Browsing by Author "Nyongesa, Kelvin Wangira"

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    Extended-spectrum β-lactamase and carbapenemase-producing bacteria urinary tract infections in adult HIV-positive outpatients at Embu County Referral Hospital, Kenya
    (Springer Nature, 2025-11) Kiongo, Norah Kagwiria; Maingi, John M.; Nyongesa, Kelvin Wangira; Musyoki,Abednego Moki
    Abstract Background Antimicrobial resistance (AMR) poses a significant threat to public health, with the Global Action Plan advocating, among others, for strengthening AMR knowledge and evidence base through surveillance and research and optimizing the use of antimicrobial medicines in human and animal health. However, due to inadequate healthcare infrastructure in many resource-constrained countries, epidemiological data to inform infection prevention interventions and guide antimicrobial policy guidelines in people living with HIV is limited. Here, we assessed the prevalence, antimicrobial resistance, and associated factors of bacterial urinary tract infections among adult HIV-positive outpatients in our study setting. Methods This was a hospital-based cross-sectional study among adult HIV-positive outpatients at Embu County Referral Hospital, Kenya, from January to February 2023. We consecutively recruited 142 patients presenting with or without UTI symptoms and excluded those aged below 18. Demographic and clinical data were collected using a pretested questionnaire, and midstream-clean-catch urine samples were processed by standard microbiological methods. Results The overall prevalence of UTI was 9.9% (95% confidence interval (CI): 4.96–14.76% (14/142), with 6.3% symptomatic [95% CI: 2.33–10.35% (9/142)], 3.5% asymptomatic [95% CI: 0.49–6.55% (5/142)], and 4.2% recurrent [95% CI: 0.92–7.53% (6/142)] UTIs. Klebsiella pneumoniae was predominant overall (57.1%, 8/14), and in asymptomatic (80%, 4/5) and recurrent (66.7%, 4/6) UTIs. All the isolates were multidrug-resistant, with 36% (5/14) as meropenem-resistant and 14.3% (2/14) of carbapenem-resistant K. pneumoniae were colistin-resistant. E. coli isolates were susceptible to meropenem, amikacin, ciprofloxacin, and levofloxacin. The lowest resistance in K. pneumoniae was in amikacin (12.5%) and colistin (25%). Notably, 79% (11/14) and 35.7% (4/14) of the isolates were extended-spectrum β-lactamase (ESBL) and carbapenemase producers, respectively. Those with recurrent UTI were at higher odds of having UTI [adjusted odds ratio: 7.37, 95% CI: 1.93—28.07 (p=0.003)]. Conclusions Our findings highlight a high prevalence of bacterial urinary tract infections, including recurrent ones caused by ESBL-, carbapenemase-producing, and colistin-resistant bacteria among HIV-infected adults.
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    Gastrointestinal Carriage of Carbapenemase-Producing Enterobacterales among Inpatient and Outpatient Children in Kenya
    (Springer Nature, 2024-12) Githii, Susan; Maingi, John M.; Nyaga, Teresia; Ndungu, Cecilia; Nyongesa, Kelvin Wangira; Musyoki, Abednego Moki
    Gastrointestinal carriage of antimicrobial-resistant bacteria, especially carbapenemase-producing Enterobacterales (CPE), presents a critical public health threat globally. However, in many resource-constrained countries, epidemiological data on CPE is limited. Here, we assessed gastrointestinal carriage and associated factors of CPE among inpatient and outpatient children (≤ 5 years). This hospital-based cross-sectional study was conducted at Thika Level 5 Hospital in Kenya from February to June 2023. In total, 540 participants were recruited from outpatient (270) and inpatient (270) children, excluding those admitted for < 48 h and outpatients with ≤ 3 months hospitalization history. Demographic data were collected using a questionnaire, and stool or swab samples were cultured following standard microbiology methods. Automated platforms were used for isolates identification and antimicrobial susceptibility testing. Gastrointestinal carriage rate of CPE was 9.6%, 95% confidence interval (CI): 6.39–13.79% (26/270) among the inpatients and 5.9%, 95% CI: 3.42–9.45% (16/270) among the outpatients. The carbapenemase-producing Enterobacterales were predominated by multidrug-resistant Escherichia coli from inpatients (22/22, 100%) and outpatients (8/10, 80%). The colonization rate was higher among inpatients who were presenting with chills (aOR = 10.57, p = 0.008). We report a high gastrointestinal carriage of CPE among children (≤ 5 years). Strict adherence to colonization screening, and antimicrobial stewardship policies are critical to control CPE dissemination in the current study area and beyond.