Bioscience Biotechnology Research Communications

An Open Access International Journal

P-ISSN: 0974-6455 E-ISSN: 2321-4007

Bioscience Biotechnology Research Communications

An Open Access International Journal

Maimuna Sidi Muhammed1, Halidu Yakub Bello2,
Shehu A. A3 and Sanjoy Kumar Pal4

1Department of Microbiology, Kano University of Science & Technology, Wudil, Nigeria

2Department of Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria

3Department of Microbiology, Kano University of Science & Technology, Wudil, Nigeria

4Department of Biological Sciences, Skyline University, Kano, Nigeria

Corresponding author email: sanjoy@sun.edu.ng

Article Publishing History

Received:

Accepted After Revision:

ABSTRACT:

Urinary Tract Infection (UTI) is a serious health problem that affects people of all ages and genders globally. A study was carried out to determine the incidence of urinary tract infection (UTI) in patients present at AKTH with UTI from January 2019 to January 2020. The study aimed to determine the incidence and identify the infective uropathogens and their antibiotic sensitivity pattern. Urine samples were collected from 128 (Male 63) patients ranging from 0 to 84 years. Culture plates with bacteria count greater than or equal to 1×105 cfu-ml-1 were taken as positive for UTI. The bacteria isolates were identified based on colony morphology characteristics, gram stain reaction and biochemical tests. The identified bacteria were then tested in vitro with standard antibiotics disc to determine their antibiotic sensitivity patterns. The result showed that 35 (27.3%) out of 128 patients investigated had UTIs.

The urine culture of 65 female patients resulted in 24(36.9%) positive samples, while 11 (17.5%) of the 63 males had significant bacteriuria. Escherichia coli constituted the predominant organism and was responsible for 24(68.7%) of the cases of UTI. The other encountered uropathogens were Klebsiella sp. 5(14.3 %), and Staphylococcus saprophyticus 2(5.5%). One sample (2.9%) each was found to have Morganella morganiiPseudomonas aeroginosaEnterococcus fecalis and Salmonella sp., respectively. All gram-negative bacteria were highly-sensitive to Meropenem and Gentamicin and were mostly-resistant to Piperacillin. Gram-positive organisms were sensitive to Gentamicin, Chloramphenicol, and Cefoxitin and resistant to Erythromycin. The highest incidence (39.1%) of UTI was found in the age range (10 – 19 years), with a significant gender difference.

KEYWORDS:

Urinary Tract Infection (UTI), Uropathogens, Antibiotic Sensitivity, Kano.

Download this article as:

Copy the following to cite this article:

Muhammed M. S, Bello H. Y, Shehu A, Pal S. K. Incidence and Antibiotic Susceptibility Pattern of Urinary Tract Infection in Aminu Kano Teaching Hospital (AKTH) Kano, Nigeria. Biosc.Biotech.Res.Comm. 2022;15(2).


Copy the following to cite this URL:

Muhammed M. S, Bello H. Y, Shehu A, Pal S. K. Incidence and Antibiotic Susceptibility Pattern of Urinary Tract Infection in
Aminu Kano Teaching Hospital (AKTH) Kano, Nigeria. Biosc.Biotech.Res.Comm. 2022;15(2). Available from: <a href=”https://bit.ly/3PM9YmP“>https://bit.ly/3PM9YmP</a>


INTRODUCTION

Urinary tract infections (UTIs) are a serious health problem that affects millions of people throughout the world every year. The presence and proliferation of microorganisms in the urinary tract cause this infection. It incurs one of the highest total healthcare expenditures among urological cases. One of the most prevalent bacterial illnesses in the community and hospitals is urinary tract infection (UTI) (Oluwafemi et al. 2018). It can cause anything from asymptomatic bacteriuria to serious kidney injury and sepsis, depending on the clinical manifestation (Nguyen 2008; Geerlings 2016). A UTI can be diagnosed based on a combination of symptoms as well as a positive urine assay or culture (Geerlings 2016). Except in early infancy, UTIs are prevalent in children, and females are at a much higher risk than boys. Urinary tract infections are linked to poor hygiene, malnutrition, and low socioeconomic position, all of which are prevalent in rural areas (Oladeinde et al. 2011; Mattoo et al 2021).

