Broad spectrum antibiotic use among in-patients at a hospital in Nairobi, Kenya

Abstract

Background: Antimicrobial resistance is an increasingly serious threat to global public health. While the use of antibiotics is an important contributing factor, there are gaps regarding this in our region. This study aimed to describe the use of nine broad spectrum antibiotics among in-patients of The Nairobi Hospital (TNH) so as to identify opportunities for quality improvement.Methods: This was a retrospective review of the use of meropenem, ertapenem, imipenem, cefepime, piperacillin, gentamicin, amikacin, vancomycin and teicoplanin among in-patients of TNH from 1st January 2018 to 31st March 2018. Demographic and clinical data of all in-patients who were prescribed these antibiotics during the study period were retrieved from patient files.Results: There were 301 study participants with a median age (range) of 30years (1day-74years), of whom 161 (53.5%) were male. More than half of the participants were admitted for less than one week and had at least one co-morbidity. Meropenem was the most commonly prescribed study antibiotic 123 (40.9%) followed by amikacin 89 (29.6%). Respiratory tract infections 125 (41.5%) were the predominant indications. Meropenem had the longest mean duration of administration, 6.5days while the aminoglycosides were administered for a relatively shorter duration of about 4.8days. Cultures were done on 187 (62.1%) patients though it is only samples of 45 patients that grew an organism, E. coli and Klebsiella sp being the most frequently isolated organisms.Conclusions: There’s a need to strongly intensify implementation of restriction strategies for Meropenem use and introduction of education programs on antimicrobial stewardship targeting all prescribers.

Detection of diverse carbapenem and multidrug resistance genes and high-risk strain types among carbapenem non-susceptible clinical isolates of target gram-negative bacteria in Kenya

“…This pattern suggests a prolonged outbreak, as previously reported in a Nairobi Hospital [ 44 ]. Carbapenem, considered a last-resort antibiotic, is used to treat MDR infections and is the most commonly prescribed antibiotic in a study in a hospital in Nairobi [ 45 ]. As higher-level drugs are often unavailable or too expensive in Kenya, C-NS infections pose a serious challenge.…”

“…The greatest number and diversity of C-NS isolates were observed in the two referral hospitals in Kisii and Nairobi. Referral hospitals have factors that contribute to a greater risk of MDR infections, such as more hospital-acquired infections, extended hospitalization stays, invasive devices, and more frequent use of third-and fourth-line drugs [ 45 ]. These factors could explain why more carbapenemase genes were detected in Nairobi and Kisii hospitals than in the other lower-level hospitals with less than four carbapenem genes.…”

Recurrent spontaneousEscherichia colimeningitis in an adult: a case report

“…A final, important aspect of this case is the extensive resistance observed in the hospital-acquired strain. Carbapenems are generally unavailable in the public sector in Kenya, 32 , 33 although they are widely used in private hospitals, 34 and there was allegedly no history of prior antimicrobial use in this patient. Carbapenems have only been available in the hospital formulary in Kilifi since 2020, although surveillance data indicate the presence of carbapenem-resistant organisms since 2005 (A. V. Amulele, A. M. Arara, E. W. Machanja, D. W. Wareham, J.…”