Urinary tract infections are defined as an inflammatory response to the urinary system as a result of the process of invasion and settlement that occurs from sick microorganisms, and it in humans, is one of the most frequent bacterial diseases, as urinary tract infections include many pathological conditions including cystitis, urethritis and pelvic nephritis (pyelonephritis) [1].It is worth noting that urinary tract infections (UTIs) Infection occurs most commonly as a result of pathogenic bacterial origins, and it is a public health concern that affects almost every country on the planet, as it affects a large proportion of community members, especially women, children, and individuals with renal impairment, and that the number of people infected with urinary tract infections is estimated at about 250 million infected each year [2]. Natural diuresis contains fluids and salts and is free from any bacterial, fungal or viral contamination, and one of the ways of Inflammation occurs in the urinary tract by entering the bacteria of the digestive system that are It is present in the anus to the parts of the urinary tract near the urethral outlet opening and then begins to grow and multiply [3]. The two types of bacteria, both positive and negative, are among the main sources of infection in the urinary tract, in addition to the fungi and viruses that are responsible for infection of the urinary tract [4]. Of all the many and prevalent forms of staphylococcal bacteria, Staphylococcus aureus is the most hazardous, Hence the seriousness of this type of bacteria and the damage that it causes and its high virulence factors that cause in the case of early lack of accurate detection and the delusional damage that leads to the injured death burden [5]. 

The scientific progress and the continuous search for a drug that has the best effect on the pathogen has contributed despite the extensive usage of antibacterial medications in recent years, antibiotics are still used to treat urinary tract infections, the effectiveness of these antibiotics has begun to be affected by the increase in the ability of bacteria to Resistance to these drugs by microorganisms that may cause side effects significant damage and damage to body tissues and cells such as acute renal insufficiency [6]. The idea of this study came from the above-mentioned data about the spread of Staphylococcus aureus that causes urinary tract infection and the development of its resistance to old and new antibiotics, as well as a comparison of some of the basic factors on which UTI depends. Aims of the study: Given the importance of diagnosing bacterial causes of urinary tract infections and Screening for genes responsible for adhesion factors in Staphylococcus aureus using a PCR technique.

200 urine samples were collected from both Gander within the age groups (7 - 60 years). Samples were collected in sterile plastic bottles after patients who had previously taken antibiotics were isolated admission to hospital, and it was recommended that the collection be from mid-urine (-Clean – Catch -Midstream Urine) after washing the genital area with soap and water to avoid contamination with natural flora the surfactant present in this area for children over the age of two years and adults, but without that, it has been done use of small adhesive bags for collection [7]. Recorded information related to the patient’s history and disease. 5 ml of diuresis was taken and placed in a centrifuge for five minutes 3000-5000 cycles / minute, the filtrate was removed and a drop of the precipitate was taken and examined under a light microscope to check for Pus cells, Bacterial cells, and Epithelial cells cell and other materials. A drop was taken from each urine sample by the loop of the conveyor and cultured on the macconky agar and blood agar and also cultured on the mannitol salt agar, and then Then it was incubated at 37 ° C for 24-18 hours, were done then the developing colonies are purified to obtain individual colonies for the purpose of diagnosing them by their characteristics phenotypic and chemical.

The urine samples collected from patients who were referred to the were examined at ages ranging from (7-60) years, of which there were 200 samples. Studies indicate that the presence of more than 5 purulent cells per microscopic field gives an indication of the presence of a urinary tract infection, in addition to the presence of bacteria, which necessitates a transplantation of the urine sample [8].

When these samples were grown on agricultural circles, 144 samples gave a growth of 72%, the isolates gave two types of negative growths for the gram stain with 101 samples at a rate of 69%, and positive growth for the gram stain with a number of 43 samples at a rate of 31%. No bacterial growth was shown for all samples, because the pathogen may be fungal, viral, or anaerobic bacteria that cannot be isolated by regular culture methods such as; Neisseria, Chlamydia [9].

