Antimicrobial resistance: capacity and practices among clinical laboratories in Kenya, 2013

Odhiambo, Fredrick; Galgalo, Tura; Arvelo, Wences; Muchemi, Onesmus Maina; Kanyina, Evalyne; Tonui, Juliana Chepkemoi; Amwayi, Samwel; Boru, Waqo

doi:10.11604/pamj.2014.19.332.5159

Cited by 12 publications

(16 citation statements)

References 11 publications

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“…Most hospitals in Kenya lack the capacity to carry out antimicrobial sensitivity tests, due to the lack of resources and technical knowhow, among other challenges. 31 This study will first provide an assessment to determine the challenges hospitals are facing; this will be done through interviews with clinicians and assessment of the capacity of the laboratories to perform the sensitivity tests. These steps will make up the initial phase and will guide the nature of implementations to be used during the implementation phase.…”

Section: Discussionmentioning

confidence: 99%

Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

et al. 2020

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IntroductionAntimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use.Methods and analysisThe study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs.Ethics and disseminationApprovals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.

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Section: Discussionmentioning

confidence: 99%

Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

et al. 2020

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“…Ceftriaxone-resistant invasive NTS infections rapidly emerged during 2009-2014 in this area of western Kenya, where malaria and HIV are endemic (Fig 1). The true prevalence of multidrug-resistant NTS infections may be even larger than the prevalence these research and surveillance programs identified, because many infections are undetected due to lack of microbiologic diagnostic capacity in standard clinical settings and the absence of surveillance systems that track antimicrobial resistance in Kenya [15].…”

Section: Discussionmentioning

confidence: 99%

“…The practice of dispensing antimicrobials for veterinary use was similar to that for human use; antibiotic purchase without a prescription, treatment without veterinarian's consult and subtherapeutic dosing were common. Agrovets also sold a wide range of antimicrobials for animal use to which ceftriaxone-resistant NTS in humans were co-resistant; all or most of the 15 interviewed agrovets sold sulfonamides (15), beta-lactams (14), tetracyclines (13) and macrolides (13) (S3 Table). In addition to antimicrobials, more than half of commonly sold brands of poultry nutritional supplements had tetracycline or oxytetracycline additives (15 of 27 observed supplements) that could contribute to co-selection of ceftriaxone-resistance.…”

Section: Survey Findings Regarding Antimicrobial Availability and Usementioning

confidence: 99%

Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya

et al. 2020

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Multidrug-resistant non-typhoidal Salmonella (NTS) infection has emerged as a prominent cause of invasive infections in Africa. We investigated the prevalence of ceftriaxone-resistant invasive NTS infections, conducted exploratory analysis of risk factors for resistance, and described antimicrobial use in western Kenya. We conducted a secondary analysis of existing laboratory, epidemiology, and clinical data from three independent projects, a malaria vaccine trial, a central nervous system (CNS) study, and the International Emerging Infections Program morbidity surveillance (surveillance program) during 2009-2014. We calculated odds ratios (OR) with 95% confidence intervals (CI) for ceftriaxone-resistant NTS infections compared with ceftriaxone-susceptible infections. We surveyed hospitals, pharmacies, and animal drug retailers about the availability and use of antimicrobials. In total, 286 invasive NTS infections were identified in the three projects; 43 NTS isolates were ceftriaxone-resistant. The absolute prevalence of ceftriaxone resistance varied among these methodologically diverse projects, with 18% (16/90) of isolates resistant to ceftriaxone in the vaccine trial, 89% (16/18) in the CNS study, and 6% (11/178) in the surveillance program. Invasive ceftriaxone-resistant infections increased over time. Most ceftriaxone-resistant isolates were co-resistant to multiple other antimicrobials. Having an HIV-positive mother (OR = 3.7; CI = 1.2-11.4) and taking trimethoprim-sulfamethoxazole for the current illness (OR = 9.6, CI = 1.2-78.9) were significantly associated with acquiring ceftriaxone-resistant invasive NTS infection. Ceftriaxone and other antibiotics were widely prescribed; multiple issues related to prescription practices and misuse were identified. In summary, ceftriaxone-resistant invasive NTS infection is increasing and limiting treatment options for serious infections.

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“…Similar resistance pattern for Ampicillin (100%) was also observed in a study conducted in Kenya. 20 A study in Ethiopia also documented to Amikacin and Ciprofloxacin, ((66.7%), each). Similar resistance pattern for Ampicillin (100%) was also observed in a study conducted in Kenya.…”

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confidence: 96%

“…Similar resistance pattern for Ampicillin (100%) was also observed in a study conducted in Kenya. 20 This similarity of the increase in the pattern of the antimicrobial resistance in the low income Eastern African countries and Eritrea could be attributed to similar climate change, societal belief and culture, access to antimicrobial drugs and achievement to modern medicine.…”

mentioning

confidence: 97%

A Retrospective Documentary Review Study of Bacterial Pathogen Resistance to Antimicrobials: A Six Months (July to December, 2016), at National Health Laboratory, Asmara, Eritrea

Seyoum¹

2017

JBMOA

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Antimicrobial resistance: capacity and practices among clinical laboratories in Kenya, 2013

Cited by 12 publications

References 11 publications

Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya

A Retrospective Documentary Review Study of Bacterial Pathogen Resistance to Antimicrobials: A Six Months (July to December, 2016), at National Health Laboratory, Asmara, Eritrea

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