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   PID: hpt/lnx 1.9.0-cur 2019-01-08   
   TID: hpt/lnx 1.9.0-cur 2019-01-08   
    Kenyan hospital visits linked to increased exposure to antibiotic-   
   resistant bacteria    
      
     Date:   
         July 5, 2023   
     Source:   
         Washington State University   
     Summary:   
         Kenyan patients who spend more than three days in the nation's   
         hospitals are more likely to harbor a form of bacteria   
         resistant to one of the most widely used antibiotic classes,   
         according to a recent study. The research team found that   
         66% of hospitalized patients were colonized with bacteria   
         resistant to third-generation cephalosporins, compared to 49%   
         among community residents. Third-generation cephalosporins are   
         typically used for serious infections, and resistance to these   
         antibiotics leaves limited options for treating patients with some   
         bacterial infections. The study was part of a pair of projects   
         in Kenya and a third in Guatemala to determine the prevalence   
         of antibiotic-resistant bacteria. The research also aimed to   
         identify risk factors for colonization with bacteria resistant to   
         important and frequently used classes of antibiotics, including   
         third-generation cephalosporins.   
      
      
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   Kenyan patients who spend more than three days in the nation's hospitals   
   are more likely to harbor a form of bacteria resistant to one of the   
   most widely used antibiotic classes, according to a recent study led by   
   Washington State University.   
      
   The research team found that 66% of hospitalized patients were colonized   
   with bacteria resistant to third-generation cephalosporins, compared   
   to 49% among community residents. Third-generation cephalosporins   
   are typically used for serious infections, and resistance to these   
   antibiotics leaves limited options for treating patients with some   
   bacterial infections.   
      
   The study, published in the Clinical Infectious Diseases journal,   
   was part of a pair of projects in Kenya and a third in Guatemala to   
   determine the prevalence of antibiotic-resistant bacteria. The research   
   also aimed to identify risk factors for colonization with bacteria   
   resistant to important and frequently used classes of antibiotics,   
   including third-generation cephalosporins.   
      
   "These bacteria can cause untreatable infections," said Sylvia Omulo,   
   an assistant professor at WSU's Paul G. Allen School for Global Health   
   who led the studies in Kenya. "We have to use surveillance to make   
   sure we understand what causes these bacteria to colonize and, later,   
   resist certain antibiotics."  By examining health records of Kenyan   
   hospital patients who were colonized with cephalosporin-resistant   
   bacteria, researchers identified three risk factors associated with   
   colonization. Those risk factors included hospitalization for more than   
   three days at 132% increased risk, intubation at 73% and a positive HIV   
   status at 70%.   
      
   A person colonized with the bacteria may show no symptoms of an infection;   
   however, the germs are present and growing in their body, and the   
   individual may be at increased risk of a more dangerous infection from   
   something as simple as a minor medical procedure or sickness from common   
   bacteria like E. coli and Klebsiella. The germs can unknowingly be spread   
   through person-to-person contact or contaminated surfaces.   
      
   While resistance is often associated with improper antibiotic   
   use, that does not appear to be a primary contributing factor for   
   cephalosporin-resistant bacteria in either Kenya or Guatemala.   
      
   The Guatemala study, led by WSU Allen School assistant professor Brooke   
   Ramay, was interrupted by the COVID-19 pandemic and resulted in data   
   being collected during two time periods. Reported antibiotic use in   
   the community declined three-fold between the pre- and post-periods,   
   but the prevalence of cephalosporin-resistant bacteria remained steady,   
   with colonization found in 67% of hospital patients and 46% of community   
   subjects.   
      
   "If antibiotic use locally in the community was a major risk factor,   
   we'd expect some change over the course of the year," said WSU Regents   
   Professor Douglas Call, corresponding author for the three publications.   
      
   In a Kenyan study of communities, the likelihood of colonization with   
   cephalosporin-resistant bacteria rose by 12% with increasing visits   
   to hospitals and clinics, and individuals who kept poultry were 57%   
   more likely to have the resistant bacteria. Previous and ongoing work   
   in both countries also highlights the role of bacterial transmission   
   due to poor sanitation and hygiene.   
      
   What is not clear is if contact with the health care system is a source   
   of transmission or if people seeking care are more likely to harbor   
   these bacteria.   
      
   "We know if you're interacting with the health care system, you're more   
   likely to carry these bugs, but we don't know why yet," Call said. "To   
   sort out the cause from the effect, we need to track the same people over   
   time and record how their colonization status changes with different   
   behaviors. Studies to do this are being set up for the coming year."   
   The research was completed in collaboration with the Centers for Disease   
   Control and Prevention, University del Valle de Guatemala, University of   
   Nairobi and the Kenya Medical Research Institute. The work was funded by   
   the CDC and is part of the broader Antimicrobial Resistance in Communities   
   and Hospitals (ARCH) study partnership, which has research projects in   
   six countries. The most recent findings from WSU and other institutions   
   involved in the ARCH study were published in a special supplement of   
   theClinical Infectious Diseases journal.   
      
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   Source: Materials provided by Washington_State_University. Original   
   written by Devin Roktya and Josh Babcock. Note: Content may be edited   
   for style and length.   
      
      
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   Journal Reference:   
      1. Teresa Ita, Ulzii-Orshikh Luvsansharav, Rachel M. Smith, Robert   
      Mugoh,   
         Charchil Ayodo, Beatrice Oduor, Moureen Jepleting, Walter Oguta,   
         Caroline Ouma, Jane Juma, Godfrey Bigogo, Samuel Kariuki, Brooke   
         M. Ramay, Mark Caudell, Clayton Onyango, Linus Ndegwa, Jennifer   
         R. Verani, Susan Bollinger, Aditya Sharma, Guy H. Palmer, Douglas   
         R. Call, Sylvia Omulo.   
      
         Prevalence of colonization with multidrug-resistant bacteria in   
         communities and hospitals in Kenya. Scientific Reports, 2022; 12   
         (1) DOI: 10.1038/s41598-022-26842-3   
   ==========================================================================   
      
   Link to news story:   
   https://www.sciencedaily.com/releases/2023/07/230705122449.htm   
      
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