Several studies have been reported on Urinary tract infections from various parts of Nigeria (Oladeinde et al 2011; Iregbu and Nwajiobi-Princewill 2013; Oluwafemi et al. 2018; Okechukwu et al. 2019). Enterobacteriaceae such as Klebsiella spp., and E. coli as well as gram-positive organisms such as Enterococci, Staphylococci, and Candida albicans in patients with underlying physiological debilitation, are the most common causative agents of UTI. Similar etiological agents have been detected for UTIs in other places viz. Enugu, Zaria, Yola, Maiduguri, and Ife in Nigeria (Iregbu and Nwajiobi-Princewill 2013; Isa et al. 2013).

Other organisms that have been identified include Staphylococcus aureus and Staphylococcus epidermidisMorganella morganii, and Group B Streptococcus. Most UTIs in infants and children is caused by E. coli, which is the most commonly isolated pathogen. (Dixon-Umo et al. 2020). Earlier investigations conducted at the AKTH had concluded that the UTI incidence range from 1.3% to 50% in various patient groups (Yakasai et al 2012; Sule et al 2018; Ibrahim et al. 2019). The purpose of the present study was to look into the prevalence and antibiotic susceptibility pattern of urinary tract pathogens among patients coming for treatment at Aminu Kano Teaching Hospital, Kano, Nigeria.

MATERIAL AND METHODS

A prospective study was conducted in the Department of Microbiology, Aminu Kano Teaching Hospital (AKTH), in northern Nigeria. AKTH is a 700-bed capacity referral hospital, serving a catchment population of 17 million from Kano and neighbouring states (Ado-Kurawa 2006). Prior ethical approval to conduct this research work was obtained from the Research Ethics committee of Aminu Kano Teaching Hospital, Kano, Nigeria (Reference no. AKTH/MAC/SUB/12A/P-3/VI/2858). The selected period of study was from January 2019 to January 2020.

The subjects were patients who presented with urinary tract complaints at the general outpatient department of AKTH. These patients are then referred to the Microbiology department. After getting verbal and written informed consent urine samples were collected from 128 people of different gender and age group. Following enrollment, each subject underwent clinical and physical examinations by the attending physician. The subjects were then given a plastic universal sterile transparent container with a screw cap for urine collection. Clear oral and written instructions on how to collect urine were given to each subject or their parents/guardians. Early morning midstream urine samples were collected. Female subjects were instructed to clean their genitalia before sample collection, while infants were instructed to be held on their laps with their genitals exposed before sample collection. Urine samples were delivered to the laboratory within 1-2 hours of collection.

All urine samples were observed macroscopically to check for turbidity, and colour and using a strip of Combii -10 to check for pH, specific gravity, presence of blood, protein, and other parameters (Wu 2010). The antibiotic susceptibility of the bacterial isolate was tested on Mueller-Hilton Agar using the traditional Kirby-Bauer disc diffusion method, and bacterial isolates were identified based on their culture, gram-stain, and biochemical properties (CLSI 2020). The disk diffusion method was used to evaluate the antibiotic susceptibility of each isolate and control strain (Okechukwu, & Thairu 2019). The following antibiotics were used for the present study Ciprofloxacin, Nitrofurantoin, Chloramphenicol, Gentamicin, Augmentin, Ceftazidime, Ceftriaxone, Meropenem, Piperacillin, and Tigecycline). SPSS version 20.0 was used to analyze the data. The student t-test was used to examine the relationship between variables. Significant was defined as a p-value of less than 0.05.

