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Ginger Decrease Uropathogenic Escherichia coli Colony in the Urinary Tract of Menopausal Women

Dony Rosmana Bimantara*, Gatut Hardianto*, Kartuti Debora MS**


*Departement Obstetric & Gynecology, Faculty of Medicine Airlangga University Dr.Soetomo Hospital, Surabaya
**Instalation of Clinical Microbiology/Microbiology Departement
Hospital, Surabaya

of Medicine Airlangga University-Dr.Soetomo

ABSTRACT
Background: Urinary tract infections are common among menopausal women and most of them will develop
recurrence. The Prevalence is increasing with age. The use of antibiotics as therapy increases resistence risk of therapy.
The affordable antibiotics, inexpensive, safe and effective are needed to find. By using In-vitro, ginger effectively inhibit
growth of isolate uropathogenic Escherichia coli.
Objective: The aim of this study is to prove the effect of ginger in the Uropathogenic Escherichia Coli Colonies in
menopausal women.
Methode: A pra-experimental study with one group pre test-post test design. Ginger with a similar variety and age is
turned into a powder capsule. The subject of the research is patient in the geriatric and menopause outpatient clinic
Dr.Soetomo Central Hospital-Surabaya. Each subject taken ginger powder for five days in row. Midstream clean catch
urine was performed before and after the treatment in order to identify and count the colony of Escherichia coli.
Result: : 12 out of 52 participants had a positive Uropathogenic Escherichia coli result from the culture before treatment.
5 subjec had colony count 105cfu/ml and 7 subjec <10 5cfu/ml. 11 subject shows a negative result and 1 subject still had
a positive result although a number of colony is decrease (10 4cfu/ml become 2x103cfu/ml). There is significant result of
the decrease of the colony calculation as a result of consume ginger powder capsule, p=0,001 (p<0,05).
Conclusion: Ginger decrease a number of Escherichia coli colony in menopausal women.
Keywords: Ginger, Menopause, Uropathogenic Eschericha coli
Correspondence: Dony Rosmana Bimantara, Departemen/SMF Obstetric & Gynecology, Faculty of Medicine Airlangga
University
Dr. Soetomo Center Hospital, Surabaya, East Java, Indonesia, Call: +6281803215579, Email:
donyrosmana@yahoo.com
Background
Urinary tract infection (UTI) is a bacterial
infection that commonly occurs in young women and
the elderly and often causes recurrence. UTI is still
often posing serious problems chiefly related to
nosocomial infections, high recurrent morbidity rate,
and high cost treatment impact. UTIs in older women
was associated with an average of high mortality,
although in some cases of asymptomatic UTI, it was is
not the cause of death(1,2,3,4).
The risk of UTI in women during their lifetime
can be more than 50%, which the prevalence of
bacteriuria was increased by age. In the epidemiological
research, it was found a 15% -20% prevalence of
bacteriuria in women aged 65-70 years and 20% -50%
prevalence in women aged >80 years(1,2,3,5).
Factors that play a role in the pathogenesis of
UTI namely: host, and the host defense mechanisms of
bacterial virulence factors. Host factor differs between
men and women. Due to the anatomical conditions in
women, instrumentation measures during pregnancy
and the menopause condition, women were more
vulnerable to infection. Defense mechanism of the body

in form of anti-adhesion process of urination and


released by the cells of the urinary tract was a defense
response of bacteria(6.7).
Uropathogen bacteria as the most common
cause of UTI was group of Escherichia coli, Candida
albicans,
Enterococcus
faecalis,
Pseudomonas
aeruginosa, and Proteus mirabilis Klepsiella
pneumoniae, E. Coli has 80% -90% as the cause of the
infection. In addition to gram-negative germs, UTIs can
be caused by gram-positive bacteria(1,2,8,9).
UTI can be classified based on the symptoms,
severity of symptoms, anatomy infected, risk factors,
laboratory findings and culture. Based on the
symptoms, it was divided into asymptomatic (without
clinical symptoms) and symptomatic (clinical
symptoms). In postmenopausal women, UTI can be a
serious problem, because of recurrence, resulting in
easily happen bacterial resistance to antibiotics. Thus,
antibiotic therapy for asymptomatic UTIs in older
women did not deliver improvements to the urogenital
symptoms, but were associated with increased antibiotic
resistance and drug side effects(2 , 4,5,10,11).

The management of patients with UTI may be


easy, simple. Yet, it may also become difficult and more
complex. It was easy and simple because relatively the
incidence was very few, and many choices of antibiotics
that can be used, as well as the bacteria causing it was
known. It became difficult if the bacteria are resistant to
antibiotics as well as the presence of some other disease
or structural abnormalities of the urinary tract anatomy
that made infection easily occurs(10).

