Defection of Uropathogens in Urinary Tract Infection and their sensitivity Detection of Uropathogens in Urinary Tract Infection and Their Sensitivity to Many Antimicrobial Agents Mohamed R. Ali Foundation of Technical Education / Medical Technical Institute/Almansur Received in : 26 September 2012 , Accepted in : 24 June 2013 Abstract Urinary tract infections (UTI) are some of the most common infections experienced by humans, exceeded in frequency among ambulatory patient only by respiratory and gastrointestinal infections. It is also the most common cause of nosocomial infection in adults. A total of three hundred urine sample were collected in age (1-69 years old) in both gender, with (UTI) symptoms referred to AL-Yarmok Teaching Hospital at Baghdad city during the period from January 2010 till August 2010. . The commonest isolates were Escherichia coli (E.Coli), Proteus mirabilis and Klebsiella pneumoniae (These represented 49.2%, 22 %, and16 % of isolates respectively). The percentage of bacteria incidence in females was higher than male in most of examined samples, except in Klebsiella; it was higher in males .The most positive case was in elder patients than in children. The infection incidences expressed higher level in summer. It reached to peak from August with percentage of (32 %) and July (24.4 %). The antibiotic sensitivityforstreptomycin,lincomycin,Rifampicin,Chloramphenicol, Tetracyclin,Ampicillin, Penicillin , Co-trimoxazole, Amoxicillin, Nalidixic acid and Gentamycin was examined , detected species of bacteria were more sensitive to Chloramphenicol(75.6 ) and streptomycin (81.4 ), while the resistances to Tetracycline (100% and Penicillin(100%) were appeared to Escherichia coli. Key word : Urinary tract infection, antimicrobial resistance 15 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 Introduction Urinary Tract Infection (UTI) is a serious bacterial infection causing illness in infants and children. Urinary tract infection is applied to a variety of clinical condition ranging from asymptomatic presence of bacteria in the urine to severe infection of the kidney with resultant sepsis [1]. Urine infection is the most common serious bacterial infection causing illness in infants and children [2].It is one of the most common bacterial infections encountered by clinicians in developing countries [3]. Various factors make bacteriuria more or less to occur for any individual. These factors are age, gender, race, genetic factors, sexual activity among the teen age girls, and circumcision in boys, nocturnal enuresis and some unhealthy behaviors. UTI is age dependent and bacteriuria is more common at the extremes of life .The Incidence of UTI is bimodal highest during the first year of life and be taking again during adolescence [4]. Most of urinary tract infections are caused by gram-negative bacteria like, E.Coli , Klebsiella species, Proteus mirabilis, Pseudomonas aeruginosa, Acinetobacter, and Serratia. 90% of UTI cases are caused by gram-negative bacteria while only 10% of the cases are caused by gram positive bacteria. Gram-positive bacteria while only 10% of the cases are caused by gram positive bacteria. Gram- positive bacteria include Enterococcus, Staphylococcus, and Streptococcus agalactiae [5]. E. Coli are the most common gram – negative bacteria responsible for UTI [6], 75% to 87% of UTI cases are due to Escherichia coli [7, 8]. At least 80% of the uncomplicated cystitis and pyelonephritis are due to Escherichia coli [1].Whereas Proteus mirabilis and Klebsiella pneumoniae infection accounts 10%, 6% respectively [ 9,10,11]. Adherence properties of some organisms prevent the normal was hot for of these organisms by bladder emptying and mucosal host defense mechanisms. Escherichia coli are virulent due to the presence of p.fimbriae, ganelles