Phenotypic and Genotypic Antimicrobial Resistance Profiles of Archived Klebsiella Isolates from Children Under Five Years of Age in Kisii and Homabay County Hospitals

Abstract

The genus Klebsiella belongs to the Enterobacteriaceae family and comprises Gram negative, opportunistic, non-motile pathogen with a mucoid appearance. The gastrointestinal tract serves as a reservoir for transfer of resistance genes and is often the potential source for infections. Multidrug resistance strains of Klebsiella cause severe nosocomial and community-acquired infections that are difficult to eradicate using available antibiotics. The increase in the incidence of extended spectrum β lactamases (ESBL) producing Klebsiella spp, has become a serious problem worldwide, because of their antibiotic resistance. The emergence and spread of β lactamase-producing Klebsiella spp has been associated with a substantial healthcare burden resulting from therapeutic failures. Multidrug resistant Klebsiella strains are resistant to extended-spectrum beta-lactam antibiotics, aminoglycosides, and fluoroquinolones. The aim of this study was to determine phenotypic and genotypic antimicrobial resistance profiles of Klebsiella species from children under five years of age in Kisii and Homabay County hospitals (Western Kenya). Although AMR bacterial infections pose a disproportionate public health challenge in sub-Saharan Africa, epidemiological data are scarce in Kenya. This was a cross-sectional study involving the use of 245 archived Klebsiella isolates. Systematic random sampling was used, and Excel formula randomization was used to generate random numbers to have a representative sample size from the two study sites. Antimicrobial resistance profiling was conducted to determine phenotypic resistance patterns and ESBLs, and producing Klebsiella Pneumoniae and Klebsiella oxytoca using antimicrobial susceptibility tests methods described by Kirby Bauer, ESBL resistance genes were analyzed using conventional PCR. Descriptive analyses were used to characterize phenotypic AMR and carriage of β-lactamase-producing genes. The modified Poisson regression models were used to assess correlates of phenotypic AMR. The prevalence of β-lactamase carriage among Klebsiella spp. isolates at hospital discharge was 62.8% (154/245). The study reported more than 58.2% Klebsiella spp. isolates were resistant to a third-generation cephalosporin; more specifically, 154 (62.6%) were resistant to ceftriaxone, 148 (60.0%) were resistant to cefotaxime and 127 (52.0%) were resistant to ceftazidime. Antibiotic use during hospitalization (adjusted prevalence ratio [aPR] =4.51; 95%CI: 1.79-11.4, p<0.001), longer duration of hospitalization (aPR=1.42; 95%CI: 1.14-1.77, p<0.002), and access to treated water (aPR=1.38; 95%CI: 1.12-1.71, p<0.003), were significant predictors of phenotypically determined β-lactamase. All the 154 phenotypically determined β lactamase-producing Klebsiella spp. isolates had at least one genetic marker of β lactam/third-generation cephalosporin resistance. The most prevalent genes were CTX-M (92.2%; 95%CI: 86.8–95.9) and SHV (92.2%; 95%CI: 86.8–95.9) followed by TEM (57.1%; 95%CI: 48.9–65.1) and OXA (31.2%; 95%CI: 24.0–39.1), respectively. Carriage of β-lactamase producing Klebsiella spp in stool is common among children discharged from hospital in western Kenya and is associated with longer duration of hospitalization, antibiotic use, and surprisingly access to treated water. These findings emphasize the need for continued surveillance of antimicrobial susceptibility patterns to inform the development and implementation of appropriate treatment guidelines. In addition, the study recommends measures beyond antimicrobial stewardship and infection control within hospitals, improved xvi sanitation, and access to safe drinking water to mitigate the spread of β-lactamase producing Klebsiella pathogens.