Research Design and Data Analysis

Several medicinal plants have been used for a


long time. Some components of the extract of ginger
(Zingiber officinale) with some solvents such as water,
ethanol, and acetone have antibacterial activity, but its
working mechanism remains unclear(9,12,13).

Because ginger has been used as antiinflammatory therapy in humans, we conducted in-vivo
studies in humans related to ginger as an antibacterial
activity that has not been done in other studies.

Sampling time was from April to June 2015. The


subjects were women aged 50-65 years and had
menopause naturally with urine culture result of
positive asymptomatic UTI, the amount of fluid intake
1500-2000ml/day, still have sex and have an index
normal body mass. The subjects were taken in
Geriatrics and Menopause Poly in General Hospital of
Dr.Soetomo. Then structured interviews were conducted
for data Characteristics and examination of urine
culture. Midstream urine capacity taken aseptically
culture was examined using Mac Conkey media in order
to identify the presence of Escherichia coli and count
the number of colonies before and after the treatment.
Every subjects joining the research, the 3 days before
the urine is taken for the first time, were treated equally
in terms of the number and types of drinks and food
consumed, and no sexual intercourse. The initial culture
examination was done in the Installation of Laboratory
of Clinical Microbiology General Hospital of
Dr.Soetomo, Surabya. After the initial urine culture, the
same treatment was continued for up to 5 days during
the treatment period up to urine culture examination
repetition.

Material and Method

Result and discussion

Ginger Powder Capsules Ingredients

In this research, the youngest age was 50 years


old and the oldest was 63 years with an average of
55.58 ( 3.98) years. It was ranged from 50 to 65 as that
range was the age range of women experience
menopause naturally and was said to be asymptomatic
UTI incidence of 45% (17,18).

In the research of the effectiveness of some


efficacious medicinal plants conducted on urine UTI
sufferers obtained in vitro growth of bacteria of E.coli,
K.pneumoniae,
P.aeruginosa,
E.faecalis
and
P.miribalis, almost all of them showed resistance to
multiple classes of antibiotics. Then each was given
efficacious medicinal plant extracts (Cinnamomum
cassia, Syzygium aromaticum, Zingiber officinale,
Azadirachata India). It was then obtained ability of
broad bacterial growth inhibition against each culture
isolates. This showed the ability of antibacterial in some
efficacious medicinal plants (9,13,14).

Ginger used in this research is elephant ginger


variety, which are harvested at the age of 11 months, at
the same farm in Pacitan, East Java. The process is done
in herbal and phytopharmaca section in Institute of
Tropical Disease, Airlangga University, Surabaya. Fresh
washed ginger is thinly sliced 2mm, dried using an
oven at 400C for 2-4 hours, then grinded into powder,
sieved using a flour sieve into ginger flour. Then the
ginger flour is processed into capsules in the Pharmacy
laboratory of Airlangga University, Surabaya. Each
capsule contains 250 mg of powdered ginger.
Dosage and Usage
The dosage used is a dose of 1000 mg/day
given two capsules two times daily for 5 days and taken
after a meal (15,16).

This research is a pre-experimental one-group


pretest-posttest research. The data of research subject
characteristics were analyzed by univariate analysis,
and the data obtained from the measurement was tested
with different of Wilcoxon rank test.
Data Collection

Duration of menopause in this research


subjects were between 2 and 10 years with an average
of 4.83 ( 3.40) years, this shows that the length of the
subjects exposed to low estrogen was relatively short.
The average of BMI was 22.99 ( 1.14). This showed
the nutritional status of the subjects was good.
The level of education was junior high school
as the majority of research subjects, and one sample had
the lowest educational level, i.e., elementary school.
From other studies, it was said that the lower the level
of education, the higher the risk of suffering from
asymptomatic UTI (17).

