Association of Bacterial Uropathogens with Urine Biochemical and Microscopic Indices among Military Personnel with Urinary Tract Infections at Nigerian Navy Reference Hospital, Ojo

Abstract

Background: Urinary tract infections (UTIs) remain a leading cause of morbidity among military personnel, whose occupational exposures predispose them to infection. Despite the high prevalence of UTIs among military personnel, there is a paucity of research evaluating the urinary biochemical profiles of military men and women with UTIs, particularly in Nigeria. This gap in knowledge hinders the development of targeted diagnostic and therapeutic strategies, potentially affecting patient outcomes. Objective: This study determined the distribution of bacterial uropathogens and urine biochemical and microscopic indices among military personnel with culture-confirmed UTIs. Methods: In a case-control study, 160 military personnel were evaluated, comprising 80 UTI cases (40 male, 40 female) with culture-confirmed growth (≥10⁵ CFU/mL) and 80 apparently healthy controls (40 male, 40 female) who returned no bacterial growth on culture. Isolates from cases were identified by standard biochemical reactions on Cystine Lactose Electrolyte Deficient (CLED), MacConkey, and Blood agar. Urine dipstick and microscopic indices were compared using Pearson correlation analysis among UTI subjects; significance was set at p<0.05. Results: Among the 80 culture-confirmed UTI cases, Staphylococcus spp. was the most prevalent isolate overall (37.5%; 20.0% of males, 17.5% of females), followed by Escherichia coli and Streptococcus spp. (16.25% each), Proteus spp. (11.25%), Pseudomonas aeruginosa (10.0%) and Klebsiella pneumoniae (8.75%). E. coli and Klebsiella pneumoniae were more common in males (10.0% and 5.0%) than females (6.3% and 3.8%), whereas Proteus spp. and Streptococcus spp. predominated in females (8.8% each) relative to males (2.5% and 7.5%). Pseudomonas aeruginosa showed equal sex distribution (5.0% each). Correlation analysis among UTI subjects showed that urine pH was significantly and positively correlated with protein (r = 0.315, p = 0.004) and leucocyte esterase (r = 0.274, p = 0.014); epithelial cells correlated positively with the bacteria count (r = 0.228, p = 0.042). Specific gravity showed no significant correlation with any parameter assessed. Conclusion: Culture-confirmed UTI cases showed a distinct sex-related uropathogen distribution, with Proteus spp. and Streptococcus spp. more common in females and E. coli and Klebsiella pneumoniae more common in males, a pattern with implications for empirical antibiotic choice. The significant positive correlations between urine pH, proteinuria, leucocyturia and bacteriuria/epithelial shedding support the interpretation of combined dipstick and microscopic indices as a rapid adjunct to urine culture in military health facilities.