Newswise — PULLMAN, Wash. --A recent study conducted by Washington State University revealed that Kenyan patients who stay in the country's hospitals for over three days have an increased likelihood of carrying a strain of bacteria that is resistant to a commonly prescribed group of antibiotics.
The study team discovered that 66% of patients admitted to hospitals were infected with bacteria that displayed resistance to third-generation cephalosporins, in contrast to 49% among individuals residing in the community. Third-generation cephalosporins are usually administered for severe infections, and the emergence of resistance to these antibiotics poses restricted treatment alternatives for patients afflicted with certain bacterial infections.
Published in the Clinical Infectious Diseases journal, the study constituted one component of a dual research initiative conducted in Kenya, alongside a third project in Guatemala. The primary objective of these projects was to ascertain the prevalence of antibiotic-resistant bacteria. Furthermore, the research aimed to identify the factors that contribute to the colonization of individuals with bacteria that are resistant to crucial and commonly prescribed antibiotic classes, such as third-generation cephalosporins.
Sylvia Omulo, an assistant professor at WSU's Paul G. Allen School for Global Health and the lead researcher of the Kenyan studies, emphasized the severity of the issue by stating, "These bacteria have the potential to cause infections that are untreatable." She further stressed the importance of surveillance in order to gain a comprehensive understanding of the factors contributing to the colonization of these bacteria and their subsequent resistance to specific antibiotics.
Through an analysis of health records pertaining to Kenyan hospital patients harboring cephalosporin-resistant bacteria, the researchers successfully identified three key risk factors linked to colonization. These risk factors include prolonged hospitalization exceeding three days, which was associated with a 132% increased risk, followed by intubation, which demonstrated a 73% increased risk. Additionally, individuals with a positive HIV status exhibited a 70% increased risk of colonization with cephalosporin-resistant bacteria.
While an individual colonized with these bacteria may not exhibit any noticeable infection symptoms, it is important to note that the germs are present and actively multiplying within their body. This colonization poses an elevated risk of contracting a more severe infection, even from seemingly minor medical procedures or exposure to common bacteria like E. coli and Klebsiella. It is crucial to be aware that these germs can be transmitted unknowingly through person-to-person contact or contact with contaminated surfaces. Therefore, proper hygiene practices and infection control measures are essential to prevent the inadvertent spread of these bacteria.
Although resistance is frequently linked to inappropriate antibiotic utilization, it seems not to be a leading causative element for cephalosporin-resistant bacteria in Kenya or Guatemala.
The study conducted in Guatemala, under the guidance of WSU Allen School assistant professor Brooke Ramay, faced disruption due to the COVID-19 pandemic and yielded data collected during two distinct time frames. Despite a three-fold decrease in reported antibiotic usage within the community between the pre- and post-periods, the prevalence of cephalosporin-resistant bacteria remained unchanged, with colonization detected in 67% of hospital patients and 46% of community individuals.
"If antibiotic usage within the local community posed a significant risk factor, we would anticipate observing some changes over the duration of the year," stated WSU Regents Professor Douglas Call, who served as the corresponding author for the three publications.
In a study conducted in Kenyan communities, it was observed that the probability of being colonized by cephalosporin-resistant bacteria increased by 12% with each visit to hospitals and clinics. Additionally, individuals who raised poultry were found to be 57% more likely to have the resistant bacteria. Previous and ongoing research in both countries further emphasizes the significance of bacterial transmission resulting from inadequate sanitation and hygiene practices.
It remains unclear whether contact with the healthcare system serves as a source of transmission for these bacteria or if individuals seeking medical care are inherently more prone to harboring them.
Call stated, "We are aware that individuals who have interactions with the healthcare system are more likely to carry these bacteria, but the underlying reasons are still unknown. To distinguish between causation and correlation, we require longitudinal tracking of the same individuals over time, along with documenting how their colonization status changes with different behaviors. Studies to address these questions are currently being established and will be conducted in the upcoming year."
The research was carried out in collaboration with the Centers for Disease Control and Prevention (CDC), University del Valle de Guatemala, University of Nairobi, and the Kenya Medical Research Institute. The CDC provided funding for the study, which is part of the larger Antimicrobial Resistance in Communities and Hospitals (ARCH) study partnership, encompassing research projects in six countries. The latest discoveries from WSU and other participating institutions in the ARCH study were published in a special supplement of the Clinical Infectious Diseases journal.
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