Broad spectrum antibiotic use among in-patients at a hospital in Nairobi, Kenya

Background: Antimicrobial resistance is an increasingly serious threat to global public health. While the use of antibiotics is an important contributing factor, there are gaps regarding this in our region. This study aimed to describe the use of nine broad spectrum antibiotics among in-patients of The Nairobi Hospital (TNH) so as to identify opportunities for quality improvement.Methods: This was a retrospective review of the use of meropenem, ertapenem, imipenem, cefepime, piperacillin, gentamicin, amikacin, vancomycin and teicoplanin among in-patients of TNH from 1st January 2018 to 31st March 2018. Demographic and clinical data of all in-patients who were prescribed these antibiotics during the study period were retrieved from patient files.Results: There were 301 study participants with a median age (range) of 30years (1day-74years), of whom 161 (53.5%) were male. More than half of the participants were admitted for less than one week and had at least one co-morbidity. Meropenem was the most commonly prescribed study antibiotic 123 (40.9%) followed by amikacin 89 (29.6%). Respiratory tract infections 125 (41.5%) were the predominant indications. Meropenem had the longest mean duration of administration, 6.5days while the aminoglycosides were administered for a relatively shorter duration of about 4.8days. Cultures were done on 187 (62.1%) patients though it is only samples of 45 patients that grew an organism, E. coli and Klebsiella sp being the most frequently isolated organisms.Conclusions: There’s a need to strongly intensify implementation of restriction strategies for Meropenem use and introduction of education programs on antimicrobial stewardship targeting all prescribers

Patient Associated Factors that Affect Adherence to Warfarin Therapy in a Tertiary Referral Hospital in Kenya

Warfarin is the most widely used oral anticoagulant but non-adherence to its therapy contributes significantly to sub-optimal anticoagulation control. A crosssectional study was carried out among 147 adult outpatients at Kenyatta National Hospital to determine the level of adherence and explore the associated factors. Adherence was associated with age, gender heart valve surgery, alcohol consumption, and cost of treatment. On multivariate analysis, the independent variables associated with adequate adherence were age (OR = 0.429, 95% CI = 0.228-0.808; p = 0.009), gender (OR = 0.299, 95% CI = 0.123-0.728; p = 0.008) and the type of thromboembolic disease (OR = 0.385, 95% CI = 0.214-0.690; p = 0.001). Adherence was better among females, older age groups and patients who had undergone heart valve surgery. Adherence was poorer among males, younger participants and patients with venous thromboembolism. We suggest that medication adherence counseling to warfarin therapy should be emphasized in poor-adherent patient populations.Key words: Warfarin, adherence, patient factors, Keny

Characterization, Comparative Genomics and Genome Mining for Antibiotics and Secondary Metabolite of two Actinomycetales isolates

Actinomycetes are ubiquitous Gram (+) bacteria commonly found to have high G+C content and best known for their metabolic by-products and novel enzymes [1]. Isolates CCMMD2014 & MRMD2014 were co-cultured from soil impacted by a rusty fire hydrant in Woods Hole, MA. The Streptomyces sp. and Curtobacterium sp. isolates were identified by marker genes for 16S rRNA, rpoB, xylose isomerase, tryptophan synthase beta chain and Cytochrome P450 monooxygenase. Both isolates showed lactic acid fermentation and urease activity. The co-isolates were separated by selective culturing with antibiotics. In addition, whole genome sequencing revealed distinct inherent metabolic pathways in each culture that allowed for mutually exclusive selective culture conditions. Assembly was done using HGAP3 with Celera8 assembler using SMRT portal [2,3]. Annotation was done using the RAST server [4], with 7540 and 3969 CDS for Streptomyces sp. and Curtobacterium sp. respectively being revealed by AMIGene and BASys [5,6]. Subsequently, antiSMASH [7], was used to predict 52 and 26 secondary metabolite biosynthetic clusters that included genes for lantipeptides, terpenes, siderophores, polyketide synthases type I and II, bacteriocin and nonribosomal peptide synthase genes for Streptomyces sp. and Curtobacterium sp. respectively. The isolates have genes of potentially beneficial traits that could help study, among others, the role of fimbrial adhesins and iron in biofilm formation and investigation on natural products