Half of the research subjects, 50%, were


housewives, which spent most of their daily activities at
home. From other studies, it was said that women who
did not work have a greater risk of UTI than those who
work(17).
Based on the number of parity, most of the
research subjects were multigravida, i.e., 91.7%. it was
known that childbirth process was one of the risk
factors of lower urinary tract disorders and childbirth.
The risk of urinary tract manipulation was so high that
it was the factor facilitating the occurrence of UTI.
Sexual intercourse done by research subjects
varied and the most frequent was obtained in more than
6 subjects, or 50% of the subjects were still having sex
more than four times a month. This may explain the risk
of asymptomatic UTI in the subjects due to ascending
factor. In theory, it was said that menopausal women
who are still active in sexual activity obtained
pathogens causing acute UTI is the same as the young
lady that is more than 75% - 80% are caused by E. coli
(19)
. In another research, the risk of asymptomatic UTI
was higher in women who are active in sexual activity
(17)
.
Data habit of rinsing the pubic after defecation
obtained the proportion rinsing toward the front was
75% compared to from back to front. It indicated good
habits in terms of preventing the risk of UTI.
From the examination result, the average of
GDA and Hemoglobin is 123.58 ( 11.11) and 13.0 (
0.67), suggesting that the condition of the immune
system of the research subjects was generally in good
condition (Table 1).

The average frequency of urination of the


subject of this research was 9.792 ( 0.950) before
the administration of ginger powder and 10.783 (
0.76) after the administration of powdered ginger
capsules. In addition, it was obtained that the
average volume of urination were almost equal
between before and after administration of
powdered ginger capsules i.e., 1218.96 ( 223.78)
and 1168.25 ( 73.81).
At the end of this research, we got the data
subjects of the perceived effects after taking ginger
capsules. 58.3% complained of hot in stomach,
25% felt palpitations, and 75% complained of
warm body.

Age

50

63

55.58 ( 3.98)

Random blood sugar

108

137

123.58 ( 11.11)

Hemoglobin

11.7

14.20

13.0 ( 0.67)

Urine specific gravity

1.006

1.022

1.0144 (

0.005)

Length of menopause

10

4.83 ( 3.40)

Body Mass Index

21.10

24.60

22.991 ( 1.14)

Variables

Frequency of
urination before
administration

12

9.792 (0.950)

Frequency of
urination after
administration

12

10.783 ( 0.76)

Urine volume
before
administration of
ginger capsules

12

1218.96 (223.78)

Urine volume
after
administration

12

1168.25 ( 73.81)

Variables
Education

Job

Parity
Min

Max

Mean (SD)

Mean (SD)

Table 1. Characteristics of Research Subjects

Variables

Numbe

Frequency

Percentage

Elementary

8.3%

Junior high

41.7%

Senior high

25%

Bachelor

25%

Housewife

50%

Civil servant

33.3%

Private
worker

16.7%

Primi

8.3%

Sexual
intercourse

Rinsing
Habits

Multi

11

91.7%

16.7%

25%

8.3%

50%

Back to front

25%

Front to back

75%

Stomach
feels the
heat

Yes

58.3%

No

41.7%

A sense of
palpitations

Yes

25%

No

75%

Yes

75%

No

25%

Warm
feeling in
Body

From this research, we get 12 research subjects


had the identification and count the number of initial
urine culture colonies result was identified E. coli with
the lowest value of 6x10 3 cfu/ml and a maximum value
of more than 105cfu/ml. The number of E. coli colonies
>105cfu/ml was found in 5 subjects of this research. In
the culture examination repetition on the same subjects,
11 subjects obtained colony count with no growth of
bacteria and 1 subject remained having positive E.coli,
yet having a decreased number of colonies in culture
(Table 2).
In Table 3, the data test comparison of the
number of E. coli colonies urine culture before and after
treatment. Obtained mean rank number E.coli colonies
ginger powder capsules prior to administration of 6.00
was mean rank number E.coli colonies after
supplementation of ginger powder is 0. With the
statistical test p value = 0.001 (p <0.05) in = 0.05, so
there is a significant difference between the number of
E. coli colonies before and after the administration of
powdered ginger capsules.
Table 2 Results of Identification Number of Urine
Culture Colony Before And After the
administration of Ginger Powder Capsules
Urine culture before
the administration

administratio
n
Escherichia
coli
(cfu/ml)

10000
1000000

11000

9000

1000000

6000

60000

1000000

36000

47000

1000000

1000000

In this research, it was obtained significant results


of the decrease of the number of E. coli colonies before
and after the administration of powdered ginger
capsules. This research used a powdered ginger at a
dose of 1000 mg per day given in divided doses and
was able to decrease the number of colonies of
Escherichia coli in the urine of research subjects. Thus,
the risk for the occurrence of UTI will also decrease.
From in-vitro studies, ginger was said to have a
good antibacterial activity against gram-positive and
gram-negative bacteria such as Escherichia.coli. It was
done by phenol compounds contained therein (20). This
research was similar to the results of in-vitro study by
Hajera T in 2013. It said that the bacteria obtained from
patients with urinary tract UTI are resistant to certain
antibiotics and some bacteria still respond to antibiotics.
It was known that ginger extract had a high ability to
suppress the growth of Escherichia coli (13).
Table 3 Comparison of Results of Identification and
Number of Colonies of Escherichia coli In
Urine culture before and after administration
of Ginger Powder Capsules
Variables
Before
the
administration of
ginger powder
After
the
administration of
ginger capsules

