Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insig...Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insights on antimicrobial susceptibilities in a rural setting, we examined specimens from suspected SSTIs from two public health facilities in Kenya. We additionally assessed antibiotic use, appropriateness of empiric therapy and risk factors for SSTI. Methodology: Between 2021 and 2023, 265 patients at Kisii and Nyamira County Referral hospitals were enrolled. Wound swabs/aspirates were collected and processed following standard microbiological procedures. Identification and antimicrobial susceptibility were performed using the VITEK 2 Compact platform. Demographic, clinical, and microbiological data were analyzed with R Statistical software. Results: S. aureus was isolated in 16.2% (43/265) of patients with a methicillin resistance (MRSA) proportion of 14% (6/43). While 13/15 drugs elicited susceptibilities ranging from 84% - 100%, penicillin (16%) and trimethoprim-sulfamethoxazole [TMP-SXT] (23%) yielded the lowest susceptibilities. Escherichia coli (n = 33), Klebsiella pneumoniae (n = 8), Pseudomonas aeruginosa (n = 8), and Citrobacter species (n = 4) were the most commonly isolated gram-negative species. Gram-negative strains showed high susceptibilities to most of the tested drugs (71% - 100%) with the exception of ampicillin (18%), TMP-SXT (33%), and first and second generation cephalosporins. Conclusions: The low MRSA prevalence and generally high antibiotic susceptibilities for S. aureus and gram-negative bacteria present opportunities for antibiotic stewardship in the study setting. Diminished susceptibilities against penicillin/ampicillin and TMP-SXT accord with prevailing local data and add a layer of evidence for their cautious empiric use.展开更多
<i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;"> <i>aureus</i></span><span style="font-fami...<i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;"> <i>aureus</i></span><span style="font-family:""><span style="font-family:Verdana;"> has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> infections in Kenya. Published data between 2000 and 2020 were evaluated. </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;">) sequence based clustering yielding four major clusters (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC359, </span><i><span style="font-family:V展开更多
文摘Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insights on antimicrobial susceptibilities in a rural setting, we examined specimens from suspected SSTIs from two public health facilities in Kenya. We additionally assessed antibiotic use, appropriateness of empiric therapy and risk factors for SSTI. Methodology: Between 2021 and 2023, 265 patients at Kisii and Nyamira County Referral hospitals were enrolled. Wound swabs/aspirates were collected and processed following standard microbiological procedures. Identification and antimicrobial susceptibility were performed using the VITEK 2 Compact platform. Demographic, clinical, and microbiological data were analyzed with R Statistical software. Results: S. aureus was isolated in 16.2% (43/265) of patients with a methicillin resistance (MRSA) proportion of 14% (6/43). While 13/15 drugs elicited susceptibilities ranging from 84% - 100%, penicillin (16%) and trimethoprim-sulfamethoxazole [TMP-SXT] (23%) yielded the lowest susceptibilities. Escherichia coli (n = 33), Klebsiella pneumoniae (n = 8), Pseudomonas aeruginosa (n = 8), and Citrobacter species (n = 4) were the most commonly isolated gram-negative species. Gram-negative strains showed high susceptibilities to most of the tested drugs (71% - 100%) with the exception of ampicillin (18%), TMP-SXT (33%), and first and second generation cephalosporins. Conclusions: The low MRSA prevalence and generally high antibiotic susceptibilities for S. aureus and gram-negative bacteria present opportunities for antibiotic stewardship in the study setting. Diminished susceptibilities against penicillin/ampicillin and TMP-SXT accord with prevailing local data and add a layer of evidence for their cautious empiric use.
文摘<i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;"> <i>aureus</i></span><span style="font-family:""><span style="font-family:Verdana;"> has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> infections in Kenya. Published data between 2000 and 2020 were evaluated. </span><i><span style="font-family:Verdana;">S</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">aureus</span></i><span style="font-family:Verdana;"> isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;">) sequence based clustering yielding four major clusters (</span><i><span style="font-family:Verdana;">spa</span></i><span style="font-family:Verdana;"> CC359, </span><i><span style="font-family:V