on its strains that may attach or adhere on specific receptors of uroepithelial cells and interfere with the washout of bacteria [1]. Escherichia coli are predominant in girls, whereas Proteus mirabilis and Klebsiella pneumonia are likely encountered in boys [9]. Treatment of UTI with the appropriate antibiotic can minimize mortality, morbidity and any renal damage from acute UTI. Choosing the appropriate antimicrobial agents sounds difficult , but advances in the understanding of the pathogenesis of UTI , the development of new diagnostic tests , and the introduction of new antimicrobial agents have allowed physicians to appropriately tailor specific treatment for each patient Sulphamethoxazole, Trimethoprime, Fluroquinolones (e.g. Ciprofloxacin), Nitrofurantoin, amino glycosides (e.g. Gentamicin, Amikacin), cephalosporin and aminopenicllins (e.g. Ampicilline and Amoxicillin). Trimethoprime, Sulphamethoxazole, Cephalosporin and Amoxicillin –clavulanate are considered to be the most acceptable antibiotics for the treatment of UTI in pediatrics in comparison to quinolones, which has an effect on joint development, and first line therapy of amoxicillin which has a high prevalence of resistance to Escherichia coli in many communities [4]. Urinary tract infections are second most common type of infection in the body, accounting for a bout 8.1 million visit to health care providers each year [14].Women are especially prone of UTIs for antibacterial resons .UTI in men are not common as in women but can be serious when they occur. Many women suffer from frequent UTIs .About 20 percent of young women with a first UTI will have a recurrent infection [15]. Men are less likely than women to have a first UTI. But once a man has a UTI, he is likely to have another because bacteria can hide deep inside prostate tissue .Women are more prone to UTIs than men because in female the urethra is much shorter and closer to the anus [16].As a woman’s estrogen level decreases with menopause, her risk of UTIs increases due to the loss of protective vaginal flora [17].UTIs are the most frequent bacteria in women [18]. They occur most frequently between the age of 16and 35 years, with 10 % of woman getting an infection. High incidence of UTI due to Proteus spp., Klebsiella spp. And Enterobacter spp. Infection is more common among Children with recurrent UTIs and in those treated with antibiotic prophylaxis. Whereas other Uropathogens like Pseudomonas, Serratia and Candida are more common among children with urogenital 16 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 abnormalities [12]. 87% of Community –acquired UTI is due to Escherichia coli and 12% by Klebsiella; whereas in hospital acquired UTI 65% are caused by Escherichia coli and other pathogens, including Pseudomonas [13]. It is very important to recognize and treat UTI rapidly yearly and 60 % having an infection at some point in their lives [19]. The incidence of true UTI in adult male younger than 50 years is low (approximately 5-8 per year per 10,000), with adult woman being 30 times more likely than men to develop a UTI. The incidence of UTI in men approaches that of woman only in men older than 60 years [20]. The aims of this study are detection of bacteria that causes urinary tract infection in some Iraqi patients and determine the sensitivity to many antibiotics . Materials & Methods Three hundred urine samples were collected from patients in age( 1-69 years old ) in both gender , with UTI symptoms referred to AL-Yarmok Teaching Hospital at Baghdad city; were studied during the period from January/ 2010August /2010. Isolation of Uropathogens was performed by a surface streak procedure on both blood and MacConkey agar (Oxoid Ltd. Bashing store Hampaire , uk) using calibrated loops for semi-quantitative method