Antimicrobial Resistance Patterns in Extended-spectrum beta- lactamase Producing Klebsiella pneumoniae isolates from Children in Mukuru Slums, Nairobi, Kenya

Abstract

The multidrug-resistant rate of K. pneumoniae has risen rapidly and is a major challenge. Since their description, the extended-spectrum β-lactamase (ESBL) producing organisms have become recognized as a worldwide problem. Treatment of these multiple drug-resistant organisms is a therapeutic challenge yet infections caused by ESBL producing pathogens, particularly K. pneumoniae, are increasingly becoming common. The general objective of the study was to determine antimicrobial resistance pattern in ESBL producing K. pneumoniae isolates from children under five years in Mukuru slums. Antimicrobial resistance is a crucial public health problem yet in kenya there is limited padiatric data not only on the resistance pattern of ESBL producing organisms such as K. pneumoniae, but also the the prevalence and the association between age,gender of such infections. A cross-sectional study was conducted among 330 children.Ethical clearance was granted by the Kenyatta University Ethical Review Committee and a written informed consent obtained from parents/guardians of all participants. Diarhea stool samples were collected, cultures done and antimicrobial susceptibility testing determined using the disc diffusion test. The ESBL positive phenotypes were analyzed by PCR to detect the presence of four beta lactamase blaSHV, blaTEM, bla CTX-M and blaOXA. The prevalence of K. pneumoniae was 29%, with age group 13-24 months being significant to acquisition of K. pneumoniae.There was no statistical significant differences between K. pneumoniae and gender. High resistance was recorded in most of the antibiotics Ampicillin 97.9%. Cefotaxime, Aztreonam and Cefpodoxime recorded an equal resistance of 68.8%,while Ceftazidime and Ceftriaxone recorded 67.7%. Ciprofloxacin 66.7%,Sulfamethoxozole 65.6%,Gentamycin 60.4%,Amoxicillin-Clavulanic 43.8% ,Tetracycline 55.2% ,Cefoxitin 41.7% ,Nalidixic acid 32.3 % . None of the isolates exhibited resistance to Imipenem. There was no significant statistical significance difference observed between age and gender in terms of resistance.The proportion of ESBL producers was 44%. There was no statistical significance difference between age and ESBL carriage. In terms of gender, males had an elevated odds with p<0.05 compared to females. The blaCTXM was the most prevalent at 100%, blaTEM at 97% and blaSHV at 90%. None of the isolates analysed expressed blaOXA. In conclusion, the observed high levels of resistance among children infected with K. pneumoniae. ESBL genes being associated with varying degree of resistance.This poses a major therapeutic challenge among children. The study recommends patient education on proper use of antimicrobials as well as surveillance on resistance pattern of ESBL producing organisms. Screening of ESBL strains in microbiology laboratory prio to prescription will assist in revising existing empirical treatment regime.