Antimicrobial resistance: capacity and practices among clinical laboratories in Kenya, 2013.
BACKGROUND
Antimicrobial resistance is neglected in developing countries; associated with limited surveillance and unregulated use of antimicrobials. Consequently, delayed patient recoveries, deaths and further antimicrobial resistance occur. Recent gastroenteritis outbreak at a children's home associated with multidrug resistant non-typhoidal Salmonella spp, raised concerns about the magnitude of the problem in Kenya, prompting antimicrobial resistance assessment preceding surveillance system establishment.


METHODS
Eight public medical laboratories were conveniently selected. Questionnaires were administered to key informants to evaluate capacity, practice and utilization of antimicrobial susceptibility tests. Retrospective review of laboratory records determined antimicrobial resistance to isolates. Antimicrobial resistance was defined as resistance of a microorganism to an antimicrobial agent to which it was previously sensitive and multidrug resistance as non-susceptibility to at least one agent in three or more antimicrobial categories.


RESULTS
The laboratories comprised; 2(25%) national, 4(50%) sub-national and 2(25%) district. Overall, antimicrobial susceptibility testing capacity was inadequate in all. Seven (88%) had basic capacity for stool cultures, 3(38%) had capacity for blood culture. Resistance to enteric organisms was observed with the following and other commonly prescribed antimicrobials, ampicillin: 40(91%) Salmonella spp isolates; Tetracycline: 16(84%) Shigella flexineri isolates; cotrimoxazole: 20(100%) Shigella spp isolates, 24(91%) Salmonella spp isolates. Comparable patterns of multidrug resistance were evident with Shigella flexineri and Salmonella typhimurium. Ten (100%) clinicians reported not using laboratory results for patient management, for various reasons.
Field Epidemiology and Laboratory Training Program, Kenya.
Fredrick
F
Odhiambo
Field Epidemiology and Laboratory Training Program, Kenya.
Tura
T
Galgalo
Field Epidemiology and Laboratory Training Program, Kenya.
Arvelo
A
Wences
Field Epidemiology and Laboratory Training Program, Kenya.
Onesmus Maina
OM
Muchemi
Field Epidemiology and Laboratory Training Program, Kenya.
Evalyne Wambui
EW
Kanyina
Ministry of Health-Kenya, Kenya.
Juliana Chepkemoi
JC
Tonui
Field Epidemiology and Laboratory Training Program, Kenya.
Samwel
S
Amwayi
Field Epidemiology and Laboratory Training Program, Kenya.
Waqo
W
Boru
D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D064790:Clinical Laboratory Services / Q000458:organization & administration / Q000706:statistics & numerical data; D003144:Communication Barriers; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification; D006276:Health Facility Size; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011364:Professional Practice / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012760:Shigella / Q000302:isolation & purification; D000078329:Workforce
Capacity; antimicrobial resistance; culture; isolates; pattern; practice; susceptibility