Prevalence of colonization with multidrug-resistant bacteria in communities and hospitals in Kenya (original) (raw)
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Clinical Infectious Diseases
Background Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistant infections. We identified risk factors potentially associated with human colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low-income urban and rural communities in Kenya. Methods Fecal specimens, demographic and socioeconomic data were collected cross-sectionally from clustered random samples of respondents in urban (Kibera, Nairobi County) and rural (Asembo, Siaya County) communities between January 2019 and March 2020. Presumptive ESCrE isolates were confirmed and tested for antibiotic susceptibility using the VITEK2 instrument. We used a path analytic model to identify potential risk factors for colonization with ESCrE. Only 1 participant was included per household to minimize household cluster effects. Results Stool samples from 1148 adults (aged ≥18 years) and 268 children (aged <5 years) were analyzed. The likelihood of colonization incre...
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BackgroundAntimicrobial resistance is a pressing global health issue. Data are lacking in detailing the presence and burden of antimicrobial resistance in low and middle-income countries. What is currently available is quarantined to large, urban centers away from the rural facilities. MethodsThis was a retrospective descriptive study performed at Kijabe Hospital, a rural 350-bed teaching hospital, from February 2016 to September 2020. Cultures from blood, urine, and cerebrospinal fluid were included from all pediatric and adult patients. Data was analyzed and an antibiogram was created using WHONET software. ResultsFrom January 2016 to September 2020 a total of 3275 distinct isolates were identified, including 1654 positive blood cultures, 1288 positive urine cultures, and 91 positive cerebrospinal fluid cultures. Aggregate gram negative susceptibility to third generation cephalosporins was approximately 41%, with 67% of isolates susceptible to piperacillin-tazobactam, and 93% of i...
PLOS ONE, 2016
Background Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data. Methods We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014. Results For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci. Conclusions The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of
PeerJ
Background Antimicrobial resistance among pathogens of public health importance is an emerging problem in sub-Saharan Africa. Unfortunately, published information on the burden and patterns of antimicrobial resistance (AMR) in this region is sparse. There is evidence that the burden and patterns of AMR vary by geography and facility. Knowledge of local epidemiology of AMR is thus important for guiding clinical decisions and mitigation strategies. Therefore, the objective of this study was to determine the burden and predictors of AMR and multidrug resistance (MDR) among bacterial pathogens isolated from specimens submitted to the diagnostic laboratory of a hospital in Nairobi, Kenya. Methods This retrospective study used laboratory records of 1,217 clinical specimens submitted for bacterial culture and sensitivity testing at the diagnostic laboratory of The Karen Hospital in Nairobi, Kenya between 2012 and 2016. Records from specimens positive for Enterobacteriaceae, Staphylococcus ...
Antimicrobial Resistance & Infection Control
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Infection and Drug Resistance
Introduction: Antimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse. Methods: A prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards. Results: We processed a total of 2620 specimens of which 388 (14.8%) were culturepositive from patients with a median (IQR) age of 28 (12-44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance to commonly used antibiotics such as Ampicillin, Amoxicillin-Clavulanic acid, Erythromycin, Gentamicin, Tetracycline, Trimethoprim, third-generation Cephalosporins (Ceftriaxone and Ceftazidime), and reserved drugs (Clindamycin and Meropenem). S. aureus isolates were resistant to most of the antibiotics tested; 66.7% were classified as MRSA infections. Conclusion: Antibiotic resistance to commonly prescribed antibiotics was alarmingly high. Our findings emphasize the need for comprehensive national control programs to combat antibiotic resistance.
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African Journal of Health Safety and Environment, 2023
ethicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Escherichia coli (MDRE) continuously pose a threat to global health, particularly in low-and middle-income countries, such as Nigeria. Therefore, given the dearth of locally-generated evidence, this study aimed to assess the prevalence of MRSA and MDRE with a view to informing local public health research, practice and policy. This was a cross-sectional study of outpatients presenting to three purposively selected healthcare facilities in Benin City, Edo State, Nigeria. Standard microbiological procedures were performed using nasal swabs and urine specimens. The outcome variables were the identification of MRSA and MDRE, defined as the proportion of persons diagnosed as carrying Staphylococcus aureus and E. coli, respectively, with these resistant bacterial strains. Descriptive analysis using frequencies and percentages by participant's characteristics was presented. Two hundred and thirty-three persons participated in this study between January 2021 and July 2021, majority of whom were females (67%) and aged 18-24 (45%). Growth of S. aureus was detected in 55.1% (91) of 165 participants who provided nasal swabs. Of these 91 participants, 91.2% (83/91) were confirmed as carrying MRSA. Additionally, 51.7% (i.e., 89) of the 172 participants who provided urine for culture were positive for E. coli growth, of which 92.1% (82/89) were identified as carrying MDRE. This study recorded a high prevalence of both MRSA and MDRE in the study setting, underlining the need for an urgent preventive public health measure, such as awareness and antimicrobial stewardship promotion.