Multidrug-resistant acinetobacter baumannii among patients admitted to intensive care unit at Moi Teaching and Referral Hospital, Uasin Gishu County, Kenya

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dc.contributor.advisorAbednego Musyokien_US
dc.contributor.advisorNelson Menzaen_US
dc.contributor.authorKipsang, Fred
dc.date.accessioned2024-02-01T09:58:53Z
dc.date.available2024-02-01T09:58:53Z
dc.date.issued2023-11
dc.descriptionA thesis submitted in partial fulfillment of the requirements for the award of the degree of Master of Science in infectious diseases in the school of health sciences, Kenyatta University , November, 2023en_US
dc.description.abstractMultidrug-resistant Acinetobacter baumannii infections pose a formidable challenge worldwide, especially in developing countries like Kenya. Despite limited treatment options, comprehensive data on Acinetobacter baumannii susceptibility profile at Moi Teaching and Referral Hospital remains scarce. This study therefore aimed to elucidate on the local epidemiology and clinical implications of these resistant strains among intensive care unit patients at this Kenyan tertiary teaching and referral hospital. This study adopted a cross-sectional study, purposefully enrolled 132 patients admitted to the intensive care unit between July 2019 and July 2020. Clinical specimens, including blood, urine, and tracheal aspirates, were systematically collected following standard bacteriological procedures. Microbiological isolation and identification were performed using culture, while antibiotic susceptibility testing utilized the VITEK®2 Compact system following the 2019 Clinical Laboratory Standards Institute guidelines. Descriptive statistics and multinomial logistic regression were conducted on the data to establish susceptibility trends and compare subject characteristics with carbapenem effectiveness. The statistical significance level for all analyses was set at a 95% confidence interval. The study revealed remarkably high rates of resistance among the sampled subjects, with 100% (n=30) showing multidrug-resistant infections and 83.3% (n=25) exhibiting carbapenem-resistant Acinetobacter baumannii infections. Among the total isolates, 83.3% (n=25) were insensitive to carbapenems, like Imipenem (IPM) and Meropenem (MPM) with 70% resistance each, Doripenem (DPM) with 86.7% resistance, Ertapenem (EPM) with 93.3% resistance, and Biapenem (BPM) with 96.7% resistance. However, alternative antibiotics such as Colistin (COL) showed a relatively lower resistance rate of 16%, and Tigecycline (TIG) demonstrated a resistance rate of 30%. The study also found significant associations between resistance to carbapenems and hospital stays of more than 10 days (aOR) = 2.11, 95% CI: 1.31 – 5.12, p = 0.002), as well as the presence of comorbidities (aOR = 2.26, 95% CI: 0.63 - 8.17, p = 0.212). Being married was significantly associated with a 4-fold higher likelihood of death (aOR = 8.56, 95% CI: 2.37 - 15.82, p = 0.011), while overweight or obese patients had about 4-fold increased risk of mortality compared to those with a normal BMI (aOR = 11.2, 95% CI: 3.57 - 21.11, p = 0.004). Additionally, each additional day of hospital stay was associated with a 41% higher likelihood of death (aOR). This study revealed alarming results of multidrug-resistant and carbapenem-resistant Acinetobacter baumannii isolates in the intensive care unit of Moi Teaching and Referral Hospital. The high resistance against common antibiotics calls for urgent implementation of strategies like enhanced surveillance and antimicrobial stewardship programs. Exploring new regimens like COL and TIG is crucial. Collaborative efforts among healthcare professionals, policymakers and researchers are essential to mitigate the spread of multidrugresistant and carbapenem-resistant Acinetobacter baumannii strains, safeguard patients' health, and preserve antimicrobial effectiveness at Moi Teaching and Referral Hospital.en_US
dc.description.sponsorshipKenyatta Universityen_US
dc.identifier.urihttps://ir-library.ku.ac.ke/handle/123456789/27384
dc.language.isoenen_US
dc.publisherKenyatta Universityen_US
dc.subjectacinetobacter baumanniien_US
dc.subjectintensive care uniten_US
dc.subjectMoi Teaching and Referral Hospitalen_US
dc.subjectUasin Gishu Countyen_US
dc.subjectKenyaen_US
dc.titleMultidrug-resistant acinetobacter baumannii among patients admitted to intensive care unit at Moi Teaching and Referral Hospital, Uasin Gishu County, Kenyaen_US
dc.typeThesisen_US
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