Antimicrobial Susceptibility and Genetic Basis of Resistance of Klebsiella Spp Isolated from Diarrheic and Non-Diarrheic Patients at Health Facilities in Mukuru Informal Settlement, Nairobi, Kenya

Abstract

Antimicrobial resistance (AMR) is a global threat to public health and particularly to children. This study aimed to determine the prevalence of multidrug resistance of fecal Klebsiella spp on selected beta-lactam (3rd generation cephalosporins and carbapenems) and fluoroquinolone classes of drugs in four health facilities serving the Mukuru slum community of Nairobi city in Kenya. Additionally, determine the genetic basis for the multidrug resistance observed. A cross-sectional laboratory-based study was undertaken where a total of 1171 children below 16 years were selected, from whom stool samples were collected, tested, and analyzed using various methods namely; culture, biochemical testing, antibiotic sensitivity testing and polymerase chain reaction. A total of 395 (33.73%) Klebsiella spp were isolated, consisting of 365 (92.4%) Klebsiella pneumoniae and 30 (7.6%) Klebsiella oxytoca were isolated. The proportion of multi-drug resistance (MDR) K. pneumoniae and MDR K. oxytoca was 64.1 % (234/365) and 96.67 % (29/30) respectively. K. pneumoniae showed the highest resistance against third-generation cephalosporins namely; cefotaxime (30.7%), ceftriaxone (29.9%), and ceftazidime (27.4%), whereas the least resistance was observed against carbapenems including imipenem (1.6%) and meropenem (1.6%). A significant association was observed in diarrheic children (OR =1.88; p=0.01) and those below 50 months (OR = 0.43; p=0.002) and carrying K. pneumoniae resistance to one or more third-generation cephalosporins. Genes associated with resistance included bla TEM 100%, bla CTX-M 95.2%, bla SHV 57.1%, bla OXA-1 66.7%, qnrS 54.1%, qnrB 47.6% and bla NDM 7.1%. In conclusion, there is a high prevalence of MDR K. pneumoniae carrying genes associated with antibiotic resistance, and this poses a threat to the Mukuru community, especially the vulnerable.