Spectrum of Microbial Diseases and Resistance Patterns at a Private Teaching Hospital in Kenya: Implications for Clinical Practice (original) (raw)
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2022
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...
Prevalence of colonization with multidrug-resistant bacteria in communities and hospitals in Kenya
Scientific Reports
We estimated the prevalence of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant Staphylococcus aureus (MRSA) in communities and hospitals in Kenya to identify human colonization with multidrug-resistant bacteria. Nasal and fecal specimen were collected from inpatients and community residents in Nairobi (urban) and Siaya (rural) counties. Swabs were plated on chromogenic agar to presumptively identify ESCrE, CRE and MRSA isolates. Confirmatory identification and antibiotic susceptibility testing were done using the VITEK®2 instrument. A total of 1999 community residents and 1023 inpatients were enrolled between January 2019 and March 2020. ESCrE colonization was higher in urban than rural communities (52 vs. 45%; P = 0.013) and in urban than rural hospitals (70 vs. 63%; P = 0.032). Overall, ESCrE colonization was ~ 18% higher in hospitals than in corresponding communities. CRE colonization was h...
Antimicrobial resistance: capacity and practices among clinical laboratories in Kenya, 2013
Pan African Medical Journal, 2014
Introduction: antimicrobial resistance is neglected in developing countries; associated with limited surveillance and unregulated use of antimicrobials. Consequently, delayed patient recoveries, deaths and further antimicrobial resistance occur. Recent gastroenteritis outbreak at a children's home associated with multidrug resistant non-typhoidal Salmonella spp, raised concerns about the magnitude of the problem in Kenya, prompting antimicrobial resistance assessment preceding surveillance system establishment. Methods: eight public medical laboratories were conveniently selected. Questionnaires were administered to key informants to evaluate capacity, practice and utilization of antimicrobial susceptibility tests. Retrospective review of laboratory records determined antimicrobial resistance to isolates. Antimicrobial resistance was defined as resistance of a microorganism to an antimicrobial agent to which it was previously sensitive and multidrug resistance as non-susceptibility to at least one agent in three or more antimicrobial categories. Results: the laboratories comprised; 2(25%) national, 4(50%) sub-national and 2(25%) district. Overall, antimicrobial susceptibility testing capacity was inadequate in all. Seven (88%) had basic capacity for stool cultures, 3(38%) had capacity for blood culture. Resistance to enteric organisms was observed with the following and other commonly prescribed antimicrobials, ampicillin: 40(91%) Salmonella spp isolates; Tetracycline: 16(84%) Shigella flexineri isolates; cotrimoxazole: 20(100%) Shigella spp isolates, 24(91%) Salmonella spp isolates. Comparable patterns of multidrug resistance were evident with Shigella flexineri and Salmonella typhimurium. Ten (100%) clinicians reported not using laboratory results for patient management, for various reasons.
bioRxiv (Cold Spring Harbor Laboratory), 2023
Background: Hospital-acquired infections (HAIs) represent the most prevalent adverse event among patients in hospital settings. Contamination with pathogenic bacteria that are highly resistant in the hospital environment increases the risk of HAIs. Objective: The antimicrobial resistance (AMR) patterns of hospital contaminants isolated from highly frequented surfaces in a tertiary hospital in Kenya. Methods: A total of 62 swabs were collected from selected surfaces, equipment, and health workers' palms in April 2020. They were cultured and bacterial contaminants were identified using standard microbiological procedures and their AMR patterns were determined using recommended laboratory assays. Results: Of the 62 swabs collected, 61.3% (n=38) yielded bacterial growth, from which 46 bacteria were isolated. Swab positivity varied across the departments as follows: gynecology wards (78.6%), New Born Unit (NBU) (56.2%), Pediatric ward (61.9%), and Renal Unit (45.5%). Gram negative species comprised 86.96%(n=40) while Gram positive species 51 comprised 13.04%(n=6). Of all the 46 isolates obtained, 36.96% (n=17) were positive for the 52 resistance markers screened. Specifically, 10.9% (n=5) showed both extended-spectrum beta-53 lactamases (ESBL) and carbapenem-resistant (CR) resistance, while 23.9%(n=11) were positive for ESBL production. The rest were non-resistant strains as shown by negative ESBL at 47.8% 55 (n=22), methicillin sensitivity at 13% (n=6) and vancomycin sensitivity at 2.2% (n=1). 56 Acinetobacter species which were most reported, had the highest resistance (36.84% (7/19). Conclusion: There was a high prevalence of contamination with resistant pathogenic bacteria 58 species. Acinetobacter species were the most common pathogen. Interventions are needed to mitigate the problem of resistant HAI.
