Anti-bacterial susceptibility patterns of blood culture isolates at a referral hospital in Eldoret

Background: Hospital treatment guidelines are often guided by scientific evidence of efficacy of the anti-microbial agents. In developing countries, most of the treatment guidelines are adopted from the World Health Organisation (WHO). However, local data is often needed to confirm or adjust these guidelines to suit a local situation. In resource limited settings there is scarce data on blood culture isolates and their antimicrobial sensitivity patterns to guide anti-biotic prescription in these settings.Objectives: To assess the bloodstream bacterial isolates and their anti-biotic sensitivity patterns in patients admitted at a tertiary teaching and referral hospital.Design: Hospital based laboratory retrospective studySetting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.Subjects: All blood culture specimens received from inpatients at MTRH over a 12 year period from 2002 to 2013.Results: The median age was 13.4yrs (IQR 0.7-29).Most of the blood samples were from female patients (51.8%). A total of 4046 blood culture samples were analysed of which 29.9% (n=1356) yielded positive growths. Majority of the positive blood cultures were from the New Born Unit (62.4%). Staph epidermidis was the most common organism isolated (43.1% n=531) followed by Klebsiella pneumoniae (22.8% n=281). Resistance to commonly used anti-biotics (penicillin, cephalosporin) was high among gram positive as well as gram negative organisms. No trend in bacterial isolates was observed over the study period.Conclusions: Staph epidermidis and Klebsiella pneumoniae were the most common organisms isolated with higher growth rates occurring in the neonatal and paediatric age groups than in adults. There was no trend in bacterial isolates over the study period. Resistance to commonly used anti-biotics was prevalent

Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications.

Background and aimsA substantial amount of antibiotic use in hospitals may be inappropriate, potentially leading to the development and spread of antibiotic resistance, adverse effects, mortality and increased hospital costs. The objective was to assess current patterns of antibiotic use in a leading referral hospital in Western Kenya. This would lead to the identification of opportunities for quality improvement in this hospital and others across Kenya.MethodologyA point prevalence survey was carried out with data abstracted principally from patient medical records supplemented by interviews from physicians when needed. The pattern of antibiotic use was analyzed by descriptive methods. Differences in antibiotic use and indications between the selected wards were compared using the Chi-square test or Fisher's exact tests.ResultsAmong the patients surveyed, 67.7% were on antibiotics. The most common classes of antibiotics prescribed were third generation cephalosporins (55%), imidazole derivatives like metronidazole (41.8%) and broad spectrum penicillins (41.8%). The most common indication for antibiotic use was medical prophylaxis (29%), with local guidelines advocating antibiotic prophylaxis in mothers after delivery of their child as well as in neonates with birth asphyxia and low weight at birth. Dosing of antibiotics was seen as generally optimal when assessed against current recommendations.ConclusionWhilst the dosing of antibiotics seemed adequate, there was high use of antibiotics in this hospital. This needs to be urgently reviewed with currently appreciable empiric antibiotic use. Programmes are being instigated to address these concerns. This includes developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities