19] However, results from previous studies that are at variance with the present study have been reported.^[20,21] The high prevalence of S. aureus can be ascribed to its high tolerance to pH and temperature variations, thus having a greater ability to colonize different areas of the body.^[22] Antibiotic susceptibility profile was also recorded for S. aureus with susceptibility to levofloxacin being 45.1% and high resistance was recorded in amoxicillin clavulanate 89%, gentamycin 78%, and azithromycin 78%. E. coli also showed susceptibility to levofloxacin (32.1%) and OFX (28.1%) but had the least susceptibility to amoxicillin clavulanate (0%) and ampiclox (0%). Salmonella typhi showed susceptibility to levofloxacin (43.5%) and nitrofurantoin (38.4%), and showed significant resistance to CTX (100%), amoxicillin-clavulanate (94.8%), and cefuroxime (89.7%) among others. While for S. dysenteriae relative susceptibility was recorded in OFX (71.4%) and levofloxacin (42.8%), there was significant high resistance recorded in ampiclox, CTX, nalidixic acid, CRO sulbactam, and cefuroxime with each being at a 100%.

The results of this study on the antibiogram profiles and dipstick urinalysis of male undergraduate students at Madonna University, Elele, who were asymptomatic, offer important new information about the frequency of bacterial infections and urine abnormalities in this population. A thorough understanding of urinary health and microbial resistance trends in an academic setting can be obtained from the results of the dipstick urinalysis, bacteriological analysis, and AST that follow.

The presence of distinct urine abnormalities across departments was shown by the dipstick urinalysis, which illustrates the range of physiological states and potential risk factors among students. Notably, proteinuria was found across a number of fields, with medicine and surgery and medical laboratory science (MLS) having the highest prevalence. Although asymptomatic proteinuria may also be benign, protein in the urine may be a sign of renal pathology, such as glomerulonephritis or UTIs.^[23] Although more research is needed to determine the clinical importance in asymptomatic persons, the presence of bilirubin in the urine was more common in pharmacies and may indicate hemolytic disorders or liver failure. Interestingly, ketones and glucose were absent in every area, which is in line with the research population’s lack of obvious metabolic conditions such as diabetes or ketosis. In addition, no nitrates were found in any of the samples, suggesting that asymptomatic students did not frequently get UTIs from nitrate-reducing bacteria (such as E. coli). Nevertheless, several participants had urobilinogen, although in trace amounts. The modest levels of urobilinogen detected here are probably not clinically significant and may be related to the physiological variability of asymptomatic persons, but elevated levels may indicate hemolysis or liver illness. In terms of the relationship between individual departments and bacteriuria, pharmacy had the highest significant level of bacteriuria, with 23 (16.3%) prevalence followed by MLS, with 17 (12.0%) prevalence, and the other subsequent department. This report is in contrast with the study done by Enwerem et al.,^[24] although the outcome is dependent on difference in the number of departments and sample size used for the study. A substantial number of pathogenic bacteria was found by bacteriological examination, with S. aureus accounting for the majority of isolates (54.97%), followed by Salmonella typhi (23.78%), E. coli (17.07%), and S. dysenteriae (4.24%). Given that S. aureus is one of the main causes of both symptomatic and asymptomatic infections, our results are in line with the larger epidemiological trend of bacterial pathogens that commonly cause UTIs.^[24] Due to the possibility of antibiotic resistance, the high frequency of S. aureus calls for concern. The relative prevalence of S. aureus in this study emphasizes the significance of taking into account both Gram-positive and Gram-negative pathogens when examining urinary health in asymptomatic populations, even though E. coli and Salmonella are also frequently linked to gastrointestinal and urinary infections. Significant AMR is evident in the antibiotic susceptibility patterns found in this investigation, particularly among the isolates of S. aureus. The statistics reveal concerning rates of resistance to popular antibiotics, such as erythromycin (57.1% resistant), gentamicin (76.9% resistant), and amoxicillin-clavulanate (89% resistant). These high rates of resistance are in line with worries around the world regarding the abuse and overuse of antibiotics, which is causing MDROs to arise.^[25] Given that S. aureus is a prevalent cause of skin infections and UTIs, which are commonly treated empirically with these antibiotics, this finding is particularly concerning.^[26] Both Salmonella typhi and E. coli were shown to be resistant to routinely given medications such as CRO and CIP among the Gram-negative isolates. This is consistent with research demonstrating a growing pattern of cephalosporin and fluoroquinolone resistance in these organisms, which makes treatment choices more challenging.^[27] Significantly, isolates of E. coli exhibited 100% resistance to CTX and ampiclox, indicating that these antibiotics may no longer be suitable first-line therapies in this population. The study’s AMR profiles highlight how urgent it is to update empirical treatment recommendations, with an emphasis on minimizing the overuse of antibiotics. More efficient management of antibiotic prescriptions is necessary since the high rates of resistance to gentamycin, CIP, and amoxicillin-clavulanate in S. aureus isolates indicate that these widely used antibiotics are losing their effectiveness. The study’s conclusions have important ramifications for clinical practice and public health at Madonna University and other comparable educational establishments. If neglected, ASB even in the absence of obvious clinical symptoms can have long-term effects, particularly when resistant bacterial strains are present. These results point to the necessity of more frequent student screenings for bacterial colonizations and UTIs, especially in light of the growing prevalence of AMR. To investigate the underlying risk factors linked to urine anomalies in asymptomatic persons, more research is necessary. The prevalence of UTIs and the emergence of AMR may be influenced by variables such as sexual activity, hygienic habits, history of antibiotic use, and socioeconomic position.^[28] The long-term dangers associated with ASB might be better understood by longitudinal studies that monitor the development of subclinical infections into symptomatic illness. To discourage self-medication, encourage the prudent use of antibiotics, and lessen the needless use of broad-spectrum antibiotics, educational institutions must also establish antimicrobial stewardship programs in light of the high prevalence of resistance. The development of resistant infections may also be avoided by teaching students about good hygiene and the value of prompt treatment for urine symptoms. Interpreting the study’s findings requires taking into account a number of limitations. Even while the sample size is somewhat representative of the student body, it is still too small to draw broad conclusions. Because the study only looked at male students, its conclusions cannot be applied to female students or the broader public. In addition, although though the dipstick urinalysis is a helpful screening method, it is not always effective in identifying all kinds of urinary infections or anomalies. Therefore, more reliable information would be obtained from a more thorough diagnostic method that includes sensitivity testing and urine culture. This study concludes by highlighting the prevalence of bacterial infections and asymptomatic urine anomalies among male undergraduate students. The need for better diagnostic screening and antimicrobial stewardship is highlighted by the high frequency of S. aureus and other infections as well as concerning patterns of antibiotic resistance.

CONCLUSION

This study concludes by highlighting the prevalence of bacterial infections and asymptomatic urine anomalies among male undergraduate students at Madonna University, Elele River State south-south, Nigeria. The need for better diagnostic screening and antimicrobial stewardship is highlighted by the high frequency of Staphylococcus aureus and other infections as well as concerning patterns of antibiotic resistance. Universities and healthcare practitioners are urged by these findings to give infection control measures top priority, teach students good hygiene habits, and create focused interventions to fight antibiotic resistance.