Carbapenem-Resistant Gram-Negative Bacterial Infections and Risk Factors for Acquisition in a Kenyan Intensive Care Unit
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Date
2024-05
Authors
Maina, Jane Wairimu
Mutua, Jeniffer Munyiva
Musyoki, Abednego Moki
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
Abstract
Background Carbapenem-resistant Gram-negative bacteria (CR-GNB) are a critical public health threat globally;
however, there are inadequate surveillance data, especially in intensive care units (ICU), to inform infection prevention
and control in many resource-constrained settings. Here, we assessed the prevalence of CR-GNB infections and risk
factors for acquisition in a Kenyan ICU.
Methods A hospital-based cross-sectional study design was adopted, recruiting 162 patients clinically presenting
with bacterial infection after 48 h of ICU admission, from January to October 2022 at the Nairobi West Hospital,
Kenya. Demographics and clinical data were collected by case report form. The type of sample collected, including
blood, tracheal aspirate, ascitic tap, urine, stool, and sputum depended on the patient’s clinical presentation and
were transported to the hospital Microbiology laboratory in a cool box for processing within 2 h. The samples were
analyzed by cultured and BD Phoenix system used for isolates’ identity and antimicrobial susceptibility.
Results CR-GNB infections prevalence was 25.9% (42/162), with Klebsiella pneumoniae (35.7%, 15/42) and
Pseudomonas aeruginosa (26.2%, 11/42) predominating. All isolates were multidrug-resistant (MDR). P. aeruginosa and
A. baumannii were 100% colistin-resistant, while K. pneumoniae (33.3%) was tigecycline-resistant. History of antibiotics
(aOR=3.40, p=0.005) and nasogastric tube (NGT) use (aOR=5.84, p=<0.001) were the risk factors for infection.
Conclusion Our study highlights high MDR- and CR-GNB infections in ICU, with prior antibiotic exposure and NGT
use as risk factors, and diminishing clinical value of colistin and tigecycline. In this study setting and beyond, strict
implementation of antimicrobial stewardship programs and adherence to infection prevention and control through
monitoring, evaluation and feedback are warranted to curb CR-GNB infections, especially among the risk groups.
Description
Article
Keywords
Carbapenem-resistant Gram-negative bacteria, Multiple antibiotic resistance index, Multidrug resistance, Risk factors
Citation
Maina, J. W., Mutua, J. M., & Musyoki, A. M. (2024). Carbapenem-resistant gram-negative bacterial infections and risk factors for acquisition in a Kenyan intensive care unit. BMC Infectious Diseases, 24(1), 1-9.