In our study, 144 bacterial isolates were isolated from the collected urine samples of 200 urine samples of different ages from (7-60) if the bacterial growth rate was 72% with 144 samples. While 56 urine samples did not give bacterial growth of 28%

These results are in agreement with was mentioned by [10] in research he did in Luxor Hospital in Egypt, where the rate of positive samples was high 78.2% While the negative samples were 28.8% (Table 1).

Table 1: Number and Percentage of Isolates

And these findings corroborate what came before [11]. In his study that he conducted in China, where the percentage of positive samples was 70.47% 136 of the 193 urine samples were collected from patients attending the First Nanjing Hospital in China, While the negative samples were 29.53% 57 of 193 urine samples.

During our study, urine samples were collected from both gender where their ages ranged between (7- 60). The number of females reached 88 samples, a rate of 61.1 %, while the number of males reached 56 samples, a rate of 38.8 % (Table 2).

Table 2: Numbers and Percentages of Gram-positive and Negative Isolates

This was also confirmed [12] in his study conducted in Uganda if the incidence of urinary tract infection among females was higher than that of males, as the rate of infection among females was 37.5% out of 176, and for males the rate of infection was 22.0% out of 91 urine samples. Also, [13] the study conducted in Poland showed that the incidence of urinary tract infection among females 72.5% is higher than that of males, whose incidence rate was 27.5%. At the age group from 40 to 50, females recorded a higher rate of infection than males, due to the hormonal changes that occur after menopause, the estrogen hormone decreases, making women more vulnerable to infected in UTI [14] (Table 3).

Table 3: The Number of Bacterial Infections According to The Age Group and Gender

It was found through our study that pregnant women are more vulnerable to urinary tract infection than non-pregnant women the percentage of pregnant women was infected If the number of pregnant women samples reached 38 out of 88 female samples, a rate of 43.18% With a percentage of 26.3% of the complete number of samples that occurred bacterial growth, which was 144 samples. This is consistent with what was reported by most of the previous studies, as the incidence of tract infection Urinary tract increases during pregnancy due to many reasons, the most important of which are the physiological and hormonal changes that occur in a pregnant woman, as changes in the level of hormones, especially during the last months of pregnancy this is consistent with what was stated in most of the previous studies, where the incidence of urinary tract infection increases during pregnancy for many reasons, the most important of which are the bacterial and hormonal physiological changes that occur in a pregnant woman, such as changes in the level of hormones, especially during the last months (the third phase). Obstructs the flow of urine in the urine the bladder, which provides an appropriate environment for bacteria to clean up the causes of urinary tract infection [15] (Table 4).

Table 4: Staphylococcus Aureus Bacteria Distributed Among UTI Patients According to Age and Gender

In our study showed that most of those with urinary tract infections have diabetes, if the proportion of males affected is 27 out of 56, with a rate of 48%, and this means that the percentage of males infected with the full number of infected 144 is 18.75%.

This study was specifically for gram-positive bacteria Staphylococcus aureus bacteria isolated from UTI patients, Where the results of the study appeared to investigate this bacterium, it showed a percentage of 15.27% with 22 samples of the total bacterial growth, which was 144 samples, this percentage was in agreement with the percentage referred to, where they confirmed that the percentage of bacteria Staphylococcus aureus was 17.9%. While [16], confirmed in his study the percentage of bacteria Staphylococcus aureus was 20.7% converge with this study.

Staphylococci species are frequently responsible for urinary tract infections (UTI). The potential of staphylococci to produce biofilms and the presence of both the icaA and icaD genes in Staphylococci aureus isolated from UTI patients were investigated in this study.

The presence of both icaA and icaD genes was assessed by PCR technique in this study, which looked at biofilm forming potential and the presence of both icaA and icaD genes among staphylococci strains recovered from patients (Table 5).

