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The Rising Threat of Carbapenem-Resistant Gram-Negative bacteria in ICUs and the Need for Effective Control: A Study from Kenya

The worldwide public health threat posed by Carbapenem-resistant Gram-negative bacteria (CR-GNB) cannot be overemphasized, especially in Intensive Care Units (ICU). The danger engendered by these organisms is exacerbated due to the scarcity of comprehensive surveillance data, especially in settings with resource constraints. This article presents findings from a study that assessed both the prevalence of CR-GNB infections and the risk factors for acquiring such infections in a Kenyan ICU.

The research study, which adopted a hospital-based cross-sectional design, occurred from January to October 2022 at the Nairobi West Hospital in Kenya and involved 162 patients. These patients, admitted to the ICU after 48 hours, showed clinical indications of bacterial infection. Analysis of samples such as blood, tracheal aspirate, ascitic tap, urine, stool, and sputum, dependent on patient conditions, was carried out within 2 hours.

The study found a 25.9% prevalence of CR-GNB infections. The predominant organisms were Klebsiella pneumoniae (35.7%) and Pseudomonas aeruginosa (26.2%). All isolated organisms displayed multidrug resistance, with P. aeruginosa and A. baumannii demonstrating complete resistance to colistin, while K. pneumoniae (33.3%) was resistant to tigecycline. Identified risk factors for infection were a history of antibiotic use and nasogastric tube (NGT) use.

These findings underscore the importance of stringent implementation of antimicrobial stewardship programs alongside rigorous adherence to infection prevention and control. Effective monitoring, evaluation, and feedback practices are crucial in curbing CR-GNB infections, particularly among susceptible groups like the ICU patients.

CR-GNB organisms pose significant challenges in clinical practice due to their resistance to multiple drugs, limited treatment options, and subsequent escalation in health care costs. ICUs are particularly susceptible due to the critical condition of admitted patients who frequently undergo invasive procedures, combined with the reduced immunity of these patients. The situation is gravely concerning in lower-middle-income countries, where the burden of ICU-acquired infections is quite higher than that in high-income nations.

The findings call for robust, evidence-based surveillance in ICUs to guide the optimization of antimicrobial use and the prevention and control of infections. The role of clinical laboratories is significant as they are essential in generating antibiograms for evidence-based antimicrobial selection.

Addressing the threat of CR-GNB infections demands comprehensive, strategic actions. These include targeted prevention strategies, ongoing education and training related to infection control, and the fostering of a culture of safety and accountability within healthcare settings. Just as crucially, healthcare providers should discourage the inappropriate use of antibiotics, and encourage responsible prescribing practices to combat the rise of resistance.


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