and incubated aerobically at 37c for 24 hours, and those cultures which became negative at the end of 24 hours incubated were further incubated for 48 hours [21]. A specimen was considered positive for UTI if a single organism was cultured at a concentrationof_>105ofU\ml. Bacteria identification was made using biochemical test, namely indol, citrate, oxidase, H2S production, lysine decarboxylase, lactose fermentation, urea hydrolysis, gas production, catalase coagulase and manitol fermentation [22]. All positive cultures were repeated again to confirm and to be accepted as UTI in association with abnormal urinalysis and UTI symptoms. The strains isolated were identified and diagnosed by Grams stain and biochemical reactions which were done by using Api 20 E and API Staph system (bio Meraux, France). In addition to the characteristics of bacterial colonies on culture media. Antibiotic sensitivity was performed for all isolates by discs diffusion method on Nutrient agar (Oxoid). Different antibiotic disc were used [Table 1]. The inhibition zones of antibiotic disc were measured according to the method of baron 1996 [23]. . Results and Discussion Bacteria species that had been seen in UTIs were of fecal origin . These organisms are a subset of the organisms found in the feces , more than 90% of acute UTIs in patients with normal anatomic structure and function are caused by certain strains of E.coli [24] . 10-20 % are caused by coagulase-negative staphylococcus saprophyticus 5 % or less are caused by other enterobacteriaceae organisms or enterococci , while in complicated cases of UTI, such as UTIs resulting from anatomic obstructions, or from catheterization the most common causes of UTI are E.coli , Klebsiella pneumoniae , Proteus mirabilis , Enterococcus sp. ,Pseudomonas aeruginosa 53 % , 12 % , 6 % , 12 % , 0.4 % [ 25 ] . Out of 300 urine samples, (250) samples showed a positive culture growth while (50) samples have no growth. Eight different isolates obtained with highest incidence for E.coli isolate 123 (49.2%) followed by Proteus mirabilis isolate 55 (22%) and Klebsiella pneumoniae 40 (16 %), while the lowest incidence was for Morganella morganie, Pseudomonas aeruginosa, Citrobacter spp., Staphylococcus aureus and Enterobacter spp. With 10 ( 4% ) , 10 (4% ), 7(2.8% ), 4 ( 1.6% ) and 1 ( 0.4% ) respectively [ Table 2 ]. In this study, the isolation rate of bacteria from urine was 83.3 %which is comparatively than reports within the country and other part of the world [26]. In our study, results showed that 50 % of the isolates were E.coli 7(33.3 %) and Klebsiella pneumoniae 4(19 %) while other gram negatives were found in asmall in number. On the 17 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 otherhand, isolated gram positive bacteria were Staphylococcus aureus with proportion of 1 (4.8 %) [27]. In other study result showed seven different isolates obtained with highest incidence for E.coli 115 (39.7 % ) followed by Proteus mirabilis 70 (24.2 % ) and Klebsiella pneumoniae 60 ( 20.8 % ) while the lowest incidence was for Morganella morganie, Pseudomonas aeruginosa, Citrobacter spp.and Staphylococcus aureus with 19 (6.6% ) ,14(4.9%),10(3.5%) and 1( 0.3%) respectively [28 ] . E .coli is the major a etiological agent in causing UTI which accounts for up to 90% cases [29] In this study, the most frequent Uropathogens were Gram negative which made up (90.8%) ofalltheisolates. Regarding sex, the study showed that the percentage of UTI in female was higher than in male four most isolates obtained except in Klebsiella pneumoniae was higher in male than female, it was (52.5 %) and its significant [Table 3 ]. Woman is at great risk for UTI primarily because of the significantly shorter urethra and closer proximity to the rectum. The female genitalia may become