Antimicrobial susceptibility profiles and prevalence of ESBLS among E.coli isolates recovered from people working in hospitality industry within Nairobi, Kenya

Objective: To determine the antimicrobial susceptibility profiles with key focus on ESBL-producing E.coli strains isolated from participants working in the hospitality industry in Nairobi, KenyaStudy design: A cross sectional descriptive study.Setting: Centre for Microbiology Research at Kenya Medical Research Institute, Nairobi.Subjects: A total of 323 food-handlers working within Nairobi County were recruited.Results: High resistances were recorded for Sulfamethoxazole/Trimethoprim (70%), Ampicillin (44.6%), Streptomycin (42%) and Tetracyclines (41%) while Imipenem and Cefepime were effective against 99% of the isolates. A third of all isolates were multidrug resistant. The prevalence of ESBLs was 3.4% while CMT, IRT and pAmpC-phenotypes accounted for <2%. About 1% of the ESBL-producers were also resistant to ciprofloxacin and gentamicin. The blaTEM accounted for 37%, blaSHV (25%), blaCTX-M (12%) and blaOXA-1 gene (7%). Majority of MDR strains were obtained from young individuals working in middle class hotels. Genetic relatedness of the MDR isolates was apparently influenced by the resistance profiles, hotel type and clinical characteristics.Conclusion: This study revealed that apparently healthy people working in the hospitality industry carry MDR E. coli that could potentially be transmitted to the general public. Infections by such strains could result in limited treatment options increasing the chances of patient mortality. Therefore, there is need to contain the spread of such strains through promotion of rational use of antimicrobials, properhygiene and certification of food handlers based on proper laboratory investigations

Antimicrobial activity of Warbugia ugandensis against gramnegative multi‐drug resistant bacteria

The rise in antibiotic resistance has resulted in decreasing numbers of effective antimicrobial agents available to treat infections caused by multi‐drug resistant (MDR) bacteria. This has necessitated a search for new antimicrobial agents. Herbal remedies may offer alternative treatment options especially because they elicit little or no transferable resistance if used in optimal concentrations. This study evaluated the antimicrobial properties of W. ugandensis against eight multi drug resistant (MDR) Gram‐negative bacterial isolates. The herbal extracts were obtained using methanol as an organic solvent and water as an inorganic solvent. Determination of the Minimum Inhibitory Concentrations (MICs) and the sub‐lethal concentrations of the effective extracts was done using broth inoculation method followed by colony count. The test isolates were habituated in sub‐lethal extract concentrations (SLC) for 72 h to investigate effect on their sensitivity to conventional antibiotics. Methanol extracts from the root and stem‐bark of W. ugandensis were active against the test strains and their inhibitory effect was significantly different (p<0.05) from that of other extracts. We determined that the extracts had an inhibitory rather than a lytic (cidal) mode of action. The extracts from this plant had an effective MIC of 42 μg/ml and exhibited an inhibitory mode of action and did not elicit resistance to conventional antibiotics. Methanol extracts from the root and bark of this plant may provide potential sources for further development of alternative antimicrobial agents for the treatment of MDR infections.Key words: multi‐drug resistant (MDR) bacteria, minimum inhibitory concentrations (MICs), sub‐lethal concentration (SLC

Carriage, antimicrobial susceptibility profiles and genetic diversity of Staphylococcus aureus and MRSA isolates recovered from students in a Kenyan university

Objective: To determine the carriage, antimicrobial susceptibility profiles and genetic diversity of Staphylococcus aureus and MRSA isolates recovered from students in a Kenyan University.Study design: A cross sectional descriptive study.Setting: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.Subjects: A total of 237 healthy students residing within the University residence halls were recruited.Results: A total of 231 S. aureus isolates were recovered. All isolates were susceptible to nitrofurantoin and linezolid and resistant in high numbers (194, 81.9%) to ampicillin. Resistances to amoxicillin-clavulanic acid, erythromycin, chloramphenicol, gentamicin, ciprofloxacin, norfloxacin and trimethoprimsulfamethoxazole were below 20%. The overall prevalence of MRSA among the study population was 11.3% (26/231). Based on carriage of the mec cassettes, the SCCmecV (61.5%) was more prevalent among the MRSA followed by SCCmecII (53.9%). Carriage of the lukFS-PV gene was 26.9% and 35.7% among the MRSA and MSSA strains respectively, and there was no statistical association between the two strains with regard to carriage of the gene (p=0.487). Analysis of genetic relations showed evidence of strain sharing among students.Conclusion: The study revealed the presence of MRSA strains, which are also multi-drug resistant, circulating among a healthy student population in a university setting within Central Kenya. Therefore, these results indicate the existence of potential risk factors, thus necessitating a comprehensive surveillance on MRSA and studies on control measures to help in curbing the spread of MRSA strains

Epidemiology of antimicrobial-resistant Escherichia coli carriage in sympatric humans and livestock in a rapidly urbanizing city

There are substantial limitations in understanding of the distribution of antimicrobial resistance (AMR) in humans and livestock in developing countries. This papers present the results of an epidemiological study examining patterns of AMR in Escherichia coli isolates circulating in sympatric human (n = 321) and livestock (n = 633) samples from 99 households across Nairobi, Kenya. E. coli isolates were tested for susceptibility to 13 antimicrobial drugs representing nine antibiotic classes. High rates of AMR were detected, with 47.6% and 21.1% of isolates displaying resistance to three or more and five or more antibiotic classes, respectively. Human isolates showed higher levels of resistance to sulfonamides, trimethoprim, aminoglycosides and penicillins compared with livestock (P0.05). These findings revealed a high prevalence of AMR E. coli circulating in healthy humans and livestock in Nairobi, with no evidence to suggest that keeping livestock, when treated as a single risk factor, contributed significantly to the burden of AMR in humans, although the presence of livestock waste was significant. These results provide an understanding of the broader epidemiology of AMR in complex and interconnected urban environments

