Discovering the Prevalence of Antimicrobial Resistance Through Creation of an Antibiogram in a Rural Kenyan Hospital

Abstract BackgroundAntimicrobial resistance is a pressing global health issue. Data are lacking in detailing the presence and burden of antimicrobial resistance in low and middle-income countries. What is currently available is quarantined to large, urban centers away from the rural facilities. MethodsThis was a retrospective descriptive study performed at Kijabe Hospital, a rural 350-bed teaching hospital, from February 2016 to September 2020. Cultures from blood, urine, and cerebrospinal fluid were included from all pediatric and adult patients. Data was analyzed and an antibiogram was created using WHONET software. ResultsFrom January 2016 to September 2020 a total of 3275 distinct isolates were identified, including 1654 positive blood cultures, 1288 positive urine cultures, and 91 positive cerebrospinal fluid cultures. Aggregate gram negative susceptibility to third generation cephalosporins was approximately 41%, with 67% of isolates susceptible to piperacillin-tazobactam, and 93% of isolates susceptible to meropenem. The most frequently identified organism was coagulase-negative Staphylococcus (1534, 47%), followed by Escherichia coli (721, 22%), Klebsiella species (482, 15%), and Staphylococcus aureus (110, 3.4%). The most common multidrug resistant organism was Escherichia coli (664, 20%), followed by Klebsiella species (461, 14%). Acinetobacter baumannii was found to be only 57% sensitive to meropenem. Staphylococcus aureus was 91% sensitive to cloxacillin.ConclusionThe high rates of antimicrobial resistance found in this rural referral center were similar to the large urban settings in sub-Saharan Africa. This along with the discovery of multidrug resistant gram negative organisms are of great concern. The need for continued surveillance, antimicrobial stewardship, and implementation of quality improvement initiatives is imperative to attempt to curb this burgeoning global problem.