Prevalence of methicillin resistant staphylococcus aureus (mrsa) among paediatric patients admitted in intensive care unit and neonatal intensive care unit at Kenyatta National Hospital-Nairobi, Kenya.

Abstract

Back ground: Methicillin-resistant Staphylococcus aureus (MRSA) remains a public health problem globally. MRSA infection increases morbidity, risk of mortality, increased financial burden and loss of productivity. MRSA on average accounts for 57% of S.aureus isolates causing nosocomial infection in intensive care units (ICUs) and are increasingly reported from many other countries worldwide. This was the first study to be carried out in Kenyatta National Hospital (KNH), the national teaching and referral hospital in Kenya to find out the prevalence of MRSA. Justification: There has not been any study done to establish the prevalence of MRSA in Kenyatta National Hospital NICU and ICU. The findings from this study will facilitate rational planning, protocol and guidelines formulation in both ICU and NICU. Objective: To determine the prevalence of methicillin resistant Staphylococcus aureus among paediatric patients admitted in neonatal intensive care unit (NICU) and ICU of KNH. Methods: This was a cross sectional descriptive study carried out over a period of five months in NICU and ICU. Children admitted in these units were recruited into the study after getting a written informed consent from their parents or guardians. Nasal swabs and tracheal aspirates were collected and taken to Kenya Medical Research Institute (KEMRI)-Microbiology laboratory where conventional culture techniques, characterization of S. aureus, determination of the mecA gene for MRSA using PCR techniques and antibiotics susceptibility were performed. SPSS version 17.0 was used for data analysis. Results: One hundred and fifty patients were recruited into the study. Of these 99 were males and 51 females. Sixty seven patients were from NICU and 83 were from ICU. A total of 218 samples (155 nasal swabs and 63 tracheal aspirates) were collected from these patients and S.aureus was isolated from 71samples (32.6%). Of the 71 S.aureus isolated 33 (46.5%) were methicillin resistant. S.aureus showed highest sensitivity to vancomycin and linezolid, followed by amikacin and highly resistance to most of the commonly used antibiotics here at KNH. Conclusion: Staphylococcus aureus was isolated from one third of the nasal and tracheal aspirates of patients in the NICU and ICU. MRSA is highly prevalent (46.5%) among the S.aureus isolates. MRSA isolates were highly sensitive to vancomycin, linezolid and amikacin. Recommendations: Continuous surveillance of antimicrobial susceptibility to inform policy and practice, and a study to establish levels of nasal carriage among health workers in these units should be done. Our second line antibiotics in NICU and ICU are not effective against MRSA and empiric antibiotic should be vancomycin, amikacin or linezolid.