Multidrug-Resistant Gram-Negative Bacterial Infections, Risk Factors, and Outcome among Patients Admitted to Intensive Care Unit at Nairobi West Hospital, Kenya
| dc.contributor.author | Maina, Jane Wairimu | |
| dc.date.accessioned | 2025-07-02T06:11:51Z | |
| dc.date.available | 2025-07-02T06:11:51Z | |
| dc.date.issued | 2024-04 | |
| dc.description | A Thesis Submitted In Partial Fulfilment of the Requirements for the Award of the Degree of Master of Science in Infectious Diseases (Bacteriology Option) in the School of Health Sciences of Kenyatta University April, 2024 | |
| dc.description.abstract | Emergence and global spread of Gram-negative bacteria (GNB) exhibiting carbapenem-resistance pose a critical public health concern since infections with these bacteria are difficult to treat, and results in increased morbidity and mortality among patients admitted in the intensive care unit (ICU). However, current epidemiological data on the circulating carbapenem-resistant pathogens to inform infection prevention and control programs in accordance with Global Action Plan on antimicrobial resistance (AMR) is limited in most Sub-Saharan African countries. This research intended to determine the spectrum of the multidrug-resistant Gram-negative bacterial infections, risk factors for acquisition and outcome among ICU-admitted patients at Nairobi West Hospital, Kenya. A descriptive cross-sectional study design was adopted and 162 patients purposively recruited based on clinical presentation suggestive of bacterial infection, as judged by the on-duty clinician. Participants with positive GNB culture were followed for 30 days to determine the ICU admission outcome (death or discharge). Patients' socio-demographic data, medical history and clinical data were gathered using case report forms and a well-structured questionnaire. Urine, pus swabs, tracheal aspirates, ascetic tap, sputum, stool, throat swab, and blood samples were collected based on the patient’s clinical presentation and transported to the hospital microbiology laboratory for processing following standard bacteriology methods. Isolation of bacteria was done on selected media, while identification and antibiotic susceptibility was done using BD PHOENIX M50 (BD, USA). Analysis of AST was based on CLSI standards (2022). Overall, 55.6% (90/162) GNB prevalence was observed. Thirteen GNB pathogens were isolated, with Escherichia coli (33.3%) being the most prevalent isolate followed by Klebsiella pneumoniae (31%), Pseudomonas aeruginosa 14.4 % and Acinetobacter baumannii (5.6%). The most predominant infection was urinary tract infections (UTI) (35/90, 39%) commonly caused by E. coli (18/35, 51%). Carbapenem resistance was highest among non-fermenting GNB (60% to 100%), including P. aeruginosa and A. baumannii, whereas among Enterobacteriaceae the dominating pathogen was Klebsiella pneumoniae (46% to 54%) followed by Escherichia coli (10% to 27%). Multidrug-resistance (MDR) was observed among 92 % of the isolates, with E. coli (27/30, 90%) being the most frequent, then K. pneumoniae (25/28, 89.3%), and P. aeruginosa (13/13, 100%). The only non-MDR bacterial pathogen isolated was Salmonella typhi. Those at increased risk of GNB infection were patients: referred from other hospitals (cOR = 2.23, p = 0.025), had prior usage of antibiotics (aOR = 4.23, p =0.001), using feeding tubes (aOR = 3.04, p = 0.013), suffered respiratory tract infections (RTI) (aOR = 5.3, p= 0.005), and with cardiovascular conditions (CVD) (aOR = 5.7, p = 0.024). Patients at increased risk of death during ICU admission were those with respiratory tract infections (aOR = 13.6, p = 0.015) and those referred from other healthcare facilities (cOR = 2.26, p = 0.039). This study findings underscores the importance of culture-based diagnosis and antibiotic susceptibility testing for rationale antibiotic prescription among ICU admitted patients, strict implementation of comprehensive infection control measures, routine screening of MDR carriage among the high-risk individuals, and continuous AMR surveillance as per Global action plan, in the current study setting and beyond | |
| dc.description.sponsorship | Kenyatta University | |
| dc.identifier.uri | https://ir-library.ku.ac.ke/handle/123456789/30295 | |
| dc.language.iso | en | |
| dc.publisher | Kenyatta University | |
| dc.title | Multidrug-Resistant Gram-Negative Bacterial Infections, Risk Factors, and Outcome among Patients Admitted to Intensive Care Unit at Nairobi West Hospital, Kenya | |
| dc.type | Thesis |