RESULTS AND DISCUSSION

A total of 128 patients with urinary tract complaints were enrolled in this study, the details of the demographic characteristic are given in Table 1. Out of the 128 samples tested 93(72.7%) had no bacterial growth after 24 hours of incubation, while 35(27.3%) were positive for bacterial presence. Among the 35 positive samples, 24(39.6%) were females and 11(17.5%) were males. The female gender was found to be a significant risk factor for acquiring UTIs. The frequency of occurrence of bacteria isolated was as follows: Escherichia coli 24(68.75%), followed by Klebsiella with 5(14.3%), and Staphylococcus saprophyticus with 2(5.5%).

One sample each was found to have Morganella morganii, Pseudomonas aeruginosa, Enterococcus faecalis and Salmonella spp., details is presented in Table 2. Among the 35 positive samples, 24(39.6%) were females and 11(17.5%) were males. A significant difference in UTIs was observed between the genders. It was observed that the most number of cases i.e., 39.1 % was from the age group 10-19 years, followed by the age group 0 – 9 years. The detailed breakup is presented in Table 3. In the age group, 0-9 years all the positive samples were from female patients. All the Gram-negative organisms were highly sensitive to Meropenem. Mixed results were seen in the case of Gentamicin, Tigecycline, Ceftriaxone, Ceftazidime, Augmentin, and Ciprofloxacin, respectively. The highest frequency of resistance was observed with Piperacillin, the details are given in Table 4. While five antibiotics were used to determine the susceptibility pattern of the gram-positive isolates. Except for Erythromycin all other antibiotics viz. Gentamicin, Chloramphenicol, Cefoxitin, and Clindamycin, showed positive results (Table 5).

Table 1. Distribution of the demographical characters

Demographical Characters Frequency Percentage (%)
Age (Years)
0  – 9    25 19.5
10 – 19    23 18.0
20 – 29    22 17.2
30 – 39    20 15.6
40 – 49    10 7.8
50 – 59      6 4.7
60 – 69      4 3.1
70 – 79    15 11.7
80 – 89      3 2.3
Total  128 100.0
 

Gender

Male    63 49.2
Female    65 50.8
Total  128 100.0

Table 2. Incidence of urinary tract infection

Suspected Organism No. of Positive Samples  Incidence (%)
Escherichia coli 24 68.75
Klebsiella pneumonia 5 14.3
Staphylococcus aureus 2 5.5
Morganella morganii 1 2.9
Pseudomonas aeruginosa 1 2.9
Enterococcus faecalis 1 2.9
Salmonella spp 1 2.9
 

Total

 

35

 

100.0

Table 3. Comparison between Demographical Characters and Isolated Organisms

Demographical Characters Isolated Organisms            X2     Df     P-value
No. Examined Positive (%)
Age (Years)                    M   |     F
00 – 09 25 7 (28.0)      –          7          2.883       8     0.942
10 – 19 23 9 (39.1)      3         6
20 – 29 22 6 (27.3)      3         3
30 – 39 20 6 (30.0)      3         3
40 – 49 10 2 (20.0)      –          2
50 – 59   6 2 (33.3)      –          2
60 – 69   4 1 (25.0)      –          1
70 – 79 15 2 (13.3)      2          –
80 – 89   3 0 (0.0)
Total 128 35 (27.3)
 

Gender

Male  63 11 (17.5)          2.828        1      0.093
Female  65 24 (36.9)
Total 128 35 (27.3)

χ² = Chi square value, significance level p-value = p ˂ 0.1. M = Male; F = Female

Table 4. Antibiotic susceptibility pattern of Gram negative bacterial organisms

Antibiotics MEM CRO AMC CTX PRL GN TGC CIP
R S R S R S R S R S R S R S R S
A = (24) 0 23 10 14 13 11 13 11 21 3 0 24 6 18 19 5
B =   (5) 0 5 4 1 5 0 4 1 4 1 3 2 0 5 2 3
C =  (1) 0 1 0 1 0 1 0 1 1 0 0 1 0 1 1 0
D =  (1) 0 1 0 1 0 1 0 1 1 0 0 1 0 1 0 1
E =  (1) 0 1 0 1 1 0 1 0 0 1 0 1 1 0 1 0

