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Multidrug-resistant Gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: a
Jane Wairimu Maina1,2, Frank Gekara Onyambu3, Peter Shikuku Kibet4
1Department of Medical Laboratory Science, The Nairobi West Hospital, Nairobi, Kenya. wairimuj100@gmail.com.
Background:
Patients admitted to intensive care units (ICU) are at risk of Gram-negative bacteria (GNB) infections, especially those caused by multidrug-resistant (MDR) isolates, increasing morbidity, mortality, and healthcare costs. However, epidemiological surveillance data on MDR bacteria to inform infection prevention and control (IPCs) interventions is limited in our study setting. Here we assessed the prevalence and factors associated with GNB infections in ICU- patients admitted in our study setting.
Methods:
This was a hospital-based cross-sectional study among patients admitted to ICU at the Nairobi West Hospital, Kenya, between January and October 2022. Altogether, we recruited 162 patients, excluding those hospitalized for less than 48 h and declining consent, and collected demographics and clinical data by case report form. Blood, wound and throat swab, ascetic tap, stool, urine, tracheal aspirate, and sputum samples were collected cultured. Isolates identity and antimicrobial susceptibility were elucidated using the BD Phoenix system.
Results:
The prevalence of GNB infections was 55.6%, predominated by urinary tract infections (UTIs). We recovered 13 GNB types, with Escherichia coli (33.3%) and Klebsiella pneumoniae (31.1%) as the most common isolates. Factors associated with GNB infections were a history of antibiotic use (aOR = 4.23, p = 0.001), nasogastric tube use (NGT, aOR = 3.04, p = 0.013), respiratory tract (RT, aOR = 5.3, p = 0.005) and cardiovascular (CV, aOR = 5.7, p = 0.024) conditions. 92% of the isolates were MDR,predominantly Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.
Conclusion:
We report a high prevalence of MDR-GNB infections, predominated by UTI, in ICU, whereby patients with a history of antibiotic use, using the NGT, and having RT and CV conditions were at increased risk. To improve the management of ICU-admitted patients, continuous education, training, monitoring, evaluation and feedback on infection prevention and control are warranted in our study setting.
Insights
Intensive care unit patients face a high risk of Gram-negative bacteria infections, particularly multidrug-resistant strains. History of antibiotic use, nasogastric tube use, and respiratory or cardiovascular conditions increase this risk.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health Surveillance
Background:
- Intensive care unit (ICU) patients are susceptible to Gram-negative bacteria (GNB) infections, including multidrug-resistant (MDR) strains, leading to increased morbidity and mortality.
- Limited epidemiological data on MDR bacteria hinders effective infection prevention and control (IPC) strategies in many settings.
Purpose of the Study:
- To determine the prevalence of GNB infections among ICU patients.
- To identify factors associated with GNB infections in this patient population.
Main Methods:
- A hospital-based cross-sectional study was conducted at Nairobi West Hospital, Kenya, from January to October 2022.
- 162 ICU patients were recruited, and various clinical samples were collected for bacterial culture and antimicrobial susceptibility testing using the BD Phoenix system.
Main Results:
- The prevalence of GNB infections was 55.6%, with urinary tract infections (UTIs) being predominant.
- Escherichia coli and Klebsiella pneumoniae were the most common GNB isolates. 92% of isolates were MDR.
- Factors associated with GNB infections included prior antibiotic use, nasogastric tube (NGT) use, and respiratory tract (RT) or cardiovascular (CV) conditions.
Conclusions:
- A high prevalence of MDR-GNB infections, primarily UTIs, was observed in the ICU.
- Patients with a history of antibiotic use, NGT use, or RT/CV conditions are at higher risk.
- Continuous education and robust IPC measures are crucial for managing ICU-admitted patients.
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