Gastrointestinal carriage of carbapenemase-producing enterobacterales among inpatient and outpatient children in Kenya.

Gastrointestinal carriage of antimicrobial-resistant bacteria, especially carbapenemase-producing Enterobacterales (CPE), presents a critical public health threat globally. However, in many resource-constrained countries, epidemiological data on CPE is limited. Here, we assessed gastrointestinal carriage and associated factors of CPE among inpatient and outpatient children (≤ 5 years). This hospital-based cross-sectional study was conducted at Thika Level 5 Hospital in Kenya from February to June 2023. In total, 540 participants were recruited from outpatient (270) and inpatient (270) children, excluding those admitted for < 48 h and outpatients with ≤ 3 months hospitalization history. Demographic data were collected using a questionnaire, and stool or swab samples were cultured following standard microbiology methods. Automated platforms were used for isolates identification and antimicrobial susceptibility testing. Gastrointestinal carriage rate of CPE was 9.6%, 95% confidence interval (CI): 6.39-13.79% (26/270) among the inpatients and 5.9%, 95% CI: 3.42-9.45% (16/270) among the outpatients. The carbapenemase-producing Enterobacterales were predominated by multidrug-resistant Escherichia coli from inpatients (22/22, 100%) and outpatients (8/10, 80%). The colonization rate was higher among inpatients who were presenting with chills (aOR = 10.57, p = 0.008). We report a high gastrointestinal carriage of CPE among children (≤ 5 years). Strict adherence to colonization screening, and antimicrobial stewardship policies are critical to control CPE dissemination in the current study area and beyond.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The study was approved by Kenyatta University’s ethical research committee, reference number (PKU/2620/E1745) as well as the National Commission of Science, Technology, and Innovation (NACOSTI), reference number (P/22/22147). Approval for collection of samples was obtained from Ethical Research Committee, Thika Level 5 hospital (Ref. MOH/TKA/GEN/VOL. VI/017). Additionally, the parent or guardian of each child who participated in the study gave their informed consent. Results and patient identification were both kept confidential. The findings of this study will guide in infection prevention and control interventions which will minimise infections of the patients. The findings will also guide in the correct selection of the antibiotics for treating the patients.
(© 2024. The Author(s).)