scholarly journals Antimicrobial resistance among Enterobacteriaceae, Staphylococcus aureus, and Pseudomonas spp. isolates from clinical specimens from a hospital in Nairobi, Kenya

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11958
Author(s):  
Jennifer Lord ◽  
Anthony Gikonyo ◽  
Amos Miwa ◽  
Agricola Odoi
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Small Sample ◽  
Mitigation Strategies ◽  
Sub Saharan Africa ◽  
Sensitivity Testing ◽  
Diagnostic Laboratory ◽  
Clinical Specimens ◽  
Extended Spectrum ◽  
Sub Saharan

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 aureus, or Pseudomonas spp. isolates were included for analysis. Firth logistic models, which minimize small sample bias, were used to investigate determinants of AMR and MDR of the isolates. Results A total of 222 specimens had bacterial growth. Most Enterobacteriaceae isolates were resistant to commonly used drugs such as penicillin/β-lactamase inhibitor combinations (91.2%) and folate pathway inhibitors (83.7%). Resistance to extended-spectrum cephalosporins was also high (52.9%). Levels of AMR and MDR for Enterobacteriaceae were 88.5% and 51%, respectively. Among S. aureus isolates, 57.1% were AMR, while 16.7% were MDR. As many as 42.1% of the Pseudomonas spp. isolates were aminoglycoside-resistant and 15% were fluoroquinolone-resistant, but none exhibited resistance to antipseudomonal carbapenems. Half of Pseudomonas spp. isolates were AMR but none were MDR. Significant predictors of MDR among Enterobacteriaceae were organism species (p = 0.002) and patient gender (p = 0.024). Conclusions The high levels of extended-spectrum cephalosporin resistance and MDR among Enterobacteriaceae isolates are concerning. However, the relatively low levels of MDR S. aureus, and an absence of carbapenem resistance among Pseudomonas isolates, suggests that last-line drugs are still effective against S. aureus and Pseudomonas infections. These findings are relevant for guiding evidence-based treatment decisions as well as surveillance efforts and directions for future research, and contribute to the sparse literature on AMR in sub-Saharan Africa.

scholarly journals Self-Reported Mask Wearing Greatly Exceeds Directly Observed Use: Urgent Need for Policy Intervention in Kenya

2021 ◽  
Author(s):  
Aleksandra Jakubowski ◽  
Dennis Egger ◽  
Carolyne Nekesa ◽  
Layna Lowe ◽  
Michael Walker ◽  
...  
Keyword(s):  
Low Income ◽  
Public Transportation ◽  
Behavioral Interventions ◽  
Economic Consequences ◽  
Mitigation Strategies ◽  
Sub Saharan Africa ◽  
Rural Setting ◽  
Direct Observations ◽  
Improve Compliance ◽  
Sub Saharan

AbstractBackgroundMany countries in sub-Saharan Africa have so far avoided large outbreaks of COVID-19, perhaps due to the strict lockdown measures that were imposed early in the pandemic. Yet the harsh socio-economic consequences of the lockdowns have led many governments to ease the restrictions in favor of less stringent mitigation strategies. In the absence of concrete plans for widespread vaccination, masks remain one of the few tools available to low-income populations to avoid the spread of SARS-CoV-2 for the foreseeable future.MethodsWe compare mask use data collected through self-reports from phone surveys and direct observations in public spaces from population-representative samples in Ugunja subcounty, a rural setting in Western Kenya. We examine mask use in different situations and compare mask use by gender, age, location, and the riskiness of the activityFindingsWe assess mask use data from 1,960 phone survey respondents and 9,549 direct observations. While only 12% of people admitted in phone interviews to not wearing a mask in public, 90% of people we observed did not have a mask visible (77.7% difference, 95% CI 0.742, 0.802). Self-reported mask use was significantly higher than observed mask use in all scenarios (i.e. in the village, in the market, on public transportation).InterpretationWe find limited compliance with the national government mask mandate in Kenya using directly observed data, but high rates of self-reported mask use. This vast gap suggests that people are aware that mask use is socially desirable, but in practice they do not adopt this behavior.Focusing public policy efforts on improving adoption of mask use via education and behavioral interventions may be needed to improve compliance.FundingWeiss Family Foundation, International Growth Centre

scholarly journals Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhoea in four provinces of Kenya