colonized with pathogenic bacteria that can more easily enter the urethra. In addition, woman lack the bacteriostatic protection that prostatic secretions offer the male [30].American women are 30 times more likely to have UTI than men [31] .In our study showed that the percentage of UTI in female was higher than in male four most isolates obtained except in Klebsiella pneumoniae was higher in male than female, it was (61.66%) and its significant . All patients taken were between 1-69 years old, [ Table 4 ] showed the age prevalence of UTI and revealed highest incidence in elder patient than in younger ones (24, 29.2 , 28 ) % were for ages ( 40-49 , 50-59 ,60-69 ) respectively .20-25% of elder women have UTI because of the number of biological factor including estrogen loss, after menopause, the wall of urinary tract thin out weakening the mucous membrane and reducing the ability to resist bacteria , the bladder may lose elasticity and fail to empty completely , besides poor over all health. 5-15% of men older than 50 -65 will have asymptomatic UTI more likely because of prostate problems [32]. In other study showed the age prevalence of UTI in elder patient than in younger (17.99, 28.72, 22.5) % were for age (40-49, 50-59, 60-69) respectively [28]. In other study showed the age range of patients was between 19-39 years is 53.5%, 40-49 is 25.9% [33]. Regarding, month distribution of the UTI obtained in the study. [Table5] the highest incidence was in summer season. It reaches the peak during July and August (56.4%) while (43.6%) distributed on the rest of the months of year .Infection caused by these bacteria has seasonal variation with higher incidence in summer and full in winter and spring may be due to hot weather and bad hygiene management during summer. our study showed highest incidence was in summer season during July ,August and September about (58.06% ) while( 41.94% ) 0n the rest of the months [ 34 ] . Bacterial Uropathogens from patients with UTIs revealed the presence of high levels of single and multiple antimicrobial resistances against commonly prescribed drugs. The increasing rates of resistance to uropathogenic, E.coli isolates reported worldwide, antibiotic susceptibility pattern of these isolates revealed that for our patients, [Table 6]. The inhibition zone of the antibiotic discs were measured on nutrient agar for all isolates, the sensitivity of bacterial isolates to the antibiotics was tested, and the results showed that most isolates were resistant to antibiotic in different ranges. E.coli which the predominant cause of UTI showed high percentage of resistance to Tetracycline and penicillin ( 100 % ) ,and low resistance to Streptomycin and Chlorompinicol (18.6 % , 24.4 % ) respectively . Sensitive to Streptomycin and Chlorompinicol (81.4%, 75.6 %) respectively. Other study showed E.coli high percentage of resistance to Tetracycline and Amoxicillin (83%, 87%) respectively. [35]. 18 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 Proteus mirabilis which is the second most prevalent pathogen of UTI showed high resistance to Rifampicin (100%) and Lincomycin (94.5%) and low resistance to Chlorompinicol (9%), sensitive to Chlorompinicol (91%). Klebsiella pneumoniae showed high resistance to Rifampicin (100%) and Penicillin (75%) and low resistance to Chlorompinicol (12, 5%), sensitive to Chlorompinicol (87.5%) , Gentamycin (80%) and Nalidixie (80%) . Morganella morgnii showed high resistance to Lincomycin, Rifampicin (100% ) respectively and low resistance to Streptomycin (20%), sensitive to Streptomycin (80%) . Pseudomonas aeruginosa showed high resistance to Lincomycin, Rifampicin (100% ) respectively and low resistance to Amoxicillin (40%), sensitive to Amoxicillin(60%) . Citrobacter spp. showed high resistance to Lincomycin, Rifampicin (100% ) respectively and low resistance to Penicillin (42.9%), sensitive to Amoxicillin(71.4%) . Staphylococcus aureus showed high resistance to Streptomycin, Nitrofurantin (100% ) respectively and low resistance to Penicillin, Chloramphenicol, Amoxicillin (25%) respectively, sensitive to Lincomycin(25%) . Enterococcus showed high resistance to Lincomycin, Rifampicin, Penicillin, Amoxicillin and Nitrofurantin,Chloromphenicol,Tetracyclin,Ampicillin and Co-trimoxazole100%) . Resistance to antimicrobial agents has been noted since the first use of these agents and is an increasing world-wide problem [ 36 ] . our study showed higher prevalence rate of resistance to the commonly prescribed antibiotic agent, finding that 100% of E.coli and Klebsiella pneumoniae isolate were resistance to Amoxicillin and Ampicillin [37]. On the otherhand very levels of resistance were detected to antibiotic such as Ceftriaxone,Nitrofurantoin and Gentamycin and a comparable rate of sensitivity has been reported for these drugs in previous studies done in Ethiopia [ 38 ,39 ] , in Kosovo [40 ],in Iran [41 ] and South Croatia [ 42] .Low resistance were observed for these drugs because they are not easily accessible and relatively expensive in price compared to other .Thus ,the drugs could be considered as alternative option in the empirical treatment of UTIs. our study in India showed that Nitrofurantoin had the best in-vitro susceptibility profile against E.coli [43 ] .In previous studies, nitrofurantoin was the most active agent (94%) , followed by Gentamycin and Cefpodoxime ,high rates of resistance to Ampicillin (55%) and Trimethoprime (40%),often in combination were observed in both sets of isolates [44] . Conclusion The isolation of bacterial Uropathogens with a higher resistance rate for commonly use antimicrobial leave the clinicians with very option to choose drug used for empirical oral treatment for UTI was extremely high level of resistance to tetracycline and penicillin. As drug resistance among pathogens is an evolving process, routine surveillance an monitoring studies should be conducted to proved physicians with knowledge about the most effective empirical treatment of UTIs. References 1- Schafer, T. (2001 ) Urinary tract infections in children younger than 5 years of age : epidemiology,diagnosis,treatment,,outcomes,and,prevention. Paediatrh,Drugs vol13p219-227. 2- Yildiz, B. Kural, N. Duruez, G. Yarar, C. and Akcar, N. (2007) Antibiotic resistance in children with complicated urinary tract infection. Saudi. Ued. J.vol .28.p: 1850- 1854. 3- Ramadan, A.(2003) Prevalence of urinary tract infection in primary school children and its relation to school achievement in Ismailia government [thesis]. Egypt: University Cairo; p184 4-Wu, C. Chiu p. Hsieh, K. Chiu d. et.al. (2004) Childhood urinary tract infection; a clinical analysis of 597 cases. Acta Paediatrh. Taiwan. vol. 45: p328- 333. 19 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 5- Nicolle, L. (2008) Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urad. Clin. North. Am.Vol.35: p1- 12. 6- Lane, D. and Takhar, S. (2011) Diagnosis and management of urinary tract infection and pyleonepliritis. Emergency medicine clinics of North America. vol. 29: p359- 552. 7- Dielubanza, E. and Schaeffer, A. ( 2011 ) Urinary tract infection in women . The medical clinical of North America .vol .95: p 27- 41. 8- Chamberlain, N. (2009) The big picture medical microbiology. Chapter 34: P: 341-346. 9- Orenstein, R. and Wong, E. (1999) Urinary tract infection in adults. American family physician.March1. 10- Wilson, NL. and Gaido, I. (2004) Laboratory diagnosis of urinary tract infection in adult patients. Clin. Infect. Dis. Vol.38 p 1150-1158. 11- Pandeg, K. (2001) Urinary tract infection and its management by renal. The Antiseptic. Vol: 98 .p:295-296. 