Result

Positive

12

Mean
Rank
0,00

Negative
Positive

0
1

6,00

Negative

11

* Significant if p <0.05
Urine culture
after the

2000

Number

Nilai p

0,001*

Antibacterial activity of ginger can be played


by several components such as phenol compound
gingerol or shagaol, seyawa of mono - and
sesqueterpenoid (21). In addition, the results of the
research was also corroborated by the role of the other
components of ginger, such as farnesol also play a role
in the antibacterial of ginger (22). In addition, the
compounds such as flavonoids quercetin, galangin etc.,
had antibacterial ability (23). Besides, the compounds
from the class of alkaloids and tannins also have
antibacterial activity (13).

binding to gyrB subunit of E. coli DNA gyrase and


inhibits the ATPase enzyme (23).

This research used a dry powder of ginger, so


that all the components were allegedly still contained in
ginger powder capsule products. Although in this
research the ginger powder was consumed with water,
its antibacterial activity was not lost. It is supported by
research that the water extract of ginger have
antibacterial activity on ginger extracts of E. coli with
the ability to inhibit the growth of bacteria in the urine
culture isolates (12.24 , 13).

In this research, it was found one research


subject who still gave a positive result after the
administration of powdered ginger capsules. It was
probably due to the low level of knowledge of mothers
who are elementary school graduated. In addition to the
subject, it was also raised complaints of burning
sensation in the stomach that made it possibly
uncomfortable so adherence ginger powder capsules
irregular control despite medication adherence by
providing drinking schedule daily capsule to be filled
each time a drink and by telephone. In addition, the
research said that the water extract of ginger has a
minimal inhibitory power against E. coli, so that the
antibacterial activity into medium - weak (28).

Another research showed that fresh ginger and


ginger powder dissolved in water has drained strong
antibacterial activity against some gram negative and
positive bacteria in vitro (25).
Antibacterial activity of ginger played by some
active component which mechanism could work
through a process of direct inhibition of virulence
factors in the bacterial surface on fimbrie and Gal-Gal
receptors. Thus, the bacterial adhesion process was
disturbed to the surface of cells of the bladder. Besides,
its metabolites were capable of disturbing virulence
factors secreted by the bacterial body so that the body
defense system can recognize bacterial and prevent
UPEC bacteria form a biofilm (26).
Phenolic compounds such as gingerol and
shogaol also was known as denaturating agent, which
was capable of changing the permeability of the cell,
which may result in cell swelling and rupture of the
bacteria. In addition, the phenol compound was a metal
chelators that could go beyond the surface of gramnegative bacteria and decreased the working ability of
the enzyme and caused a decrease in metabolism and
reproduction of bacteria (24).
In a research using terpene compounds that is
farnesol of ginger extract has the ability to damage the
surface of the bacterial cell, causing impaired balance
and ion transport membrane permeability of bacterial
cells (22).
Flavonoid compounds from ginger has
antibacterial activity through a mechanism interfere
with the synthesis of DNA/RNA and inhibits the
activity of E. coli DNA gyrase including quercetine by

Ginger extract has potential as an immune


system enhancer. It has been demonstrated in studies
conducted by Tejasari, which examines ginger extract
bioactive components such as gingerol, shogaol and
zingerone towards increasing the ratio of T-cell surface
molecule CD3 + CD4 +: CD8 + CD3 +. It was
concluded that in vitro ginger extract has the ability to
increase cellular and humoral immune response (27).

The last, from the research, we obtained 12


research subjects, with the positive identification and
count colonies urine culture before the treatment of
Escherichia coli. After the administration of ginger
powder capsules obtained 11 subjects with negative
urine culture results repetition and obtained one subject
with repeat urine culture results which remained
positive with a number of Escherichia coli colonies
which is decreasing. We got that a decreased in the
number of colonies of Escherichia coli before and after
the administration of powdered ginger capsules on urine
culture from the urine of postmenopausal women with
asymptomatic UTI. By using a comparison test of the
number of colonies of Escherichia coli, the urine
culture result between before and after treatment
showed a significant decrease in the number of
colonies.
Conclusion
.Bese on this study, we can conclude that
powdered ginger capsules can decrease the number of
colonies of Escherichia coli from urine of menopausal
women with asymptomatic UTI.
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