Klebsiella pneumoniae resistance pattern and patient outcomes at kenyatta national hospital intensive care unit from september 2013 to august 2017

Abstract

Background: Antimicrobial resistance is a growing concern globally. Antimicrobial resistance by gram-negative bacteria is of special concern in intensive care settings. At Kenyatta National Hospital, Klebsiella pneumoniae is a significant cause of nosocomial infections. Despite this, there is a lack of up to date data on K. pneumoniae antimicrobial susceptibility pattern at Kenyatta National Hospital Intensive Care Unit. Objective: To describe antimicrobial susceptibility patterns and outcomes in patients with drug-resistant K. pneumoniae at Kenyatta National Hospital ICU, from September 2013- August 2017. Methodology: This was a retrospective study. Data on antimicrobial resistant K. pneumoniae was extracted from the VITEK-2 system and patients’ medical records. Data was analyzed using WHONET and IBM-SPSS statistical software. F-test was used to evaluate the equality of variances and relative risk (RR) to establish mortality risk. Results and Outcomes: There was a progressive decline in susceptibility to antibiotics in K. pneumoniae from the 214 study participants. Susceptibility to gentamicin by all specimen isolates declined from 24.5% to 16.7%, while susceptibility to meropenem declined from 60.6% to 36.7% (P=0.043). Isolates from urine had marginally higher resistance when compared to all the isolates. Susceptibility to ciprofloxacin in urine isolates of K. pneumoniae was 25.6% versus 15.6% (P=0.009) for all isolates. The relative risk of death among those who received inadequate antibiotic treatment was 1.5 (CI: 0.85, 2.7) times the risk of death among those who received adequate antibiotic treatment. Conclusion: There was an increase in the resistance in K. pneumoniae at KNH ICU over the study period. Despite this, the use of an inadequate antibiotic treatment, which is the use of an antibiotic to which an isolate is resistant, in the management drug-resistant K. pneumoniae is commonplace.