Antimicrobial Resistance Profiles and Clonal Relatedness of <i>Pseudomonas aeruginosa</i> Strains Recovered from Wounds Infections of Outpatient Population Presenting in a Rural Hospital in Kenya
- 1 Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
- 2 Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
- 3 Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- 4 Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- 5 Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- 6 Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
Abstract
Pseudomonas aeruginosa is a leading cause of hospital infections and is intrinsically resistant to most antibiotics. Emergence of multidrug resistant (MDR) strains has been reported in the world and poses a great challenge in the management of infections associated with this species. While a substantial amount of research has been done on strains from most of other infection caused by this species in developed countries, little is known about the susceptibility profiles of strains recovered from African countries in general and Kenya in particular. Furthermore, there is paucity of data regarding strain, phenotype and genetic diversity of strains recoverable from wounds among patients in Kenya. The possible risk factors for acquisition of MDR strains and possible factors that could fuel clonal expansion in hospital and community settings remain undetermined. This cross-sectional study conducted in Tigoni Hospital, a rural area in Central Kenya sought to determine risk factors associated with carriage of MDR Pseudomonas aeruginosa in wounds among rural population. We also analyzed antimicrobial resistance profiles among these isolates. Prevalence of P. aeruginosa in wounds was 28% with 85 isolates recovered from wounds of 299 participants. Most antimicrobial resistance prevalence was recorded towards Ceftazidime (64%) and Cefepime (52%) while Piperacillin-tazobactam was the most effective antimicrobial agent with a resistance prevalence rate of 20%. Resistance towards new classes of aminoglycosides such as Gentamicin was at 45% while that towards Amikacin was at 40%. Compared to other related studies, relatively lower resistance towards Ciprofloxacin (25%) and Meropenem (40%) were recorded. Some of the risk factors identified for carriages of MDR strains were self-medication (p: 0.001, C.I: 3.01 - 8.86, O.R: 5.17) and non-completion of dosage (p: 0.12, C.I: 0.9 - 2.5, O.R: 1.5).
- Ahmed, S.H., Daef, E.A., Badary, M.S., Mahmoud, M.A. and Abd-Elsayed, A.A. (2009) Nosocomial Blood Stream Infection in Intensive Care Units at Assiut University Hospitals (Upper Egypt) with Special Reference to Extended Spectrum Beta-Lactamase Producing Organisms. BMC Research Notes, 2, 76. https://doi.org/10.1186/1756-0500-2-76
- Sanchez, A., Gattarello, S. and Rello, J. (2011) New Treatment Options for Infections Caused by Multiresistant Strains of Pseudomonas aeruginosa and Other Nonfermenting Gram-Negative Bacilli. Seminars in Respiratory and Critical Care Medicine, 32, 151-158. https://doi.org/10.1055/s-0031-1275527
- Farshadzadeh, Z., Khosravi, A.D., Alavi, S.M., Parhizgari, N. and Hoveizavi, H. (2014) Spread of Extended-Spectrum Beta-Lactamase Genes of blaOXA-10, blaPER-1 and blaCTX-M in Pseu-domonas aeruginosa Strains Isolated from Burn Patients 1. Burns, 40, 1575-1580. https://doi.org/10.1016/j.burns.2014.02.008
- Magiorakos, A.P., Srinivasan, A., Carey, R.B., et al. (2012) Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance. Clinical Microbiology and Infection, 18, 268-281. https://doi.org/10.1111/j.1469-0691.2011.03570.x
- Oli, A.N., Eze, D.E., Gugu, T.H., Ezeobi, I., Maduagwu, U.N. and Ihekwereme, C.P. (2017) Multi-Antibiotic Resistant Extended-Spectrum Beta-Lactamase Producing Bacteria Pose a Challenge to the Effective Treatment of Wound and Skin Infections. Pan African Medical Journal, 27, 66. https://doi.org/10.11604/pamj.2017.27.66.10226
- Pitout, J.D., Revathi, G., Chow, B.L., et al. (2008) Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Isolated from a Large Tertiary Centre in Kenya 1. Clinical Microbiology and Infection, 14, 755-759. https://doi.org/10.1111/j.1469-0691.2008.02030.x
- Jeong, J.H., Shin, K.S., Lee, J.W., Park, E.J. and Son, S.Y. (2009) Analysis of a Novel Class 1 Integron Containing Metallo-Beta-Lactamase Gene VIM-2 in Pseudomonas aeruginosa. Journal of Microbiology, 47, 753-759. https://doi.org/10.1007/s12275-008-0272-2
- Woodford, N., Zhang, J., Kaufmann, M.E., et al. (2008) Detection of Pseudomonas aeruginosa Isolates Producing VEB-Type Extended-Spectrum Beta-Lactamases in the United Kingdom 1. Journal of Antimicrobial Chemotherapy, 62, 1265-1268. https://doi.org/10.1093/jac/dkn400
- Al-Charrakh, A.H., Al-Awadi, S.J. and Mohammed, A.S. (2016) Detection of Metallo-Beta-Lactamase Producing Pseudomonas aeruginosa Isolated from Public and Private Hospitals in Baghdad, Iraq. Acta Medica Iranica, 54, 107-113.