12- Dhingra, K. (2008) A case of complicated UTI; Klebsiella pneumonia comphysematous cystitis presenting as abdominal pain in the emergency department . West J.Emerg .Med. vol:.9 .p 171-173 . 13- Foxman, B. (2002) Epidemiology of UTI; incidence, morbidity, and economic costs. Am. J.Med. Vol: 113. P.5-13. 14-Schappert, SM .and Rechlsliner,EA.(2006 ) Urinary tract infection in adult . National kidney and urologic Diseases information clearing house. 15- Tolkoff, NE. Cotran, RS.and Rubin, r. (2008) Urinary tract infection, pyelonephritis, and reflux nephropathy. 16-Harper, M . and Fowls, G.(2007 ) Management of urinary tract infection in men . Trends in Urology Gynecology and sexual health 12(1) p: 30-35. 17- Dielubanza , E. and Schaeffer , A. (2011 ) Urinary tract infection in women . Medical Clinical of North America 95 (1 ) p: 27-40. 18-Colgan, R. and Willams, M. (2011) Diagnosis and treatment of a cute uncomplicated cystitis. American family physician 48 (7) p: 771-776. 19-Nicotte, L. (2008) Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Ural Clinic North America 35(1) p: 1-12. 20- Salvatore, S. and Cattion, E. (2011) Urinary tract infection in women. European Journal of obstetrics gynecology, and reproductive biology 156 (2) p; 131-136, 21-John, L.and Brush, M. (2011) Urinary tract infection in males. Antimicrobial chemo her . 66 (3) p: 650-656. 22- Inabo, H. and Obanibi, B. (2006) Antimicrobial susceptibility of some urinary tract clinical isolate to commonly used antibiotics. African J. Biotechnology. 5(5) p: 487-489 . 23-Samuel,.Baron,(1996).Medical Microbiology,4th edition . university of Texas Medical Bronch SBN-10 . 24- Tessema, B. Kassu, A. and Mulu, A. Yismaw, G. (2007) Predominant and their susceptibly pattern in gender university teaching hospital. Ethio Med.J vol: 45: p:1-67. 25- Rakaa, L . G. et.al (2004) Etiology and susceptibility of urinary tract infection isolates in Kosovo. Int. J.Antimicrob agents 23-25. 26- Kebira, AN. Ochola, P. and Khamadi, SA.( 2009) Isolation and antimicrobialusceptibility testing of Escherichia coli causing urinary tract infection J. Apple Biosci. ; 1320-1325. 27-Gentenet,B. et al.(2011). Bacterial Uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital south west ethiooia.Ethiop J.Health sci vol:21 No.2 . 28- Janet, A. (2010). Detection of some bacterial infection in urinary tract and their antibiotic sensitivity .International J for sci and Tec. Vol:5 No.3 p. 21-29 . 29-Ronald ,A (2002) .The etiology of urinary tract infection :Traditional and Emerging Pathogen.Am.J Med 113 suppli1A: 14S-19S . 20 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 30- Gupta ,K,ScholesD,and Stamm WE.(1999).Increasing prevalence of antimicrobial resistance among Uropathogens causing a cute uncomplicated cystitis in women. Jama 281 (8): 73-75 . 31- Saint D et al..(1999) T he effect iveness of a clinical practice guideline for the management of premed uncomplicated of premed uncomplicated UTI in women . The American J Med 06:p638-641. 32-Stamm, WE. And Horton, TM. (1993) Management of urinary tract infection in adults. ME JM. 329:1328-1334 . 33- Wilson ML, and Gaido L (2004). Laboratory diagnosis of UTIs in adult patients .Clin Infect Dis. 38 :1150-1158 . 34-Uhair Minutemen, M.(1988) Epidemiology of symptomatic infections of the urinary tract in children. BMJ 297:p450-452. 35- Mezue K.et al ,.(2005). Antibiotic sensitivity patterns in UTI at a Tertiary Hospital . Medicin on CD- Rom oxford university v:1 522-528 . 36- Sefton AM. (2002). The impact of resistance on the management of UTIs . Int. J Antimicrobial Agents 16: 489-491 . 37- Tessema D .et al,.(2007) . Predominant isolates of urinary tract pathogens and their susceptibility pattern in gender university teaching hospital ,North west Ethiopia .Ethio Med J 45 P 61-67 . 