Abstract
Africa has experienced rapid urban migration in the past two decades. New informal settlements continue to emerge and expand but the sanitation provision of facilities has not improved at the same pace and this poses a serious health concern to the public especially the urban poor. Open sewage systems and sludge-clogged drainage systems as well as soil contaminated with industrial and domestic wastes are possible sources of germs that probably cause clinical infections and epidemics. In this cross-sectional study, we recorded diverse genera of Gram-negative non-fastidious bacteria that included; Escherichia coli (23%), Klebsiella spp (21%), Enterobacter spp (19%), Citrobacter spp (10%), Pseudomonas aeruginosa (8%), Proteus spp (7%), Salmonella (3%), Yersinia spp (3%), Shigella spp (2%), Morganella morganii (2%), Edwardisella spp (1%), Hafnia spp (1%), Serratia marcesence (0.5%), and Acinetobacter baumannii (0.5%). Most of these isolates were resistant to ampicillin while imipenem and ciprofloxacin were the most effective antimicrobial agents. Resistance combination towards ampicillin, trimethoprim, sulfamethoxazole and streptomycin was also noted in recovered isolates (16%). An overall high antimicrobial resistance was recorded among isolates from slum as compared to those recovered from Juja, a middle-class settlement located at the edge of Nairobi metropolis. The prevalence of isolates with a combined resistance to 3rd generation cephalosporins (cefotaxime, ceftriaxone and ceftazidime), gentamicin and ciprofloxacin was the highest among P. aeruginosa isolates (13%) but none of the Yersinia species and Edwardisella tarda exhibited this resistance. Carriage of blaTEM (52%) was most prevalent in all bacteria species followed by blaCTX-M (20%), blaSHV (18%) while blaOXA (17%) was the least common. The phylogeny analysis revealed significant genetic similarity among strains belonging to E. coli, K. pneumoniae, E. agglomerans and P. mirabilis strains but less relatedness was noted among strains belonging to C. freundii. Further analysis showed possible clonal expansion of E. agglomerans and K. pneumoniae within the environmental ecosystems.
Highlights
The emergence and spread of antimicrobial resistance have become a global concern and affect our ability to combat severe infections
As a result of over-use and misuse of antibiotics in human and animal health, domestic waste is likely to be highly contaminated with fecal materials which in turn have bacteria that are resistant to multiple antimicrobials due to their possible clinical origin [2]
A total of 14 non-fastidious bacteria genera were identified from these samples obtained from the slum (Kibera) and from middle class settings (Juja)
Summary
The emergence and spread of antimicrobial resistance have become a global concern and affect our ability to combat severe infections. It is estimated that nearly 1 M deaths annually occur across the globe as a result of treatment failure due to antimicrobial resistance [1]. The increase in infections caused by Gram-negative bacteria has led to a surge in usage and over-reliance on antimicrobials for human and animal infection treatment and prophylaxis. As a result of over-use and misuse of antibiotics in human and animal health, domestic waste is likely to be highly contaminated with fecal materials which in turn have bacteria that are resistant to multiple antimicrobials due to their possible clinical origin [2]. Previous studies have documented sludge and sewage effluents as major sources of antimicrobial resistant bacteria strains in the environmental compartment [3] [4]
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