2012 ◽  
Vol 6 (07) ◽  
pp. 572-578 ◽  
Author(s):  
Willie Kipkemboi Sang ◽  
Valerie Oundo ◽  
David Schnabel
Keyword(s):  
Antimicrobial Resistance ◽  
Rural Areas ◽  
Hospital Admissions ◽  
Sub Saharan Africa ◽  
Vibrio Cholera ◽  
Antimicrobial Drug Resistance ◽  
E Coli ◽  
Shigella Isolate ◽  
Stool Samples ◽  
Sub Saharan

Introduction: Diarrhoea is one of the main causes of morbidity and mortality among children in sub-Saharan Africa, and one of the main causes of hospital admissions in rural areas of Kenya. In Kenya, antimicrobial resistance surveillance has been conducted only at the institutional levels, with limited sharing of information and analysis of data. As a result, the actual scale of regional or national antimicrobial drug resistance is not well defined. Methodology: Stool samples were collected between 1 October 2007 and 30 September 2008 from a total of 651 outpatients with diarrhoea who were under five years of age in four provinces of Kenya.  Conventional, biochemical methods, multiplex PCR and antimicrobial susceptibility were conducted to identify the bacterial causes and virulence factors in the isolates, respectively.  Results: Of the 651 patients screened, we identified the causes of 115 cases (17.7%) as follows: Pathogenic E. coli (11.2%) [enteroaggregative (8.9%), enterotoxigenic (1.2%), enteroinvasive (0.6%), shigatoxigenic (0.5%)], Salmonella (3.5%), Shigella (2%) and Vibrio cholera O1 (0.7%). The highest levels of resistance among the E. coli isolates were observed in ampicillin and trimethoprim/sulphamethoxazole each at 95% followed by tetracycline at 81%. Shigella isolate levels of resistance ranged from 80% to 100% for ampicillin, tetracycline and trimethoprim/sulphamethoxazole. Conclusion: The highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin.

scholarly journals A Multi-Phase Assessment of the Effects of COVID-19 on Food Systems and Rural Livelihoods in Zimbabwe

2021 ◽  
Author(s):  
Vine Mutyasira
Keyword(s):  
Food Systems ◽  
Smallholder Farmers ◽  
Rapid Assessment ◽  
Policy Research ◽  
Rural Livelihoods ◽  
Mitigation Strategies ◽  
Sub Saharan Africa ◽  
Response Measures ◽  
Sub Saharan ◽  
Multi Phase

The COVID-19 pandemic has continued to affect agri-food systems around the world and lay bare its fragility, worsening the welfare of millions of smallholder farmers whose livelihoods are anchored on agricultural activities. For the vast majority of sub-Saharan Africa, COVID-19 has coincided with a number of other macroeconomic shocks, which have also exacerbated the impacts of the pandemic on food security, nutrition and general livelihoods, as well curtailed policy responses and mitigation strategies. In Zimbabwe, the COVID-19 pandemic struck at a time the country was experiencing a worsening economic and humanitarian situation. This study focused more on community and household dynamics and response measures to cope with the pandemic. This paper presents a summary of findings emerging from a series of rapid assessment studies undertaken by the Agricultural Policy Research in Africa (APRA) Programme in Mvurwi and Concession areas of Mazowe District in Zimbabwe to examine how COVID-19 is affecting food systems and rural livelihoods in our research communities.

Brain growth after surgical treatment for infant postinfectious hydrocephalus in Sub-Saharan Africa: 2-year results of a randomized trial

2021 ◽  
pp. 1-9
Author(s):  
Steven J. Schiff ◽  
Abhaya V. Kulkarni ◽  
Edith Mbabazi-Kabachelor ◽  
John Mugamba ◽  
Peter Ssenyonga ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Brain Volume ◽  
Mitigation Strategies ◽  
Cognitive Outcome ◽  
Growth Potential ◽  
Sub Saharan Africa ◽  
Third Ventriculostomy ◽  
Normal Brain ◽  
Brain Growth ◽  
Sub Saharan