38- Assfa A ,et al,. (2008) . Bacterial profile and drug susceptibility pattern of UTI in pregnant women at Tikur Anbessa specialized Hospital Addis Ababa Ethiopia. Ethiop Med. J 46 p 227-235 . 39-Wolday, D. and Erge, W. (1997) Incrated incidence of resistance to antimicrobial by urinary pathogens isolated at Taker Anbessa hospital .Ethiop med J 35: 127 – 135. 40– Rakaa L et al,.( 2004 ) Etiology and susceptibility of urinary tract isolates in Kosovo. Int J . Antimicrobial agents 23S1-S2-S5 . 41-Farajnia S, et al,.(2009) . Causative agents and antimicrobial susceptibility of UTIs in northwest of Iran .Int J Infect Dis 13 p 140-144 . 42- Barisic Z et al,.(2003) . Urinary tract infection in south Croatia , etiology and antimicrobial .Int J Antimicrob.Agents 22 S61-S64. 43- Jha N ,Bepat SK. (2005) . A study of sensitivity and resistance of pathogenic micro organisms causing UTI in Katmandu valley Med.J Vol 3 No2 p 123-129 . 44- Alos J ,et al,.(2005).Antibiotic resistance of E.coli from community acquired UTIs in relation to demographic and clinical data .Clin Microb infect11 p 199-203 . Table (1): The antibiotics discs used to study the sensitivity of the isolate Antibiotics Concentration µg\disc Company Streptomycin 10 Oxoid(England) Lincomycin 15 Oxoid(England) Nitrofurantin 300 Oxoid(England) Rifampicin 5 Oxoid(England) Chloramphenicol 30 Oxoid(England) Tetracycline 30 Oxoid(England) Ampicilline 25 Oxoid(England) Penicillin 10 IU Oxoid(England) Co-trimoxazole 25 Oxoid(England) Amoxicillin 25 Oxoid(England) Nalidixic acid 30 Oxoid(England) Gentamycin 10 Oxoid(England) 21 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 Table (2): Types of isolates isolated from patients with (UTI ) and their percentage percentage NO. of isolates isolates 49.2 123 E.coli 22 55 Proetus mirabilis 16 40 Klebsiella pneumoniae 4 10 Morganella morganie 4 10 Pseudomonas aeruginosa 2.8 7 Citrobacter spp. 1.6 4 Staphylococcus aureus 0.4 1 Enterobacter spp. 100 250 Total Table (3): Sex prevalence in positive case s with (UTI) Female Male No. of isolates Isolates % No % NO 56.9 70 43.1 53 123 E.coli 60 33 40 22 55 proteus mirabilis 47.5 19 52.5 21 40 Klebsiella pneumoniae 60 6 40 4 10 Morgarella morganie 80 8 20 2 10 Pseudomonas aeruginosa 57.1 4 42.9 3 7 Citrobacter spp. 100 4 0 0 4 Staphylococcus aureus 100 1 0 0 1 Enterobacter spp. 145 105 250 Total Table (4): Age prevalence in patients with (UTI) % No. of positive cases Age (years) 8 20 1-9. 6 15 10-19. 3.2 8 20-29. 1.6 4 30-39. 24 60 40-49. 29.2 73 50-59. 28 70 60-69. 100 250 Total 22 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 Table ( 5 ): Monthly prevalence of ( UTI ) \ 2010 % of positive Total Negative case Positive case Month 0.8 10 8 2 January 4 24 14 10 February 6.8 26 9 17 March 6.4 22 6 16 April 12.8 37 5 32 May 12.8 35 3 32 June 24.4 63 2 61 July 32 83 3 80 August 100 300 50 250 Total (Table 6): The sensitivity of Uropathogens to many antibiotic 23 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 التحري عن الممرضات المسببة أللتھاب المجاري البولیة وحساسیتھا للمضادات الحیاتیة محمد رفیق علي ھیئة التعلیم التقني / المعھد الطبي التقني / المنصور 2013حزیران 24، قبل البحث في : 2012أیلول 26استلم البحث في : الخالصة التھاب المجاري البولیة ھي من اغلب اإلصابات الشائعة التي تصیب اإلنسان ، وتكرارھا أكثر من إصابات الجھاز عینة إدرار 300التنفسي والھضمي . وكذلك ھي المسبب الغالب لإلصابات من داخل المستشفیات في البالغین. من مجموع ال الجنسین الذین یعانون من التھابات المجاري البولیة الوافدین ) سنة ولك 69-1جمعت من مرضى تتراوح أعمارھم بین ( . اغلب العزالت كانت 2010الى غایة آب / 2010إلى مستشفى الیرموك التعلیمي / بغداد خالل المدة من كانون الثاني/ E.coli .Proteus mirabilis ،Klebsiella pneumoniae )49.2%-22%-16.22( وكانت % على التوالي . Klebsiella pneumoniaeالنسب المئویة للعزالت البكتیریة في اإلناث أكثر من الذكور في العینات المفحوصة ماعدا .