Antimicrobial Susceptibility Patterns of Bacterial Isolates from Patients in Medical Wards at Kenyatta National Hospital in 2015-2016

Abstract

BACKGROUND There is worldwide concern of rapidly increasing antimicrobial resistance (AMR). However, there is paucity of resistance surveillance data and updated antibiograms in Kenya. This study was undertaken in Kenyatta National Hospital (KNH) to help bridge existing AMR knowledge and practice gaps. This would contribute towards best clinical practice with eventual patient and cost benefits. OBJECTIVES 1. To document the antimicrobial susceptibility of bacterial isolates in culture specimens obtained from KNH medical wards in a 1-year retrospective review. 2. To describe the antimicrobial susceptibility of bacterial isolates in culture specimens of KNH medical ward inpatients with clinical profiles prospectively over a 3-month period. METHODS A retrospective review of laboratory records capturing antimicrobial susceptibility data for the year 2015 was done, and augmented with a prospective cross-sectional descriptive study of medical ward inpatients over 3 months in 2016 to obtain relevant clinical correlates. Data was analysed using WHONET and SPSS version 20. RESULTS Retrospective arm Analysis of 823 isolates revealed AMR rates higher than most recent local and international reports. Eighty-eight percent (88%) of isolates tested were multi-drug resistant (MDR) whereas 26% were extensively-drug resistant (XDR). The critical World Health Organization antibiotic-resistant ‘priority pathogens’ claimed majority of the resistance burden, with resistant Gram negative enterobacteriaceae surpassing Gram positive bacteria. Prospective arm The antimicrobial susceptibility patterns were similar to those in the retrospective arm. Fifty-one percent of patients were empirically treated with cephalosporins yet we documented overwhelming cephalosporin resistance rates, such as ceftriaxone resistance of 82%. Uninformed clinician prescription practices and misuse of antibiotics could possibly be a key driver of AMR leading to increased morbidity and mortality. CONCLUSION There is overwhelming resistance to commonly used antibiotics, underscoring the need for antimicrobial stewardship programmes including guided empirical therapy and restricted prescription of reserve antibiotics following culture and sensitivity testing.