A = Escherichia coli; B = Klebsiella pneumonia; C= Morganella morganii; D= Pseudomonas aeruginosa; E= Salmonella spp. MEM = Meropenem; CRO = Ceftriaxone; AMC = Augmentin; CTX = Ceftazidine; PRL = Piperacillin; GN = Gentamicin; TGC = Tigecycline; CIP = Ciprofloxacin

Table 5. Antibiotic susceptibility of Gram-positive bacterial organisms

ERY GN C FOX DA
R S R S R S R S R S
F = (1) 1 0 0 1 0 1 0 1 0 1
G = (2) 2 0 0 2 0 2 1 1 0 2

Key: ERY= Erythromycin, GN = Gentamicin, C = Chloramphenicol, FOX = Cefoxitin, DA = Clindamycin,
F= E. faecalis,  G= Staphylococcus saprophyticus

The present investigation revealed the incidence of UTI of 27.3% with a significant gender difference (p < 0.1). This result is similar to the earlier investigations conducted by Muhammad et al. (2017) and Muhammad (2015), who reported UTI incidences of 26% and 25%, respectively. However, a low prevalence of UTIs (16%) was reported in malnourished children (Ibrahim et al. 2019). Even lower incidences of UTIs 12-13% have been reported (Aiyegoro et al. 2007; Iregbu et al. 2013). A high incidence of UTI (38%) was reported by Sule et al. (2018); a study done in Onitsha by Nwachukwu et al. (2018) report a prevalence of 46.1%. Even higher prevalence of 56% and 61% UTI was reported by Nwachukwu et al. (2018) and Simon et al. (2019), respectively. The variations in prevalence of UTI in different places of Nigeria might be due to differences in study populations and the criteria used by various centres in sample selecting, mode of screening, and compounding risk factors, like gravidity, type of toilet used, age, drainage system, socioeconomic condition, etc. (Simon-Oke et al 2019; Ibrahim et al. 2019; Dixon-Umo et al. 2020).

The incidence of UTIs varies based on age, sex, and gender. In the present study, the age group with the highest frequency of UTIs was 10-19 years (39.1%). In an earlier study, Aiyegoro et al. (2007) reported 12% of UTIs in the age group of 5-18 years. In resource-rich countries, the prevalence of UTIs is very less compared to developing countries. Overall, UTIs of children in the United States annually are estimated to be between 1-3% (Moreno 2016). This is to be expected, as infection rates are low due to improved sanitation and easy access to standardized health care (Dixon-Umo et al. 2020). Most of the bacteria isolates in the present investigation are normal flora of faecal materials. Escherichia coli was the most common pathogen encountered in the present study. Much earlier investigation reports also indicated E. coli to be the most prominent organism of UTI (Oladeinde et al. 2011; Isa et al. 2013; Simon-Oke et al 2019; Dixon-Umo et al. 2020).

The present study indicated that UTIs are less prevalent in males than females. Different studies have reported female predominance (Aiyegoro et al. 2007; Oladeinde et al., 2011). There is a significant association between sex and positive cases. The higher prevalence rate recorded in females could be due to the proximity of the urethral to the anus, shorter urethra, contraception, pregnancy, and sexual intercourse which introduces bacteria into the female urinary tract (Omoregie 2008) Furthermore, the spread of normal flora in faeces from the anus to the vagina from where it may ascend to the bladder could result from poor anal hygiene. In a contrasting report by (Otajevwo, 2013), a prevalence rate of 30.1% was recorded among males. Even though they stated that the reason for this was not clear, they, however, enumerated the probable causes like lack of circumcision, and receptive anal intercourse (Dixon-Umo et al. 2020).

