Abstract:
Background The emergence and spread of β-lactamase-producing Klebsiella spp. has been associated with a sub
stantial healthcare burden resulting in therapeutic failures. We sought to describe the proportion of phenotypic
resistance to commonly used antibiotics, characterize β-lactamase genes among isolates with antimicrobial resistance
(AMR), and assess the correlates of phenotypic AMR in Klebsiella spp. isolated from stool or rectal swab samples col
lected from children being discharged from hospital.
Methods We conducted a cross-sectional study involving 245 children aged 1–59 months who were being dis
charged from hospitals in western Kenya between June 2016 and November 2019. Whole stool or rectal swab
samples were collected and Klebsiella spp. isolated by standard microbiological culture. β-lactamase genes were
detected by PCR whilst phenotypic antimicrobial susceptibility was determined using the disc diffusion technique fol
lowing standard microbiology protocols. 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 pheno
typic beta-lactam resistance.
Results The prevalence of β-lactamase carriage among Klebsiella spp. isolates at hospital discharge was 62.9%
(154/245). 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
β-lactamase-producing Klebsiella spp. isolates had at least one genetic marker of β-lactam/third-generation cepha
losporin resistance. The most prevalent genes were blaCTX-M 142/154 (92.2%,) and blaSHV 142/154 (92.2%,) followed
by blaTEM 88/154 (57.1%,) and blaOXA 48/154 (31.2%,) respectively.
Conclusion 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 access