Table 5: Biochemical Test of Staphylococcus Aureus

The presence of icaA and icaD genes was checked in all strains. Both genes were shown to be positive in all biofilm-producing bacteria isolated, with a 190-bp band for icaA and a 200- bp band for icaD genes. There are two possible explanations for Staphylococcal organisms' capacity to colonize artificial materials. The first is bacteria producing polysaccharide slime. The second component is the existence of adhesins for the host matrix proteins that are adsorbed onto the biomaterial surface. Because biofilm protects microbes from opsonophagocytosis and antibacterial drugs, the ability of Staphylococci to form biofilms aids the bacteria in evading the host's immune response and is thought to be the cause of chronic or persistent infections. All biofilm- and abiotic-membrane-generating strains of S. aureus were submitted to polymerase chain reaction to identify icaA and icaD genes in order to identify and confirm biofilm- forming strains. The icaA and icaD genes were detected in all the tested biofilm producing S. aureus strains. The findings of [17] a gree with this study (Figure 1). 

Figure 1: PCR amplification of (A) IcaA and (B) IcaD gens

The current study showed the sensitivity of Gram-positive bacteria isolated from people with urinary tract infection towards a group of antibiotics shown in the table, where these bacteria showed a medium sensitivity to anti (Rifampicin) with a percentage of 86.36% and towards anti- (Ciprofloxacin) with a percentage of 31.81%.and towards the anti (Amoxicillin) by 9.9% towards the anti (Vancomycin) by 81.81%, and towards the anti (Levofloxacin) by 4.54%, towards the anti (Gentamicin) by 13.6% and towards the anti (Methicillin) by 4.54% and towards anti (Ampicllin) 40.90%, towards anti (Eromycinth) by 4.54% and towards anti (Tetracycline) by 9.9%.

The current study showed the sensitivity of Gram-positive bacteria isolated from people with urinary tract infection towards a group of antibiotics shown in the table, where these bacteria showed a medium sensitivity to antibiotic (Rifampicin) with a percentage of 86.36% and towards antibiotic (Ciprofloxacin) with a percentage of 31.81% and towards the antibiotic (Amoxicillin) by 9.9% towards the antibiotic (Vancomycin) by 81.81% and towards the antibiotic (Levofloxacin) by 4.54% towards the antibiotic (Gentamicin) by 13.6% and towards the anti (Methicillin) by 4.54% and towards antibiotic (Ampicllin) 40.90% towards antibiotic (Eromycinth) by 4.54% and towards antibiotic (Tetracycline) by 9.9% .

This study showed that some bacteria were sensitive to some antibiotics, and the bacteria were sensitive to the antibiotic (Rifampin) by 13.6% to the antibiotic (Ciprofloxacin) by 63.63% and to the antibiotic (Amoxicillin) by 86.3% and this was indicated by [18] in their study, which showed sensitivity to the antibiotic (Amoxicillin) by 83.0% and this result was close to our current study. The bacteria were sensitive to the antibiotic (Vancomycin) by 9.0% and sensitive to the antibiotic (Levofloxacin) by 81.81% and to the antibiotic (Gentamicin) by 81.81% and this did not agree with a study conducted. These bacteria showed the highest percentage of resistance towards the antibiotic (Eromycinth) with a percentage of 90.90% and also these bacteria showed resistance towards the antibiotic (Tetracycline) with a percentage of 81.81 % and this was consistent with the study [19] (Table 6).

Table 6: Antibiotics

• At all ages included in the study, the incidence of urinary tract infection in females was higher, except from the age of 51 to 60 where the percentage of males was higher

• Pregnant women, especially from the last trimester, are affected by urinary tract infection

• The effect of people with diabetes on urinary tract infection significantly

• Formation of staph aureus bacteria of the gene icA and icD

• All isolates of Staphylococcus aureus were biofilm-forming

• The best antibiotic that had a significant effect on the sensitivity of staph bacteria was methicillin, gentamicin, levofloxin and amoxicillin.

• The staph aureus bacteria gave a high resistance to erythromycin and tetracycline

Recommendations 

• Early referral to a specialist doctor when suffering from a urinary tract infection

• The necessity of early detection of urinary tract infections using advanced methods

• For the purpose of identifying and diagnosing bacterial causes as soon as possible and to avoid other complications

• Not to take antibiotics without medical advice to avoid the emergence of bacterial strains that are resistant to antibiotics

• Using advanced generations of effective antibiotics in treating UTI due to the high resistance of bacterial species to existing antibiotics

• Paying attention to personal hygiene, using sterilizers and disinfectants, and washing the genital areas well

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