Among the isolates observed in the present study, gram-negative microorganisms’ presence was 96.2%, while Gram-positive organisms accounted for 3.8%. This observation was consistent with an earlier report (Otajevwo 2013). Our investigation also had a marked resemblance with the earlier investigation done by Aiyegoro et al. (2007). E.coli was the most predominant isolate causing UTI in this study while Klebsiella spp ranked second in prevalence. This is consistent with other studies ( Uwaezuoke et al. 2006; El-Mahmood 2009; Otajevwo 2013; Otajevwo and Eriagbor 2014) and emphasizes the fact that the majority of organisms causing UTIs are found in the lower gastrointestinal tract, it is noteworthy that E. faecalis was isolated only in the female population which may be an indication of poor anal hygiene, especially among teenagers. Among the age groups, UTIs occurred highest in the 10–19 years age group with a prevalence of 39.1%. This could be because patients in this age group are sexually active. Infections were observed to be higher in males under 0-9 years of age than in females. Some reports have stated that at advanced ages, males have more complicated UTIs and also more drug-resistant pathogens than females (Alhambra 2004; Dixon-Umo et al. 2020).

The uropathogens isolated in this study showed high sensitivity to Meropenem, gentamicin, and Tigecycline. The sensitivity to Meropenem is in tandem with other reports of 97.6% and above 50% sensitivity (Haruna et al. 2014; Alabi et al. 2014). In a study conducted at Redeemers University, Nigeria Augmentin and Piperacillin were also found to be resistant (Ayoade et al. 2013). This might be due to the abuse of these drugs leading to mutations that may be transferred through bacteriophages or plasmids thereby promoting resistance. The availability of drugs over the counter without the need for a prescription encourages the abuse of drugs. In addition, the use of fake and substandard drugs in Nigeria may also be a contributory factor to the emergence of resistant strains (Mordy et al. 2006).

Inappropriate antimicrobial use as a result of a lack of drug knowledge can result in ineffective therapy and contribute to the spread of drug resistance. (Kariuki et al. 2007; Getachew et al. 2012). The strength of this prospective study was that it tested a good number of urine samples for pathogenic bacteria and underlined the presence of susceptible and resistant bacterial strains. This may provide clear-cut scientific information for appropriate UTI treatment, prevention, and control (Dixon-Umo et al. 2020).

CONCLUSION

The findings of the present study indicated the incidence of UTI to be 27.3%, and most of the infection was noted in children and teenagers. Females showed significantly higher infection rates. As many patients come from rural backgrounds poor hygiene practices and poor sanitation by these patients may be one of the major factors for UTIs. Though all the Gram-negative bacteria were found to be sensitive to Meropenem. Many other antibiotics that were studied indicated mixed results and some like Piperacillin and Erythromycin were found to be resistant to gram-negative and gram-positive bacteria, respectively. However, the sample studied was very small. Antibiotic resistance is a universal problem and can result in a delay in the recovery process and escalation of the treatment cost. It is always better to have information about the microbe before starting the antibiotic treatment. However, in many situations, if the UTI needs immediate treatment, then it should be started with Meropenem even though it is an expensive drug.

ACKNOWLEDGEMENTS

This investigation is part of graduate dissertation of the first author.

Conflict of Interests: Authors declare no conflict of interests to disclose.

REFERENCES

Ado-Kurawa. (2006). Geography and History of Kano in Three Year of Good Governance Shekara’u Stewardship in Kano State. Research and documentation directorate Government house, Kano.

Aiyegoro, O. A., Igbinosa, O. O., Ogunmwonyi, I. N., et al. (2007). Incidence of urinary tract infections (UTI) among children and adolescents in Ile-Ife, Nigeria. Afr J Microbial Res Vol. 1 No 2: Pages 13-19.

