Evaluation of Antiboay coated Bactrria in the Diagnosis of Pyelonephritis and Cystitis

Abstract

This is a descriptive study was conducted in Khartoum State hospitals included Central Police Hospital, Ahmed Gasim Hospital, Ibn Husham Clinic and Ibraheim Malik Hospital, from November 2004 to July 2005. Its aim was to evaluate antibody-coated bacteria (ACB) test in the diagnosis of pyelonephritis and cystitis using direct immunofluorescent technique, besides identification of cystitis and pyelonephritis aetiologic agents, and determining their antimicrobial susceptibility. Urine and blood samples were collected from one hundred patients of known diagnosed urinary tract infection (UTI), including different ages and sexes. Blood samples were tested for C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), and total white blood cells count (WBCs). Urine culture resulted in the isolation of (50%) Escherichia coli, (12.5%) Staphylococcus epidermidis, (9.4%) Pseudomonas spp, (9.4%) Staphylococcus saprophyticus, (6.3%) Citrobacter spp, (3.1%) Klebsiella spp, (3.1%) Providencia spp, (3.1%) Staphylococcus aureus and (3.1%) Candida spp from immunocopromised patients. Of the 45 patients with complicated UTI, (66.6%) were positive for antibody-coated bacteria (ACB) test. The sensitivity and specificity of ACB test in this study was found to be (69%) and (80%) respectively. The evaluation of antibody-coated bacteria test (ACB) among known localized patients (imaging) was statistically significant (P < 0.05). In patients known with upper UTI (70%) were ACB positive, and in patients known with lower urinary tract infection (20%) were positive for ACB. In 13 adult male and female patients with positive (ACB), Creactive protein was positive in all patients. The aetiologic agents in patients with positive antibody-coated bacteria test resulted in the isolation of 7 (44%) E.coli, 3 (75%) Staphylococcus epidermidis, 1 (33%) Staphylococcus saprophyticus, 1 (33%) Pseudomonas spp and 1 (100%) Candida spp. Ninety-four percent of E.coli strains were found to be susceptible to ceftriaxone, (69%) ciprofloxacin, (62.5%) gentamicin and (56.2%) to amikacin. Ceftriaxone was (100%) active against Providencia spp, Klebsiella spp and Citrobacter spp. Nosocomial E. coli strains were found to be susceptible in (67%) to ciprofloxacin and (33%) to amikacin. Amoxicillin and cephalexin were (100%) resistant in all of nosocomial pathogens. In 31 species of the bacterial isolates tested by mannose haemagglutination test, (51.6%) were sensitive to D-mannose sugar. The study concluded that, ACB is complementary and promising test to urine culture that can be used in the diagnosis and distinction between upper and lower UTI. It is of great help in the management and treatment of UTI. In conclusion further research studies and more scientific evaluation of ACB test in the areas of sensitivity and specificity are highly recommended.