Patient factors impacting on oral anticoagulation therapy among adult outpatients in a Kenyan referral hospital

Background: Patients’ factors such as knowledge on warfarin use are important in achieving desirable anticoagulation outcomes. Objective: To assess the patient factors impacting on oral anticoagulation control among adult outpatients taking warfarin at Kenyatta National Hospital. Methodology: A cross-sectional survey of 147out-patients on warfarin at Kenyatta National Hospital was carried out between March and April 2015. Data were collected using a pre-designed interviewer administered questionnaire. The data included patient characteristics such as indication and duration of anticoagulation; knowledge on anticoagulation; and international normalized ratio tests. The Oral Anticoagulation Knowledge test was used with a score of ≥75% indicating sufficient knowledge. Logistic regression was used to determine independent variables associated with anticoagulation control. Results: Females were majority (74.9%) while optimal anticoagulation control was at 43.5%. Only 10.1% had sufficient knowledge on anticoagulation. Anticoagulation knowledge scores were associated with marital status (p=0.015), education level (p=0.014) and indication (p=0.032). Independent predictors of poor anticoagulation were female gender (p=0.011) and lower education level (p=0.005). Optimal anticoagulation control was, however, not associated with knowledge on anticoagulation (p=0.794). Conclusion: Knowledge and control of anticoagulation among the patients are poor. Female gender and lower education level were predictors of poor anticoagulation. Provision of information on anticoagulation to patients on was warfarin is recommended. Key words: Knowledge, Warfarin, Anticoagulation, International normalized rati

Complete Genome Sequence of Curtobacterium sp. Strain MR_MD2014, Isolated from Topsoil in Woods Hole, Massachusetts

Here, we present the 3,443,800-bp complete genome sequence of Curtobacterium sp. strain MR_MD2014 (phylum Actinobacteria). This strain was isolated from soil in Woods Hole, MA, as part of the 2014 Microbial Diversity Summer Program at the Marine Biological Laboratory in Woods Hole, MA

Complete Genome Sequence of Streptomyces sp. Strain CCM_MD2014, Isolated from Topsoil in Woods Hole, Massachusetts

Here, we present the complete genome sequence of Streptomyces sp. strain CCM_MD2014 (phylum Actinobacteria), isolated from surface soil in Woods Hole, MA. Its single linear chromosome of 8,274,043 bp in length has a 72.13% G+C content and contains 6,948 coding sequences

Alignment used for reconstruction of Maximum likelihood tree showing phylogenetic placement of S. hawaiiensis based on concatenated rpoB-trpB-recA-atpD

Alignment used for reconstruction of Maximum likelihood tree showing phylogenetic placement of S. hawaiiensis based on concatenated rpoB-trpB-recA-atp

Correlates and management of anaemia of chronic kidney disease in a Kenyan Tertiary Hospital

Background: Anaemia is a common complication of chronic kidney disease. There is paucity of published local and regional data regarding its associated factors and management.Objective: To assess the correlates and management of anaemia in chronic kidney disease.Design: Cross sectional descriptive studySetting: Kenyatta National Hospital, Nairobi County, Kenya.Subjects: Two hundred and twelve (212) chronic kidney disease patients attending the renal clinic from March 2015 to June 2015 were recruited consecutively.Results: The prevalence of anaemia was high at 67.0%. There was a positive correlation between anaemia and stage of renal disease (p<0.0001), diabetes (p=0.015), glomerulonephritis (p=0.028) and systemic lupus erythematosus (p=0.002). Although correction of anaemia was done in less than half of the patients presenting with it, treatment using erythropoietin, iron sucrose and blood transfusion correlated positively with the severity (p<0.05).Conclusion: Anaemia of the chronic kidney disease is prevalent, and the severity increases with the degree of renal damage, but it is sub-optimally managed. Screening and management of anaemia for patients with renal failure should focus more on patients with diabetes, glomerulonephritis and systemic lupus erythematosus