Microbiology Research Journal International
Objective: Control of hospital environment is key to success of healthcare quality. Increasing emergence and spread of pathogenic bacteria is of great concern and continues to challenge infection prevention and epidemiology practice. This study aimed at providing information about the management of hospital environment and wastes in selected hospitals in Kenya, determine prevalence of pathogenic bacteria and their antibiotic susceptibility. Methods: A cross sectional study was conducted at Kenyatta National Hospital (KNH) (public) and Kikuyu Mission Hospital (KMH) (private) in Kenya from May 2015 to April 2017. In microbiological analysis, a total of 246 samples from each of the two hospitals was obtained using sterile cotton swabs from random sampling of hospital different surfaces, drainages, hands of healthcare givers and hospital waste dump site among others. Results: A total of 471 bacterial isolates were recovered, and were distributed as follows; Providentia spp, Staphylococc...
African Journal of Laboratory Medicine, 2018
Background Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). The emergence and spread of AMR threatens effective control and treatment of various infections worldwide. 1,2 These infections, often caused by multidrug-resistant organisms, take a heavy toll on patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and sometimes death. 3,4,5 Thus, HCAIs are major causes of preventable morbidity and mortality in low-and middle-income countries where infection rates are relatively higher due to poor infection control practices, inappropriate use of limited resources, under-staffing of healthcare facilities and overcrowding of hospitals. 6 Healthcare-associated infections rank among the 10 leading causes of death in the United States, accounting for 1.7 million affected individuals and about 99 000 deaths in 2002 and resulting in up to USD33 billion of excess medical costs every year. 7 In England, more than 100 000 cases of HCAI are estimated to cost £1 billion and directly cause over 5000 deaths annually. 5 Although data are sparse, evidence suggests HCAI exerts greater burden in developing countries. Pooled prevalence of HCAI in developing countries is 15.5 per 100 patients (95% confidence interval; 12.6-18.9), with surgical site infections being the leading HCAI, caused mainly by Gram-negative organisms and multidrug-resistant organisms. Multidrug-resistant organisms account for 25% of HCAI globally. 2,5 There are different types of HCAIs as highlighted by the National Healthcare Safety Network patient safety component manual of the United States Centers for Disease Control and Prevention. 8,9 These include urinary tract infection (UTI), which is usually catheter-related, surgical site infection (SSI), bloodstream infection (BSI)-laboratory-confirmed bloodstream infection or central-line associated bloodstream infection-and pneumonia (clinically-defined pneumonia or ventilator-associated). Other HCAIs occur in the bones, joints, central nervous system, cardiovascular system (e.g. endocarditis) and in the skin and soft tissue. Background: Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). It is a major cause of morbidity and mortality with economic consequences. Objective: This review provides an update on the occurrence of HCAI, as well as the contribution of emerging AMR on healthcare delivery in Africa. Methods: We searched PubMed, Cochrane database, African Journals Online and Google Scholar for relevant articles on HCAI in Africa between 2010 and 2017. Preferred reporting items of systematic reviews and meta-analyses guidelines were followed for selection. Thirtyfive eligible articles were considered for the qualitative synthesis. Results: Of the 35 eligible articles, more than half (n = 21, 60%) were from East Africa. Klebsiella spp., Staphylococcus aureus, Escherichia coli and Pseudomonas spp. were the common pathogens reported in bloodstream infection, (catheter-associated) urinary tract infection, surgical site infection and healthcare-associated pneumonia. Among these various subtypes of HCAI, methicillin-resistant S. aureus (3.9%-56.8%) and extended-spectrum beta-lactamase producing Gram-negative bacilli (1.9%-53.0%) were the most reported antimicrobial resistant pathogens. Conclusion: This review shows a paucity of HCAI surveillance in Africa and an emergence of AMR priority pathogens. Hence, there is a need for a coordinated national and regional surveillance of both HCAI and AMR in Africa. A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective Read online: Scan this QR code with your smart phone or mobile device to read online. 'Cross infecƟon' [MeSH term], 'nosocomial infecƟon', 'nosocomial infecƟons', 'hospital acquired infecƟon', 'hospital acquired infecƟons', 'hospital-acquired infecƟon', 'hospital acquired infecƟons', 'health care associated infecƟon', 'health care associated infecƟons', 'health care-associated infecƟon', 'health care-associated infecƟons', year of publicaƟon 'January 2010 to January 2017', and names of African countries individually. MeSH, Medical subject headings.