OBJECTIVE Hydrocephalus in infants, particularly that with a postinfectious etiology, is a major public health burden in Sub-Saharan Africa. The authors of this study aimed to determine whether surgical treatment of infant postinfectious hydrocephalus in Uganda results in sustained, long-term brain growth and improved cognitive outcome. METHODS The authors performed a trial at a single center in Mbale, Uganda, involving infants (age < 180 days old) with postinfectious hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV+CPC; n = 51) or ventriculoperitoneal shunt (VPS; n = 49). After 2 years, they assessed developmental outcome with the Bayley Scales of Infant Development, Third Edition (BSID-III), and brain volume (raw and normalized for age and sex) with CT scans. RESULTS Eighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms in terms of BSID-III cognitive score (p = 0.17) or brain volume (p = 0.36), so they were analyzed together. Raw brain volumes increased between baseline and 2 years (p < 0.001), but this increase occurred almost exclusively in the 1st year (p < 0.001). The fraction of patients with a normal brain volume increased from 15.2% at baseline to 50.0% at 1 year but then declined to 17.8% at 2 years. Substantial normalized brain volume loss was seen in 21.3% patients between baseline and year 2 and in 76.7% between years 1 and 2. The extent of brain growth in the 1st year was not associated with the extent of brain volume changes in the 2nd year. There were significant positive correlations between 2-year brain volume and all BSID-III scores and BSID-III changes from baseline. CONCLUSIONS In Sub-Saharan Africa, even after successful surgical treatment of infant postinfectious hydrocephalus, early posttreatment brain growth stagnates in the 2nd year. While the reasons for this finding are unclear, it further emphasizes the importance of primary infection prevention and mitigation strategies along with optimizing the child’s environment to maximize brain growth potential.

Management of superficial and deep-seated Staphylococcus aureus skin and soft tissue infections in sub-Saharan Africa: a post hoc analysis of the StaphNet cohort

Infection ◽  
2018 ◽  
Vol 46 (3) ◽  
pp. 395-404 ◽  
Author(s):  
Abraham Alabi ◽  
Theckla Kazimoto ◽  
Marthe Lebughe ◽  
Delfino Vubil ◽  
Patrick Phaku ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Sub Saharan Africa ◽  
Soft Tissue Infections ◽  
Post Hoc Analysis ◽  
Sub Saharan ◽  
Post Hoc

scholarly journals Trends in antibiotic resistance patterns of methicillin resistant and methicillin sensitive Staphylococcus aureus in Khwaja Yunus Ali Medical College Hospital

KYAMC Journal ◽  
2018 ◽  
Vol 9 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Abdullah Akhtar Ahmed ◽  
Md Abdus Salam ◽  
Md Shakhaowat Hossain ◽  
Md Babul Aktar ◽  
Nusrat Akhtar Juyee ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Pathogenic Bacteria ◽  
Current Status ◽  
Clinical Samples ◽  
Sensitivity Testing ◽  
Methicillin Resistant ◽  
Resistance Patterns ◽  
Antibiotic Resistance Patterns

Background: Antimicrobial resistance in pathogens is a growing concern for health. It is a great concern around the globe about the threat of increasing antimicrobial resistance. In response to this concerns, medical experts have proposed initiatives to curtail the spread of antimicrobial resistance in pathogenic bacteria. We have taken this surveillance study in KYAMCH to contain the spread of antimicrobial resistance.Objectives: To determine the prevalence of MRSA from different clinical samples and to record its current status to commonly used anti Staphylococcus antibiotics.Methods: The clinical samples were taken to the laboratory and within four hours cultured for isolates and identification pathogens. Finally, antibiotic sensitivity testing of the isolated Staphylococcus aureus was performed. Results: More than 80% of MRSA isolates were resistant to ampicillin (98%) followed by amoxicillin, cefixime and azithromycin with 94%, 93.5% and 85% respectively and maximum sensitivity toward tobramycin with 86% followed by 85% gentamicin and 79% meropenem.Conclusion: The detected trend in antibiotic resistance patterns of methicillin-resistant and methicillin-sensitive Staphylococcus aureus in this study is alarming. This has created a huge clinical burden in the hospital settings as well as in the community.KYAMC Journal Vol. 9, No.-1, April 2018, Page 6-10

scholarly journals Antimicrobial Resistance of Sterile Site Infections in Sub-Saharan Africa: A Systematic Review

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Meklit Workneh ◽  
Morgan J Katz ◽  
Mohammed Lamorde ◽  
Sara E Cosgrove ◽  
Yukari C Manabe
Keyword(s):  
Antimicrobial Resistance ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
World Health ◽  
Fluoroquinolone Resistance ◽  
Mechanisms Of Resistance ◽  
Salmonella Spp ◽  
Sterile Site ◽  
Sub Saharan ◽  
Tract Infections