Alabi, O. S., Onyenwe, N. E., Satoye, K. A., et al. (2014). Prevalence of extended beta lactamase producing isolates from asymptomatic bacteriuria among students in a tertiary institution in Ibadan, Nigeria. Nat Sci Vol. 12 No 4: Pages 111-114.

Alhambra, A., Cuadros, J. A., Cacho, J., et al. (2004). In vitro susceptibility of recent antibiotic-resistant urinary pathogens to ertapenem and 12 other antibiotics.  J Antimicrob Chemother Vol. 53 No 6: Pages 1090-1094.

Ayoade, E. Moro, D. D. and Ebene, O. L. (2013). Prevalence and antimicrobial susceptibility pattern of asymptomatic urinary tract infections of bacterial and parasitic origins among the University students in redemption camp, Ogun state, Nigeria. Open Journal of Medical Microbiology Vol. 3 No 4: Pages 219-222.

Clinical and Laboratory Standard Institute. (2020). Performance Standards for Antimicrobial Susceptibility Testing; Twenty Fourth Informational Supplement. CLSI document M100-S24. Clinical and Laboratory Standard Institute, Wayne.

Dixon-Umo, O. T., Ikpeme, E. E. and Kan, K. M. (2020). Urinary Tract Infection in Infants and Pre-school children at a tertiary hospital in Uyo, Nigeria: The Prevalence, Clinical and Bacteriological Profiles”. Acta Scientific Paediatrics Vol. 3 No 9: Pages 02-09.

El-Mahmood, M. (2009). Antimicrobial susceptibility pattern of pathogenic Bacteria causing urinary tract infections at the Specialist Hospital, Yola, Adamawa State, Nigeria. J Clin Med Vol. 1 No 1: Pages 1-8.

Getachew, F., Gizachew, Y., Yitayih W, et al. (2012). The prevalence and antimicrobial susceptibility pattern of bacterial uropathogens isolated from pregnant women. Eur Jornal Exp Biol. Vol. 2 No 5: Pages 1497–1502.

Geerlings, S. E. (2016). Clinical presentations and epidemiology of urinary tract infections. Clin Microbiology Vol. 4 No5: 4.5.03 https://doi.org/10.1128/microbiolspec.UTI-0002-2012

Haruna, M. S., Magu, J., Idume, J., et al. (2014). Antibiotic susceptibility of some uropathogenic bacterial isolates from Ahmadu Bello University Teaching Hospital Zaria, Nigeria. IOSR Journal of Pharm Biol Sci Vol. 9 No 2: Pages 20-23.

Ibrahim, U. A., Aikhionbare, H. A. and Aliyu, I. (2019). Urinary tract infection in children with protein-energy malnutrition in Aminu Kano Teaching Hospital Kano, Northwest Nigeria. Niger J Basic Clin Sci Vol. 16 No 1: Pages 64-69.

Iregbu, K. C. and Nwajiobi-Princewill, P. I. (2013). Urinary tract infections in a tertiary hospital in Abuja, Nigeria. Afr J Clin Exp Microbiol Vol. 14 No 3: Pages 169 -173.

Isa, M. A., Isil, H. Y., Allamin, I. A., et al. (2013). Prevalence of urinary tract infection among primary school children in Maiduguri, Borno State, Nigeria. Inter J Environment Vol. 2 No 1: Pages 9-15.

Kariuki, S., Revathi, G., Corkill, J., et al. (2007). Escherichia coli from community-acquired urinary tract infections resistant to fuoroquinolones and extended-spectrum beta-lactams. J Infect Dev Ctries Vol. 1 No. 3: Pages 257–262.

Mattoo, T. K., Shaikh, N. and Nelson, C. P. (2021). Contemporary management of urinary tract infection in children. Pediatrics Vol. 147 No 2:e2020012138.

