Low prevalence of methicillin resistant Staphylococcus aureus as determined by an automated identification system in two private hospitals in Nairobi, Kenya: a cross sectional study

Omuse, Geoffrey; Kabera, Beatrice; Revathi, Gunturu

doi:10.1186/s12879-014-0669-y

Cited by 33 publications

(41 citation statements)

References 27 publications

(30 reference statements)

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“…There is a low MRSA prevalence in this study at 9% compared to higher income countries, like USA with a prevalence of 41% [18]. The MRSA prevalence of < 10% is similar to a study at AKUH, N in 2014, that showed a prevalence of 4.8% [19] and other African countries like in Madagascar with 4.4% [20]. The commonest organism was E. coli followed by K. pneumonia similar to both Raith, et al [8] and Khwannimit, et al [9] cohorts.…”

Section: Severity Of Illness and Outcomesupporting

confidence: 82%

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

A¹,

Wangari-Waweru²,

Mung’ayi³

et al. 2019

Int J Crit Care Emerg Med

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Introduction: Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown. Methods: We compared the performance of SOFA and qSOFA in predicting the in-hospital mortality of an adult critical care unit in Kenya. We conducted a retrospective review of all patients admitted to the critical care units with suspected infection between 1 January 2017 and 31 December 2017. A standardized electronic data collection tool was be used to collect demographic, clinical and outcome data on the participants. Area under the receiver operating characteristic curves (AUROC) with 95% confidence intervals was used to compare SOFA and qSOFA. Results: We enrolled 450 patients with a mean age of 56 years [SD ± 19.10] and 57.60% were male. Majority of the patients, 352 (78.20%), presented through the emergency department. Pneumonia was the commonest source of infection 293 (65.10%). There were 92 deaths (mortality rate of 20.44%). The majority of patients, 371 (82.44%) manifested a SOFA score of ≥ 2 and 190 (42.22%) had a qSOFA score of ≥ 2. SOFA score was superior in predicting in hospital mortality compared to qSOFA with an AUROC = 0.799 [0.752-0.846] vs. 0.694 [0.691-0.748, P < 0.001]. Conclusion: A SOFA score of two or more is better than qSOFA score in predicting in-hospital mortality among adult critical care patients with suspected infection. This finding suggests that SOFA is an appropriate tool in the initial diagnosis sepsis in critical care setting in a developing country.

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Section: Severity Of Illness and Outcomesupporting

confidence: 82%

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

A¹,

Wangari-Waweru²,

Mung’ayi³

et al. 2019

Int J Crit Care Emerg Med

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“…However, in the developing countries, manual methods are the mainstay for identification of staphylococci, and in most cases the tube coagulase test is the confirmatory test for identification of S. aureus [5]. The tube coagulase test is considered to be more reliable at identifying S. aureus when a firm clot that doesn't move on tilting the tube occurs; therefore, the subjectivity in interpreting the tube coagulase test probably leads to misidentification of CoNS as S. aureus [31] In this study, a high staphylococcal nasopharyngeal colonization rate (63.5%, 485/764) was reported for healthy children in Eastern Uganda. However, our rate is comparable to the rates reported by other investigators e.g.…”

Section: Discussionmentioning

confidence: 99%

Species and drug susceptibility profiles of staphylococci isolated from healthy children in Eastern Uganda

et al. 2020

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Staphylococci are a key component of the human microbiota, and they mainly colonize the skin and anterior nares. However, they can cause infection in hospitalized patients and healthy individuals in the community. Although majority of the Staphylococcus aureus strains are coagulase-positive, some do not produce coagulase, and the isolation of coagulase-positive non-S. aureus isolates in humans is increasingly being reported. Therefore, sound knowledge of the species and characteristics of staphylococci in a given setting is important, especially isolates from children and immunocompromised individuals. The spectrum of Staphylococcus species colonizing children in Uganda is poorly understood; here, we aimed to determine the species and characteristics of staphylococci isolated from children in Eastern Uganda. Seven hundred and sixty four healthy children less than 5 years residing in Iganga and Mayuge districts in Eastern Uganda were enrolled. A total of 513 staphylococci belonging to 13 species were isolated from 485 children (63.5%, 485/764), with S. aureus being the dominant species (37.6%, 193/513) followed by S. epidermidis (25.5%, 131/513), S. haemolyticus (2.3%, 12/513), S. hominis (0.8%, 4/513) and S. haemolyticus/lugdunensis (0.58%, 3/513). Twenty four (4.95%, 24/485) children were co-colonized by two or more Staphylococcus species. With the exception of penicillin, antimicrobial resistance (AMR) rates were low; all isolates were susceptible to vancomycin, teicoplanin, linezolid and daptomycin. The prevalence of methicillin resistance was 23.8% (122/513) and it was highest in S. haemolyticus (66.7%, 8/12) followed by S. aureus (28.5%, 55/193) and S. epidermidis (23.7%, 31/131). The prevalence of multidrug resistance was 20.3% (104/513), and 59% (72/122) of methicillin resistant staphylococci were multidrug resistant. Four methicillin susceptible S. aureus isolates and a methicillin resistant S. scuiri isolate were mupirocin resistant (high-level). The most frequent AMR genes were mecA, vanA, ant(4')-Ia, and aac(6')-Ie-aph(2'')-Ia, pointing to presence of AMR drivers in the community.

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“…One study suggests an interesting explanation for previously reported high rates of oxacillin resistance reported from lowresourced laboratories in Africa, and that is due to misidentification of coagulase-negative staphylococci as S. aureus, the former which is typically oxacillin resistant, due to subjective interpretation of manual phenotypic tests, specifically the tube and slide coagulation tests. 25 This may be overcome by the use of automated systems.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Antimicrobial Susceptibility Trends Among Bacterial Isolates from a Tertiary Health-Care Facility in Kigali, Rwanda

Carroll

Ashok

Musabeyezu

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. Antimicrobial resistance (AMR) is a global public health threat. There is limited information from Rwanda on AMR trends. This longitudinal study aimed to describe temporal trends of antibiotic susceptibility among common bacteria. We collated the antimicrobial susceptibility results of bacteria cultured from clinical specimens collected from inpatients and outpatients and submitted to the microbiology laboratory at King Faisal Hospital, Kigali, Rwanda, from January 1, 2009, to December 31, 2013. Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using χ 2 test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp., 11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gramnegative bacteria. Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus. Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda. Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat.

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Low prevalence of methicillin resistant Staphylococcus aureus as determined by an automated identification system in two private hospitals in Nairobi, Kenya: a cross sectional study

Cited by 33 publications

References 27 publications

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

Species and drug susceptibility profiles of staphylococci isolated from healthy children in Eastern Uganda

Five-Year Antimicrobial Susceptibility Trends Among Bacterial Isolates from a Tertiary Health-Care Facility in Kigali, Rwanda

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