Browsing by Author "Mutuma, Kirito Caroline"

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    Asymptomatic Intestinal Carriage of Carbapenem-Resistant Enterobacteriaceae among Children (≤5 Years) Admitted at Mama Lucy Kibaki Hospital, Nairobi City County, Kenya
    (Kenyatta University, 2024-05) Mutuma, Kirito Caroline
    Asymptomatic intestinal carriage of carbapenem-resistant Enterobacteriaceae (CRE), particularly the carbapenemase-producing Enterobacteriaceae (CPE), presents a risk of endogenous infections that are difficult to treat with a rise in morbidity, mortality and healthcare costs, with the carriers potentially serving as hidden reservoirs for dissemination of the ‘superbug’ in hospital environment. In Kenya, however, the epidemiological data to inform CRE programs on infections prevention and control are limited. This study assessed CRE intestinal carriage rate and risk factors for colonization among children (≤5 years) admitted at the Mama Lucy Kibaki Hospital (MLKH) in Nairobi City County. A cross-sectional study was conducted, recruiting through systematic random sampling 267 children (≤5years) hospitalized for more than 48 hours in pediatrics’ ward, and whose parents/guardians gave formally consent. Those presenting with diarrhea were excluded. Clinical and demographic attributes were captured on a well-organized questionnaire and clinical forms. Stool specimens were collected in single-use, clean, dry and impervious aseptic containers. Participants not able to pass stool had their samples collected by rectal swabbing and all samples transported to the laboratory at the Kenya Medical Research Institute's Center for Microbiology using Cary-Blair medium as the transport medium, inside a cool-box (4-6oC) and analyzed in less than 2 hours after sampling. Screening for CRE intestinal carriage was performed using MacConkey broth and agar augmented with 0.5 mg/L and 1mg/L of meropenem, respectively. All CRE isolates were screened for CP via modified carbapenemase inactivation method (mCIM). Automated platform, Vitek 2® (France's bioMèrieux, Marcy l'Etoile), was utilized in testing antimicrobial susceptibility and identifying isolates. Data analysis was done by use of SPSS version 24 for Windows, with bivariate logistic regression and multivariate logistic regression analysis performed, with a p ≤ 0.05 regarded as statistically significant. Ethical approval was obtained from Kenyatta University Ethical Review Board. The rate of asymptomatic CRE intestinal carriage was 2.3% (6/267). Six bacterial types were identified, predominated at 33.33% by Escherichia coli and Enterobacter dissolvens. With an exception of Citrobacter farmeri, other isolates showed 100% non-susceptibility to the tested beta-lactam inhibitors. The highest resistance to third-generation cephalosporins and ciprofloxacin was noted among Citrobacter farmeri and Enterobacter cloacae. A100% resistance to colistin was recorded in all the isolates, except in Enterobacter cloacae. All isolates were CPE and MDR, with high multiple antibiotic resistance indexes (0.53 to 0.82) and mostly in Escherichia coli and Citrobacter farmeri. The study found no statistically significant relationship between participants’ sociodemographic and clinical characteristic and carbapenem resistant Enterobacteriaceae and CPE intestinal carriage. This study reports a significant asymptomatic intestinal carriage CRE among children (≤5 years) admitted at MLKH. In highlighting the substantial prevalence of asymptomatic CRE carriage among children under 5 years, this study underscores the critical need to address the associated risks of increased mortality and morbidity in this age group, urging for proactive measures in infection prevention and management to safeguard pediatric health. Routine screening for CRE intestinal carriage for early detection and containment, rationale antibiotics use, and strict adherence to hospital infection management and prevention programs in pediatric wards are warranted to curb CRE spread from asymptomatic carriers.