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 ...
Infection and Drug Resistance, 2020
Background: The emergence of antimicrobial resistance (AMR) is a public health threat in developing countries including Ethiopia; and there is a paucity of information regarding antimicrobial resistance patterns of commonly isolated pathogens, particularly in the study area. Hence, this study aimed to assess the microbiological profiles and resistance patterns of pathogens among patients who visited a tertiary hospital in the study setting. Methods: This study was based on secondary data sources from the hospital microbiology database and culture reports between September 2019 and August 2020 at the University of Gondar comprehensive specialized hospitals, Ethiopia. Data about socio-demographic characteristics and clinical parameters, types of specimens collected, culture results, and antibiotic resistance pattern were collected manually by using a data abstraction format from the department of clinical bacteriology registration book and electronic database. Results: A total of 5328 culture results were included in the final analysis. Bacterial growth was documented only in 803 (15.1%) samples. From the positive culture results documented, the highest positivity rate was reported from abscess (47.8%) followed by blood (26.2%) and urine (15.1%) samples. Among the bacterial isolates S. aureus (32.5%), Klebsiella species (17.9%), E. coli (14.8%) and Streptococcus species (7.4%) were the commonly identified organisms. Of the 803 bacterial isolates, about 672 (83.6%) isolates were resistant to at least one antibiotic and 19.7% isolates were MDR. Conclusion: This study showed that Staphylococcus aureus, Klebsiella pneumonia species, and Escherichia coli were the commonest isolated pathogens. Antimicrobial resistance among common isolates was high for most routinely used antibiotics, and some reserved drugs like carbapenems and fourth-generation cephalosporin. Thus, this study may have implications on patient management, drug procurement, local treatment guideline development, and rational use of antibiotics. Furthermore, this finding could also help to facilitate the implementation of antimicrobial stewardship and infection prevention and control interventions within the hospital.
2021
Background Nosocomial infections are of public health concern globally. These infections are frequently caused by microbes residing in the healthcare environment, including contaminated medical equipment, wards, and operating theaters. Objectives To determine the prevalence and susceptibility pattern of bacteria that contaminated the wards and operating rooms of Mama Lucy Kibaki Hospital. MethodsA cross-sectional descriptive study was done from October - November 2018. Surface swabs taken from predefined areas within the wards and operating room were assessed for bacterial contamination. The samples were processed through gram reaction, culture, and an array of biochemical tests. Antibiotics susceptibility tests were done for each swab by the Kirby Bauer disc diffusion technique. Statistical work was done through a statistical package for the social sciences version 20. ResultsThe present work revealed an isolation rate of 64.7% (44/68) for culture-positive surface swabs while 35.3%...
Infection and Drug Resistance
Background: Bloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria. Objective: To determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia. Methods: A cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software. Results: The prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Preschool P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI. Conclusion: Pediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.