Mordy, R. M. and Erah, P. O. (2006). Susceptibility of common urinary isolates to the commonly used antibiotics in a tertiary hospital in Southern Nigeria. Afr Journal of Biotechnol Vol. 5 No 11: Pages 1067-1071.

Moreno, M. A. (2016). Urinary tract infections in children and adolescents. JAMA Pediatr Vol. 170 No 9: Pages 916.

Muhammed, M. (2015). Urinary tract infections amongst pregnant women attending a medical centre in Kaduna, Nigeria. Afr J Clin Exp Microbiol Vol. 16 No 1: Pages 7-11.

Muhammad, R.  H., Bashir, S. F. and Auyo, F. Y. (2017). Bacteriuria among pregnant women attending Dutse general hospital, Jigawa state-Nigeria.  Dutse J Pure App Sci Vol. 3 No 2: 211-217.

Nwachukwu, E., Onyebuchi, O. and Michael, O. (2018).  Prevalence of urinary tract infections in pregnant women in Onitsha, Nigeria. Journal of Bacteriology & Mycology Open Access. Vol. 6 No 5: Pages 284‒285.

Okechukwu, A. A. and Thairu, Y. (2019). Bacteria urinary tract infection in HIV-infected children and adolescents in Abuja, Nigeria: a cross-sectional study. Afr J Clin Exper Microbiol Vol. 20 No 4: Pages 306-314.

Oladeinde, B. H., Omoregie, R., Olley, M., et al. (2011). Urinary tract infection in a rural community of Nigeria. North American J Med Sci Vol. 3 No 2: Pages 75-77.

Oluwafemi, T. T., Akinbodewa, A. A., Ogunleye, A., et al. (2018). Uninary tract infection and antibiotic sensitivity pattern of uropathogens a tertiary hospital in South West Nigeria. Sahal Med J Vol. 21 No 1: 18-22.

Omoregie, R., Erebor, J. O., Ahonkhai, I., et al. (2008). Observed changes in the prevalence of uropathogens in Benin City, Nigeria. N Z J Med Lab Sci Vol. 62: Pages 29-31.

Otajevwo, F. D. and Eriagbor, C. (2014). Asymptomatic urinary tract infection occurrence among students of a private university in Western Delta, Nigeria. World J Med Med Sci. Vol. 2 No 5: Pages 1-26.

Otajevwo, F. D. (2013). Urinary tract infection among symptomatic outpatients visiting a tertiary hospital based in Midwestern Nigeria. Glob J Health Sci Vol. 5 No. 2: Pages 187-199.

Simon-Oke, I. A., Odeyemi, O. and Afolabi, O. J. (2019). Incidence of urinary tract infection and antimicrobial susceptibility pattern among pregnant women in Akure, Nigeria. Scientific African, 6. e00151.

Sule, H., Uba, A. and Kumurya, A. S. (2018). Antibiotic susceptibility pattern of uropathogens from some selected hospitals in Kano-Nigeria. J Microbiol Exp Vol. 6 No 2: Pages 127-134.

Nguyen, H. T. (2008). Bacterial Infections of the Genitourinary Tract. In Smith’s General Urology, Tanagho, E. A., McAninch, J. W. (Eds). McGraw- Hill Lange. Pp 193-218.

Uwaezuoke, J. C. and Ogbulie, J. N. (2006). Antibiotic sensitivity pattern of urinary tract pathogens in Port – Harcourt, Nigeria. J Appl Sci Environ Manag. Vol. 10 No 3: Pages 103-107.

Wu X. (2010). Urinalysis: a review of methods and procedures. Crit Care Nurs Clin North Am. Vol. 22 No 1: Pages 121-128.

Yakasai, I. A., Ugwa, E. A. and Garba, D. I. (2021). Antimicrobial sensitivity pattern of symptomatic urinary tract infection in pregnancy in Aminu Kano Teaching Hospital. Trop J Obstet Gynaecol Vol. 29 No 1: Pages 55 – 59.