Abstract Sparse data exist from sub-Saharan Africa (SSA) on the prevalence of antimicrobial resistance (AMR). A prior review of antimicrobial resistance in SSA from 1990 to 2013 showed a high prevalence of AMR to commonly used antibiotics in this setting. We reviewed the literature published since 2013. Four databases (PubMed, EMBASE, Cochrane, and African Journals Online) were searched for articles between February 2013 and March 2016 with a focus on sterile site infections (bacteremia, urinary tract infections [UTIs], and meningitis). We focused on the original World Health Organization–identified priority pathogens and antibiotics, prior to the release of the most recently updated and expanded list in 2017. There were 19 eligible studies: bacteremia (12), UTI (6), and meningitis (1). Eight studies were from Western and Central Africa, 8 from Eastern Africa, and 4 from Southern Africa. Prevalence of Escherichia coli resistance to third-generation cephalosporins ranged from 0% to 75%. No studies reported resistance to carbapenems among Klebsiella spp. Prevalence of fluoroquinolone resistance ranged from 8.3% to 100% among E. coli and 0% to 15% among Salmonella spp. Prevalence of resistance to penicillin among Streptococcus pneumoniae isolates ranged from 25% to 100%. Testing for extended-spectrum beta-lactamase was reported in 7 studies (range, 1.3–60% among tested isolates). Methods for evaluating AMR varied across studies; standardized approaches are needed in the region. Testing for mechanisms of resistance is low even in research settings, but important mechanisms of resistance such as ESBL production are present.

scholarly journals Milk Hygiene in Rural Southwestern Uganda: Prevalence of Mastitis and Antimicrobial Resistance Profiles of Bacterial Contaminants of Milk and Milk Products

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Paul Ssajjakambwe ◽  
Gloria Bahizi ◽  
Christopher Setumba ◽  
Stevens M. B. Kisaka ◽  
Patrick Vudriko ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Production Efficiency ◽  
Sub Saharan Africa ◽  
Milk Products ◽  
E Coli ◽  
Antimicrobial Sensitivity ◽  
Causative Agents ◽  
Sub Saharan ◽  
The Government ◽  
Milk Hygiene

Mastitis and antimicrobial resistance are a big challenge to the dairy industry in sub-Saharan Africa. A study was conducted in Kashongi and Keshunga subcounties of Kiruhura District (in Uganda) where the government and private sector have deliberate programs to improve production efficiency, quality, and safety of milk and its products. The study aimed to determine the prevalence of mastitis, its common causative agents, antimicrobial sensitivity of mastitis causing organisms, and contaminants of processed milk products: yoghurt and ghee. Seventy-one milk, fourteen yoghurt, and three ghee samples were collected from nine farms. Of the 71 cows tested, 54 (76.1%) had mastitis. The mastitis cases from Keshunga were 32 (59.3%) and Kashongi contributed 22 (40.7%) of the cases. The common mastitis causative agents wereStaphylococcusspp. (30.8%),Streptococcusspp. (12.3%),Corynebacteriumspp.(15.4%), andE. coli(7.7%). Some of the isolates were resistant to tetracycline and penicillin. Prevalent contaminants of yoghurt wereStaphylococcusspp. (8.3%),Streptococcusspp. (8.3%),Corynebacteriumspp. (8.3%), andE. coli(8.3%), whereas all ghee containedStreptococcusspp. (100%). Prevalence of mastitis, antimicrobial resistance, and contamination of milk products are high in the study area. Targeted programs to prevent and control mastitis as well as antibiotic resistance are recommended.

scholarly journals Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance (ARGUS) in Zimbabwe – a study protocol

2020 ◽  
Vol 5 ◽  
pp. 140
Author(s):  
Ioana D. Olaru ◽  
Shunmay Yeung ◽  
Rashida A. Ferrand ◽  
Richard Stabler ◽  
Prosper Chonzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Molecular Mechanisms ◽  
Outpatient Setting ◽  
Sub Saharan Africa ◽  
Gram Negative ◽  
Sub Saharan ◽  
Few Data ◽  
Tract Infections

Antimicrobial resistance (AMR) is compromising our ability to successfully treat infections. There are few data on gram-negative AMR prevalence in sub-Saharan Africa especially from the outpatient setting. This study aims to investigate the prevalence of and underlying molecular mechanisms for AMR in gram-negative bacilli causing urinary tract infections (UTIs) in Zimbabwe. Risk factors for AMR and how AMR impacts on clinical outcomes will also be investigated. Adults presenting with UTI symptoms at primary health clinics in Harare will be included. A questionnaire will be administered, and urine samples will be collected for culture. Participants with positive urine cultures will be followed up at 7-14 days post-enrolment. All participants will also be followed by telephone at 28 days to determine clinical outcomes. Bacterial identification and antibiotic susceptibility testing will be performed on positive cultures. The results from this study will be used to inform policy and development of treatment recommendations. Whole genome sequencing results will provide a better understanding of the prevalent resistance genes in Zimbabwe, of the spread of successful clones, and potentially will contribute to developing strategies to tackle AMR.

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