Kenyan hospital visits linked to increased exposure to antibiotic-
resistant bacteria

Date:
July 5, 2023
Source:
Washington State University
Summary:
Kenyan patients who spend more than three days in the nation's
hospitals are more likely to harbor a form of bacteria
resistant to one of the most widely used antibiotic classes,
according to a recent study. The research team found that
66% of hospitalized patients were colonized with bacteria
resistant to third-generation cephalosporins, compared to 49%
among community residents. Third-generation cephalosporins are
typically used for serious infections, and resistance to these
antibiotics leaves limited options for treating patients with some
bacterial infections. The study was part of a pair of projects
in Kenya and a third in Guatemala to determine the prevalence
of antibiotic-resistant bacteria. The research also aimed to
identify risk factors for colonization with bacteria resistant to
important and frequently used classes of antibiotics, including
third-generation cephalosporins.


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==========================================================================
FULL STORY ========================================================================== Kenyan patients who spend more than three days in the nation's hospitals
are more likely to harbor a form of bacteria resistant to one of the
most widely used antibiotic classes, according to a recent study led by Washington State University.

The research team found that 66% of hospitalized patients were colonized
with bacteria resistant to third-generation cephalosporins, compared
to 49% among community residents. Third-generation cephalosporins
are typically used for serious infections, and resistance to these
antibiotics leaves limited options for treating patients with some
bacterial infections.

The study, published in the Clinical Infectious Diseases journal,
was part of a pair of projects in Kenya and a third in Guatemala to
determine the prevalence of antibiotic-resistant bacteria. The research
also aimed to identify risk factors for colonization with bacteria
resistant to important and frequently used classes of antibiotics,
including third-generation cephalosporins.

"These bacteria can cause untreatable infections," said Sylvia Omulo,
an assistant professor at WSU's Paul G. Allen School for Global Health
who led the studies in Kenya. "We have to use surveillance to make
sure we understand what causes these bacteria to colonize and, later,
resist certain antibiotics." By examining health records of Kenyan
hospital patients who were colonized with cephalosporin-resistant
bacteria, researchers identified three risk factors associated with colonization. Those risk factors included hospitalization for more than
three days at 132% increased risk, intubation at 73% and a positive HIV
status at 70%.

A person colonized with the bacteria may show no symptoms of an infection; however, the germs are present and growing in their body, and the
individual may be at increased risk of a more dangerous infection from something as simple as a minor medical procedure or sickness from common bacteria like E. coli and Klebsiella. The germs can unknowingly be spread through person-to-person contact or contaminated surfaces.

While resistance is often associated with improper antibiotic
use, that does not appear to be a primary contributing factor for cephalosporin-resistant bacteria in either Kenya or Guatemala.

The Guatemala study, led by WSU Allen School assistant professor Brooke
Ramay, was interrupted by the COVID-19 pandemic and resulted in data
being collected during two time periods. Reported antibiotic use in
the community declined three-fold between the pre- and post-periods,
but the prevalence of cephalosporin-resistant bacteria remained steady,
with colonization found in 67% of hospital patients and 46% of community subjects.

"If antibiotic use locally in the community was a major risk factor,
we'd expect some change over the course of the year," said WSU Regents Professor Douglas Call, corresponding author for the three publications.

In a Kenyan study of communities, the likelihood of colonization with cephalosporin-resistant bacteria rose by 12% with increasing visits
to hospitals and clinics, and individuals who kept poultry were 57%
more likely to have the resistant bacteria. Previous and ongoing work
in both countries also highlights the role of bacterial transmission
due to poor sanitation and hygiene.

What is not clear is if contact with the health care system is a source
of transmission or if people seeking care are more likely to harbor
these bacteria.

"We know if you're interacting with the health care system, you're more
likely to carry these bugs, but we don't know why yet," Call said. "To
sort out the cause from the effect, we need to track the same people over
time and record how their colonization status changes with different
behaviors. Studies to do this are being set up for the coming year."
The research was completed in collaboration with the Centers for Disease Control and Prevention, University del Valle de Guatemala, University of Nairobi and the Kenya Medical Research Institute. The work was funded by
the CDC and is part of the broader Antimicrobial Resistance in Communities
and Hospitals (ARCH) study partnership, which has research projects in
six countries. The most recent findings from WSU and other institutions involved in the ARCH study were published in a special supplement of theClinical Infectious Diseases journal.

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========================================================================== Journal Reference:
1. Teresa Ita, Ulzii-Orshikh Luvsansharav, Rachel M. Smith, Robert
Mugoh,
Charchil Ayodo, Beatrice Oduor, Moureen Jepleting, Walter Oguta,
Caroline Ouma, Jane Juma, Godfrey Bigogo, Samuel Kariuki, Brooke
M. Ramay, Mark Caudell, Clayton Onyango, Linus Ndegwa, Jennifer
R. Verani, Susan Bollinger, Aditya Sharma, Guy H. Palmer, Douglas
R. Call, Sylvia Omulo.

Prevalence of colonization with multidrug-resistant bacteria in
communities and hospitals in Kenya. Scientific Reports, 2022; 12
(1) DOI: 10.1038/s41598-022-26842-3 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/07/230705122449.htm

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