Results from the Survey of Antibiotic Resistance (SOAR) 2011-14 in the Democratic Republic of Congo, Ivory Coast, Republic of Senegal and Kenya

Objectives: To assess antibiotic susceptibility of community-acquired respiratory tract isolates from Ivory Coast, Kenya, Democratic Republic of Congo (DRC) and Senegal in 2011–14. Methods: Bacterial isolates were collected and MICs determined using Etest® for all antibiotics except erythromycin, for which testing was by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide interpretation, CLSI breakpoints were adjusted for incubation in CO2. Results: Susceptibility to penicillin (using CLSI oral or EUCAST breakpoints) was low among isolates of Streptococcus pneumoniae from the DRC and Kenya (17.4% and 19%, respectively) but higher among isolates from the Ivory Coast (70%) and Senegal (85.7%). Penicillin susceptibility using CLSI iv breakpoints was higher in all countries, but still only 69.6% in the DRC. Macrolide susceptibility (based on CLSI erythromycin disc diffusion breakpoints) was also low in Kenya (∼65%) but 87%–100% elsewhere.Haemophilus influenzae were only collected in the DRC and Senegal, with β-lactamase prevalence of 39% and 4%, respectively. Furthermore, β-lactamase-negative ampicillin-resistant (BLNAR) isolates were found in DRC (four isolates, 17%), but only two isolates were found in Senegal (by EUCAST definition). Amoxicillin/clavulanic acid in vitro susceptibility was 73.9% in the DRC and 100% in Senegal based on CLSI breakpoints, but this reduced to 65.2% in the DRC when BLNAR rates were considered. Clarithromycin susceptibility was \u3e95% in both countries. Conclusions: There was considerable variability in antibiotic susceptibility among the African countries participating in the surveillance programme. Thus, continued surveillance is necessary to track future changes in antibiotic resistance. Use of EUCAST versus CLSI breakpoints showed profound differences for cefaclor and ofloxacin against S. pneumoniae, with EUCAST showing lower susceptibility

Constraining political transformations:The two faces of activist religious organizations in the search for a new constitution in Kenya

Religious organizations are key structural components of Kenyan civil society that have played or continue to play a critical role in socio-political developments. In the last two and half decades especially, religious institutions have been among the principal actors shaping the mechanics and trajectories of Kenya's political order. But religious organizations’ political behaviour, especially in the country's search for a new constitution, was contentious and remarkably inconsistent. There were moments of progressive actions but also behaviour that imperilled progress. This article probes this ambivalence of Kenyan faith groups in the struggles for a new constitution. It is argued that their political behavioural inconsistencies largely reflect an ethnic, class and, to a lesser extent, instrumentalized doctrinal or denominational schism that is ever present in the wider Kenyan society. By analysing how religious leaders and their organizations challenged political elite domination while remaining amenable to its influence, this article illustrates the contradictions of elite pacts in these struggles and how they constrained progressive transformation