Predominance of multidrug-resistant bacteria causing urinary tract infections among symptomatic patients in East Africa : a call for action

Background In low- and middle-income countries, antibiotics are often prescribed for patients with symptoms of urinary tract infections (UTIs) without microbiological confirmation. Inappropriate antibiotic use can contribute to antimicrobial resistance (AMR) and the selection of MDR bacteria. Data on antibiotic susceptibility of cultured bacteria are important in drafting empirical treatment guidelines and monitoring resistance trends, which can prevent the spread of AMR. In East Africa, antibiotic susceptibility data are sparse. To fill the gap, this study reports common microorganisms and their susceptibility patterns isolated from patients with UTI-like symptoms in Kenya, Tanzania and Uganda. Within each country, patients were recruited from three sites that were sociodemographically distinct and representative of different populations. Methods UTI was defined by the presence of >104 cfu/mL of one or two uropathogens in mid-stream urine samples. Identification of microorganisms was done using biochemical methods. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion assay. MDR bacteria were defined as isolates resistant to at least one agent in three or more classes of antimicrobial agents. Results Microbiologically confirmed UTI was observed in 2653 (35.0%) of the 7583 patients studied. The predominant bacteria were Escherichia coli (37.0%), Staphylococcus spp. (26.3%), Klebsiella spp. (5.8%) and Enterococcus spp. (5.5%). E. coli contributed 982 of the isolates, with an MDR proportion of 52.2%. Staphylococcus spp. contributed 697 of the isolates, with an MDR rate of 60.3%. The overall proportion of MDR bacteria (n = 1153) was 50.9%. Conclusions MDR bacteria are common causes of UTI in patients attending healthcare centres in East African countries, which emphasizes the need for investment in laboratory culture capacity and diagnostic algorithms to improve accuracy of diagnosis that will lead to appropriate antibiotic use to prevent and control AMR.Peer reviewe

Developing textile entrepreneurial inclination model by integrating experts mining and ISM-MICMAC

The Indian textile industry is lacking in an entrepreneurial inclination of a skilled young generation; because of this, the industry is facing a challenge to achieve sustainable development and growth. To overcome this problem, the goal of this work is to build an entrepreneurial inclination model in the context of the textile industry. For achieving this goal, a combined approach of an extensive literature review and experts mining has been used to establish the entrepreneurial inclination factors in phased of the study. In the second phase, an Interpretive Structural Modelling (ISM) with Matrice d'Impacts Croisés Multiplication Appliqués à un Classement (MICMAC) has been applied to build a structural model and to find the driving force factors and dependence power. The results show that effective entrepreneurship courses, institutional policy, training and internship, institutional corporation and the involvement of institutional heads play a very significant role in encouraging youth towards entrepreneurship. The outcomes of the study can help both the government and academic institutes to draw up effective policy and develop an entrepreneurial culture which can help to create more entrepreneurs in the textile field.N

The influence of the accessory genome on bacterial pathogen evolution

Bacterial pathogens exhibit significant variation in their genomic content of virulence factors. This reflects the abundance of strategies pathogens evolved to infect host organisms by suppressing host immunity. Molecular arms-races have been a strong driving force for the evolution of pathogenicity, with pathogens often encoding overlapping or redundant functions, such as type III protein secretion effectors and hosts encoding ever more sophisticated immune systems. The pathogens’ frequent exposure to other microbes, either in their host or in the environment, provides opportunities for the acquisition or interchange of mobile genetic elements. These DNA elements accessorise the core genome and can play major roles in shaping genome structure and altering the complement of virulence factors. Here, we review the different mobile genetic elements focusing on the more recent discoveries and highlighting their role in shaping bacterial pathogen evolution

Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance : a study of urinary tract infection patients in Kenya, Tanzania and Uganda

Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours (‘patient pathways’) using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR.Peer reviewe

Genomic epidemiology of Escherichia coli:Antimicrobial resistance through a One Health lens in sympatric humans, livestock and peri-domestic wildlife in Nairobi, Kenya

BackgroundLivestock systems have been proposed as a reservoir for antimicrobial-resistant (AMR) bacteria and AMR genetic determinants that may infect or colonise humans, yet quantitative evidence regarding their epidemiological role remains lacking. Here, we used a combination of genomics, epidemiology and ecology to investigate patterns of AMR gene carriage in Escherichia coli, regarded as a sentinel organism.MethodsWe conducted a structured epidemiological survey of 99 households across Nairobi, Kenya, and whole genome sequenced E. coli isolates from 311 human, 606 livestock and 399 wildlife faecal samples. We used statistical models to investigate the prevalence of AMR carriage and characterise AMR gene diversity and structure of AMR genes in different host populations across the city. We also investigated household-level risk factors for the exchange of AMR genes between sympatric humans and livestock.ResultsWe detected 56 unique acquired genes along with 13 point mutations present in variable proportions in human and animal isolates, known to confer resistance to nine antibiotic classes. We find that AMR gene community composition is not associated with host species, but AMR genes were frequently co-located, potentially enabling the acquisition and dispersal of multi-drug resistance in a single step. We find that whilst keeping livestock had no influence on human AMR gene carriage, the potential for AMR transmission across human-livestock interfaces is greatest when manure is poorly disposed of and in larger households.ConclusionsFindings of widespread carriage of AMR bacteria in human and animal populations, including in long-distance wildlife species, in community settings highlight the value of evidence-based surveillance to address antimicrobial resistance on a global scale. Our genomic analysis provided an in-depth understanding of AMR determinants at the interfaces of One Health sectors that will inform AMR prevention and control