Antimicrobial Resistance Patterns of bacterial Septicaemia infecting infants in Mbita Subcounty, Western region of Kenya

Abstract

Background: Gram positive bacteria such Escherichia coli, Group B Streptococcus coagulase-negative staphylococci, Staphylococcus aureus, and Gram-negative bacteria such as Klebsiella and Pseudomonas species are listed as some of the bacteria etiologies for pediatric septicemia. These bacteria are rapidly becoming multi drug resistant to penicillin (or aminopenicillin), gentamicin, the pragmatic antibiotic treatment regimens.  Further, the ever-increasing burden of bacteria septicemia infection due to extended-spectrum β-lactamase (ESBL) producing Gram negative bacteria cumulatively presents a major health concern in the management and treatment of bacterial septicemia. In this study we present data on the prevalence and type of antimicrobial resistant patterns among children with bacterial septicemia in Mbita Sub county Hospital, Western region of Kenya.

Methods: Blood samples were obtained from 248 children whose parents/guardian consented. The bacterial isolation and characterization were done using the automated BACTEC 9240 system, conventional culture using morphology, Gram stain and biochemical identification. Further identification and resistant gene detection were determined using Polymerase Chain Reaction (PCR). Descriptive statistics were used to present data.

Results: Eighty-four (33.9%) patients had septicemia where Staphylococcus epidermidis (28.6%), S. aureus (13.1%), Escherichia coli (13.1%) and single Salmonella Paratyphi B, Citrobacter freundii, Gemella morbillorum, Klebsiella pneumoniae, Lactococcus lactis cremoris, Pantoea spp, and Pseudomonas putida were implicated. The majority of gram-negative bacteria were resistant to penicillin (Ampicillins) 100%, 96.1% to tetracyclin, 84.6% to sulphonamides (Trimethoprim/sulfamethoxazole), 73.1% Aminoglycosides (Gentamicin) 73.1% and 19.2% to Quinolone (Ciprofloxacin). For gram positive bacteria majority 96.7% were resistant to sulphonamides (Trimethoprim/sulfamethoxazole) followed by tetracycline 76.7%, penicillin (Oxacilline) 73.3% and least resistant to Quinolone (Ciprofloxacin) 30%. Various antimicrobial resistant genes mecA, SulII, blaTEM, TetA aac (3) were identified.

Conclusion. In this geographically defined region of Kenya, of the 33.9% children with septicemia, gram positive bacteria were the leading cause septicemia. High level resistance due to various resistant genes were seen all type of antibiotics by both Gram positive and negative bacteria. Rapid antibiotic resistant testing is encouraged for appropriate treatment and management of septicemia infection.

Keywords: bacterial Septicemia, Epidemiology, Children under five, South Nyanza, Kenya

DOI: 10.7176/JNSR/10-10-07

Publication date:May 31^st 2020