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Diagnostic Underuse and Antimicrobial Resistance Patterns Among Hospitalized Children in a National Referral Hospital
Veronicah M Chuchu1,2,3,4,5, Teresa Ita2, Irene Inwani6,7
1Department of Medical Microbiology, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya.
Insights
Limited diagnostic use and high rates of multidrug-resistant organisms (MDROs) and extensively drug-resistant (XDR) infections were found in Kenyan children. Enhancing pediatric diagnostics and antimicrobial stewardship is crucial.
Area of Science:
- Infectious Diseases
- Global Health
- Pediatric Medicine
- Antimicrobial Resistance
Background:
- Antimicrobial resistance (AMR) poses a significant global health challenge, disproportionately affecting children in low- and middle-income countries.
- Limited data exist on AMR patterns and diagnostic practices within pediatric populations in these regions.
- This study addresses the need for data on diagnostic utilization and AMR in hospitalized children in Kenya.
Purpose of the Study:
- To evaluate diagnostic utilization among pediatric inpatients with bacterial infections.
- To determine the prevalence of antimicrobial resistance, including multidrug-resistant organisms (MDROs) and extensively drug-resistant (XDR) infections, in this population.
- To identify risk factors associated with MDRO infections in hospitalized children.
Main Methods:
- A retrospective cohort study was conducted on pediatric inpatients (0-12 years) admitted with bacterial infections from 2017 to 2021.
- Patient records were reviewed for diagnostic testing (cultures, antimicrobial susceptibility testing) and infection data.
- Descriptive statistics and logistic regression were used to analyze infection counts, diagnostic utilization, resistance outcomes, and associated risk factors.
Main Results:
- Of 1608 patients, 63% were infants under one year. Diagnostic cultures were performed in 40% and susceptibility testing in only 17% of cultured samples.
- The most common infection was gastroenteritis (46%). Among isolated organisms, Klebsiella pneumoniae showed 100% resistance to third-generation cephalosporins.
- High rates of MDROs (72% of tested samples, 76% of tested patients) and XDR infections (28% of MDRO samples, 30% of MDRO patients) were observed. Children under 5 and those with multiple admissions had higher odds of MDRO infections.
Conclusions:
- The study highlights significantly limited diagnostic utilization and a high burden of MDROs and XDR infections among hospitalized children in Kenya.
- Younger age and multiple hospital admissions are associated with increased risk of MDRO infections.
- Urgent strengthening of diagnostic capacity and pediatric antimicrobial stewardship programs is essential in resource-limited settings.
Abstract:
Background: Antimicrobial resistance (AMR) is a growing global health threat, with children in low- and middle-income countries bearing a disproportionate burden. Data on resistance patterns and diagnostic practices in pediatric populations remain limited. This study evaluated diagnostic utilization and AMR among children hospitalized with bacterial infections at a national referral hospital in Kenya. Methods: We conducted a retrospective cohort study of pediatric inpatients (0-12 years) admitted with bacterial infections between 2017 and 2021. Patient records were identified using ICD-10 codes and reviewed for diagnostic testing and antimicrobial susceptibility. Descriptive statistics were conducted to show infection counts, diagnostic testing, and resistance outcomes. Results: Among 1608 patients, 1009/1608 (63%) were infants under one year. Culture was conducted in 640/1608 (40%) and antimicrobial sensitivity testing in 111/640 (17%) patients. Gastroenteritis (46%) was the most common infection and blood the most frequently collected specimen (31%). Of 1039 cultured specimens, 896/1039 (86%) showed no growth. The most commonly isolated organisms were Klebsiella pneumoniae 19/128 (15%), Staphylococcus epidermidis (13%, 17/128), and Enterococcus faecium (13%, 16/128). Notably, K. pneumoniae showed 100% resistance to third-generation cephalosporins, suggestive of ESBL production. Among the tested samples, 92/128 (72%) had MDROs, and 26/92 (28%) were extensively drug-resistant (XDR). Among the patients tested, 84/111 (76%) had MDROs, of which 25/84 (30%) were XDR. Children under 5 years had higher odds (OR = 5.84, 95% CI: 1.17-38.21) of having MDRO infections, as well as those with multiple admissions (OR = 3.77, 95% CI: 1.06-20.34). Further, increasing age was inversely associated with MDRO presence. The odds of MDRO infection decreased by 24% for every year increase in age (aOR = 0.76; 95% CI: 0.60-0.93; p = 0.006). Conclusions: The findings highlight the limited diagnostic use and a high burden of MDROs and XDR infections in hospitalized children. Strengthening diagnostic capacity and pediatric antimicrobial stewardship is urgently needed in such settings.
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