Environmental contamination across multiple hospital departments with multidrug-resistant bacteria pose an elevated risk of healthcare-associated infections in Kenyan hospitals

Abstract

Background Healthcare-associated infections (HAIs) are often caused by multidrug-resistant (MDR) bacteria contaminating hospital environments which can cause outbreaks as well as sporadic transmission. Methods This study systematically sampled and utilized standard bacteriological culture methods to determine the numbers and types of MDR Enterococcus faecalis/faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli (ESKAPEE) from high-touch environments of five Kenyan hospitals; level 6 and 5 hospitals (A, B, and C), and level 4 hospitals (D and E), in 2018. Six hundred and seventeen high-touch surfaces across six hospital departments; surgical, general, maternity, newborn, outpatient and pediatric were sampled. Results 78/617 (12.6%) of the sampled high-touch surfaces were contaminated with MDR ESKAPEE; A. baumannii, 23/617 (3.7%), K. pneumoniae, 22/617 (3.6%), Enterobacter species, 19/617 (3.1%), methicillin resistant S. aureus (MRSA), 5/617 (0.8%), E. coli, 5/617 (0.8%), P. aeruginosa, 2/617 (0.3%), and E. faecalis and faecium, 2/617 (0.3%). Items found in patient areas, such as beddings, newborn incubators, baby cots, and sinks were the most frequently contaminated. Level 6 and 5 hospitals, B, 21/122 (17.2%), A, 21/122 (17.2%), and C, 18/136 (13.2%), were more frequently contaminated with MDR ESKAPEE than level 4 hospitals; D, 6/101 (5.9%), and E, 8/131 (6.1%). All the sampled hospital departments were contaminated with MDR ESKAPEE, with high levels observed in newborn, surgical and maternity. All the A. baumannii, Enterobacter species, and K. pneumoniae isolates were non-susceptible to piperacillin, ceftriaxone and cefepime. 22/23 (95.6%) of the A. baumannii isolates were non-susceptible to meropenem. In addition, 5 K. pneumoniae isolates were resistant to all the antibiotics tested except for colistin. Conclusion The presence of MDR ESKAPEE across all the hospitals demonstrated gaps in infection prevention practices (IPCs) that should be addressed. Non-susceptibility to last-line antibiotics such as meropenem threatens the ability to treat infections.

Risk factors and genetic characteristics of the carriage of hypervirulent and carbapenem-resistant Acinetobacter baumannii among pregnant women

“…Therefore, there was no direct evidence to indicate whether the origins of the relevant strains in pregnant women were from the hospital, the community environment, or other transmission chains, particularly the newly created CTs isolates. Despite these limitations, the findings in the present study are significant since, in the potential chain of mother-to-newborn transmission, all are very susceptible to infections, with quite limited antibiotics for therapeutic options, particularly in the face of previous fatal neonatal outbreaks and contamination over animate and inanimate environment ( Osei Sekyere et al, 2021 ; Odoyo et al, 2023 ; Woon et al, 2023 ). In China and most developing countries, there needs to be more individual rooms to take contact precautions and enforce patient isolation in the Department of Obstetrics and Gynecology, especially in public hospitals, which is an issue that deserves more attention.…”

“…Pregnant women who undergo physiological immunological changes, present a notable risk group for acquiring or reactivating infections ( Hazenberg et al, 2021 ; Osei Sekyere et al, 2021 ), and who are carriers of AB are not only more predisposed to associated infections at an uncertain time during pregnancy, intrapartum or postpartum period, but also have a risk of maternal carriers transferring the AB to their newborns ( Sood et al, 2019 ; Osei Sekyere et al, 2021 ). AB as a cause of pneumonia, urinary tract infections, and sepsis ( Cavallo et al, 2023 ), has manifested among pregnant women and newborns in numerous countries ( Sood et al, 2019 ; Osei Sekyere et al, 2021 ; Ghanchi et al, 2023 ; Odoyo et al, 2023 ; Woon et al, 2023 ), inciting adverse outcomes including spontaneous abortion, premature labor, and perinatal deaths ( Aivazova et al, 2010 ; He et al, 2013 ; Osei Sekyere et al, 2021 ). Although the World Health Organization (WHO) estimates that puerperal sepsis accounts for 10.68% of maternal deaths, antepartum screening for AB remains scant, with prevailing data often emerging from retrospective studies and postpartum examinations ( Say et al, 2014 ; Bebell et al, 2017 ; Osei Sekyere et al, 2021 ; Sousa et al, 2023 ).…”

Multidrug-resistant Gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: a cross-sectional study

“…In the current study, Enterobacteriaceae isolates showed third-generation cephalosporins (3GCs) resistance, ranging from 50 to 100%. Third-generation cephalosporins-resistant Enterobacteriaceae (3GCRE), including Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae , were recently reported in Kenya among severely ill COVID-19 patients [ 13 ], from ‘high-touch’ sites in multiple hospital departments [ 42 ], and in communities and hospitals settings [ 43 ]. These bugs appear among the top World Health Organization (WHO) global priority pathogens (GPP), along with carbapenem-resistant- Enterobacteriaceae , - Pseudomonas, and -Acinetobacter baumannii , categorized as critical due to drug resistance and the need to discovery and development of new antimicrobial agents [ 44 ], In Enterobacterales , 3GC resistance is predominantly due to the production of extended-spectrum β-lactamases (ESBL) [ 45 ] and 3GCRE-strains pose higher disease burden than carbapenem-resistant ones [ 46 ].…”

Healthcare-Associated Infections and the Hospital Bed

“…2,3 Many of the most relevant pathogens associated with HCAIs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Enterobacter species, and Clostridioides difficile) can be shed from infected or colonized patients and survive on environmental surfaces for extended periods, some for several months. [3][4][5][6][7][8][9][10][11][12][13] Environmental surfaces associated with the transmission of HCAIs include walls, 8,14 fabrics and plastics, 15 furniture, 16 hospital bed handsets and bedrails, 10,17 and soap dispensers. [18][19][20] Many studies underappreciate the significance of the bedframe or mattress deck as a potential source of bacteria leading to HCAIs.…”