كانت أعلى في الذكور . وكانت اغلب العینات ایجابیة في المرضى البالغین أكثر من األطفال % ) وتموز 32الصیف ووصلت أعلى مستویاتھا مابین آب( صابة البكتیریة كانت عالیة في فصل وجد إن اإل % ) . وكانت منھا البكتریا الحساسیة للمضادات الحیویة ( ستربتومایسین ، لنكومایسین ، نتروفیورانتین ، ریفامبسین 24( انت بكتریا القولون األكثر ، كلورامفینیكول ، تتراسایكلین ، امبیسیلین ، نالدكسك اسد ، جنتامایسین ) قد اختبرت وك بینما األكثر مقاومة للمضادات الحیویة تتراسایكلین %75.6) والكلورامفینیكول ( (%81.4) حساسیة للستربتومایسین . % )100وبنسلین( ( 100%) الكلمات المفتاحیة :التھاب المجاري البولیة وحساسیتھا للمضادات الحیاتیة 24 | Biology @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ÚÓ‘Ój�n€a@Î@Úœäñ€a@‚Ï‹»‹€@·rÓ:a@Âig@Ú‹©@Ü‹1a26@@ÖÜ»€a@I3@‚b«@H2013 Ibn Al-Haitham Jour. for Pure & Appl. Sci. Vol. 26 (3) 2013 << /ASCII85EncodePages false /AllowTransparency false /AutoPositionEPSFiles true /AutoRotatePages /None /Binding /Left /CalGrayProfile (Dot Gain 20%) /CalRGBProfile (sRGB IEC61966-2.1) /CalCMYKProfile (U.S. Web Coated \050SWOP\051 v2) /sRGBProfile (sRGB IEC61966-2.1) /CannotEmbedFontPolicy /Error /CompatibilityLevel 1.4 /CompressObjects /Tags /CompressPages true /ConvertImagesToIndexed true /PassThroughJPEGImages true /CreateJobTicket false /DefaultRenderingIntent /Default /DetectBlends true /DetectCurves 0.0000 /ColorConversionStrategy /CMYK /DoThumbnails false /EmbedAllFonts true /EmbedOpenType false /ParseICCProfilesInComments true /EmbedJobOptions true /DSCReportingLevel 0 /EmitDSCWarnings false /EndPage -1 /ImageMemory 1048576 /LockDistillerParams false /MaxSubsetPct 100 /Optimize true /OPM 1 /ParseDSCComments true /ParseDSCCommentsForDocInfo true /PreserveCopyPage true /PreserveDICMYKValues true /PreserveEPSInfo true /PreserveFlatness true /PreserveHalftoneInfo false /PreserveOPIComments true /PreserveOverprintSettings true /StartPage 1 /SubsetFonts true /TransferFunctionInfo /Apply /UCRandBGInfo /Preserve /UsePrologue false /ColorSettingsFile () /AlwaysEmbed [ true ] /NeverEmbed [ true ] /AntiAliasColorImages false /CropColorImages true /ColorImageMinResolution 300 /ColorImageMinResolutionPolicy /OK /DownsampleColorImages true /ColorImageDownsampleType /Bicubic /ColorImageResolution 300 /ColorImageDepth -1 /ColorImageMinDownsampleDepth 1 /ColorImageDownsampleThreshold 1.50000 /EncodeColorImages true /ColorImageFilter /DCTEncode /AutoFilterColorImages true /ColorImageAutoFilterStrategy /JPEG /ColorACSImageDict << /QFactor 0.15 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /ColorImageDict << /QFactor 0.15 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /JPEG2000ColorACSImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /JPEG2000ColorImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /AntiAliasGrayImages false /CropGrayImages true /GrayImageMinResolution 300 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 300 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict << /QFactor 0.15 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /GrayImageDict << /QFactor 0.15 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /JPEG2000GrayACSImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /JPEG2000GrayImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /AntiAliasMonoImages false /CropMonoImages true /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 1200 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict << /K -1 >> /AllowPSXObjects false /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile () /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False /CreateJDFFile false /Description << /ARA /BGR /CHS /CHT /CZE /DAN /DEU /ESP /ETI /FRA /GRE /HEB /HRV (Za stvaranje Adobe PDF dokumenata najpogodnijih za visokokvalitetni ispis prije tiskanja koristite ove postavke. 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