Antibiotic susceptibility of Enteric pathogens from the Maasai community, Narok and Kajiado Districts, Kenya

The emergence of resistance to antimicrobial agents in bacterial pathogens is a worldwide problem that has been associated with inappropriate use in human and veterinary medicine. Between August 2004 and July 2005 stool samples from 380 patients were cultured for enteric pathogens and characterized by Polymerase Chain Reaction for the presence of virulence properties. Patients were from Narok and Kajiado Districts of Kenya, mainly populated by the Maasai community majority of who practice traditional medicine. 218 patients were from Narok District Hospital and 62 from Entosopia Clinic in Kajiado. A total of 107 E. coli and 35 Shigella isolates were tested. Antibiotic susceptibility testing was done using the E-test strips containing Tetracycline, Gentamicin, Chloramphenicol, Fosfomycin, Amoxicillin/Clavulanic acid, Trimethoprim/Sulphamethoxazole, Ticarcillin/ Clavulanic acid and Ciprofloxacin. The resistance frequencies did not differ significantly between other E. coliand Shiga toxigenic E. coli, respectively; Gentamicin (3% vs. 3%), Chloramphenicol, (24% vs. 23%) and ampicillin (25% vs. 23%), Tetracycline (63% vs. 68%), Fosfomycin (44% vs. 54%) and Trimethoprim/Sulphamethoxazole (84% vs. 84%). Overall antibiotic resistance levels were at much lower levels than those reported from the rest of Kenya, possibly due to the lower levels of exposure and usage of antimicrobials among the Maasai community

Low anti tuberculosis drug resistance despite high rates of recurrent tuberculosis and HIV infection in western Kenya

Background: The high rates of recurrent tuberculosis and HIV in Kenya raised the assumption that anti -tuberculosis drug resistance may be an increasing problem. Objective: To determine whether HIV co infection and TB recurrence are associated with anti TB drug resistance. Methods: Cross sectional study in which sputa from 872 TB suspects underwent ZN smear microscopy and culture. Growth was identified using Hain molecular identification kits. Screening for HIV infection was done using Uni GoldTM rapid test and the positives confirmed with enzyme linked immunosorbent assay. Results: A total of 186 M. tuberculosis complex and 15 non tuberculous mycobacteria isolates were obtained. The tuberculosis recurrence and TB HIV co infection rates amounted to 44.8% and 41.8%, respectively. All the 186 M. tuberculosis isolates were susceptible to streptomycin and ethambutol. Only 12 (6.5%) of the isolates were mono drug resistant, nine to isoniazid and three to rifampicin. Only 3/27 isoniazid resistant isolates were from recurrent TB cases. Conclusion and recommendation: No MDR strains of M. tuberculosis were observed in the current study. However, the study suggests an association between HIV co-infection and anti TB mono drug resistance. High TB recurrence observed in the current study was not associated with anti TB drug resistance. What needs to be examined is the cause of this high TB recurrence rate in Western Kenya. Keywords: Recurrent TB; HIV co infection; antiTB drug resistance; prevalenc

NON-TYPHI SALMONELLA IN CHILDREN WITH SEVERE MALARIA

Objective: To determine the association between Plasmodium falciparum malaria andnon-typhi Salmonella in children.Design: Cross-sectional hospital based study.Setting: Kilifi District Hospital (KDH) between January 1997 and June 2001.Subjects: Children aged between three months to 123 months (mean age 28.28 months)and who had been admitted to the paediatric or High Dependency Research Ward(HDRW) of the KDH.Methods: A total of 19, 118 blood cultures routinely obtained for all admissions and1,820 clinically indicated stools samples were obtained from 9,147 children admittedwith malaria. The specimens were cultured and antibiotic sensitivity done using standardlaboratory procedures with stringent internal and external quality control in place.Results: The total bacterial pathogens isolated from blood and stool were 1,395/19,118(7.3%) and 342/1,820 (19%) respectively. Non-typhi salmonella consisted of 260/1,395(18.6%) of the positive blood cultures and 92/324 (28.4%) of the stool cultures out ofwhich a total of 101 NTS occurred in children with severe malaria. Out of the 9,147malaria cases admitted, 101/9,147 (1.10%) had concomitant NTS infection. NTS withsevere malaria as a proportion of all malaria admissions for the period varied between0.8% and 1.5%. There was a significant association (p-value=0.032) between clinicaloutcome of death and female sex of the patient. The NTS isolates which occurred withsevere malaria showed various levels of antibiotic resistance. They were resistant toampicillin (35%), chloramphenicol (18%), gentamicin (22%), cefuroxime (29%),sulphamethoxazole-trimethoprim (39%), ciprofloxacin (3%), cefotaxime (14%),amoxycillin-clavulanic acid (26%) and tobramycin (18.0%). Multidrug resistance (MDR)was seen in 34 (33.6%) of the isolates.Conclusions: NTS and severe malaria occurring together are a problem in this areaand that a large number of the isolates are MDR. An elaborate case-controlled studyis required to elucidate the chain of events of both NTS and malaria parasite co-existence