Prevalence of colonization with multidrug-resistant bacteria in communities and hospitals in Kenya

Abstract

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 higher in hospital than community settings (rural: 7 vs. 1%; urban: 17 vs. 1%; with non-overlapping 95% confidence intervals), while MRSA was rarely detected (≤ 3% overall). Human colonization with ESCrE and CRE was common, particularly in hospitals and urban settings. MRSA colonization was uncommon. Evaluation of risk factors and genetic mechanisms of resistance can guide prevention and control efforts tailored to different environments.

<i>Escherichia coli</i> Pathotypes in Children with Acute Diarrhea in an Informal Settlement in Nairobi, Kenya

“…Antibiotic susceptibility testing. All DEC isolates were tested for susceptibility to 17 antibiotics-belonging to 11 antibiotic classes [16]-using the VITEK ® 2 AST-GN71 cards. Interpretation of antibiotic susceptibility results was based on the 2020 Clinical and Laboratory Standards Institute (CLSI) guidelines [17].…”

The Fragmented Picture of Antimicrobial Resistance in Kenya: A Situational Analysis of Antimicrobial Consumption and the Imperative for Antimicrobial Stewardship

“…Alarmingly, carbapenem-resistant Enterobacterales (CRE) and extended-spectrum-lactamase-producing organisms, which are associated with poor clinical outcomes in invasive infections, are increasingly prevalent in Kenya. A recent study found that 7–17% of hospitalized patients had infections caused by these bacteria, with 39% of isolates meeting the “difficult-to-treat resistance” definition [ 15 ]. This situation poses a significant public health challenge requiring urgent attention.…”

Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study

“…Beyond antibiotic administration, less is known about other factors that could contribute to colonization before or during hospitalization. Earlier work showed that the prevalence of ESCrE and CRE colonization within a regional hospital in Guatemala (67% and 37%, respectively) is relatively high compared with other low- and middle-income countries [20] , [21] , [22] and very high compared with high-income countries [ 23 , 24 ]. This high prevalence offers an opportunity to detect potential contributions from the community to colonization in hospitalized patients.…”