Six out of ten people with a resistant bacterial bloodstream infection in Kenya will die. This is the stark reality of Antimicrobial Resistance (AMR) ravaging almost every home in the country at the moment.
Antimicrobial Resistance is now a major public health concern in the country, and scientists describe it as the silent pandemic that’s threatening to reverse some gains made in the country’s health sector.
At the centre of this evolving situation are some four commonly studied bacteria, which scientists note, are steadily stretching the country’s healthcare system, and self-medication is the culprit here.
““If you’re sick, don’t run to a pharmacy and buy for yourself antibiotics,” stated Dr. Loice Ombajo, Lead, Centre for Epidemiological Modelling and Analysis (CEMA).
Chances are, whatever you have, maybe a viral infection, it does not require antibiotics. If it’s a common cold, give it a few days, it will clear. The other thing for hospitals is now we really have to think about following the guidelines that we have developed for using antibiotics, so that you’re not using the wrong antibiotic for the wrong duration, for the wrong indication.
And if new findings released recently are anything to go by, then the country could be staring at an uncompromising public health concern of scale. The findings show a spiraling of AMR prevalence, a situation where some infections are completely not responding to antibiotic use.
These bacteria are also resistant to common antibiotics as 70 percent of bacteria causing the most common infections are resistant to Ceftriaxone, the most commonly used antibiotic in hospitals.
“Inappropriate antibiotic use drives resistance, and overuse of antibiotics both in the community and in hospitals is associated with increased antimicrobial resistance (AMR),” stated Dr. Ombajo.
She was speaking during the official launch of the World AMR Awareness Week in a hotel in Nairobi where alongside Ceftriaxone, she listed Escherichia coli, which is responsible for 70 percent resistant, Klebsiella pneumoniae -contributing to 80 percent resistant, and Staphylococcus aureus that has been seen to influence 50 percent resistant when used to treat common infections.
“So looking at our data, we found that the most common bacteria, Escherichia coli (E. coli), causes most of the urine infections as well as infections in the bloodstream.
“Then we also have another one called Klebsiella. Klebsiella has been responsible for a lot of outbreaks, particularly within newborn units, making the neonates extremely vulnerable,” she said, expressing concern that Klebsiella pneumonia is responsible for a lot of newborn infections.
It causes about 70 to 80 percent resistance to some of the most common antibiotics that are used in the country
And then there’s Staphylococcus aureus, which is common for infections in the blood, as well as infections of the tissues. “Therefore, these three bacteria represent the bacteria causing infections,” she added, further highlighting that several studies are showing that antibiotic use is common both in the community and in hospitals.
In the community for instance, Dr. Ombajo noted people are using azithromycin for every cold and every cough and every ache. She cautions that this trend is fatal as it is exposing normal healthy bacteria that lives in a human body to antibiotics and it begins to change and become resistant.
“Thus, the day you have an infection, we don’t have an antibiotic to treat you,” she warns.
Dr. Ombajo says E. coli, for instance, causing urine and blood infections, is about 60 to 70 percent resistant to the most common and most readily available antibiotics that we have.
On Staphylococcus aureus, about 50 percent, again, is resistant to common antibiotics. “Which means if today, God forbid, I go to hospital and I end up with pneumonia that’s caused by one of these bacteria, we have to think about what other antibiotics are available. These other antibiotics are not always available to us,” she said.
Some of the diseases caused by these infections end up requiring longer hospitalization, leading to high mortality.
Last week research scientists at a high-level advocacy meeting warned that AMR rates are high in both public and private hospitals in Kenya. It’s also known as a silent pandemic when you see the traffic of those seeking quick medication, thronging the chemists to purchase over the counter.
The researchers paint a grim picture. The number of people doing self-diagnosis is going up. They purchase an antibiotic even for a slight cough, or a stitch in the rib cage is enough.
On top of that, there’s not even a single line of the doctors’ report.
“Someone who has a drug-resistant infection has a higher likelihood of dying than if they did not have an infection, or if the infection was caused by a bacteria that is not resistant,” Dr. Ombajo highlighted, pointing out that the realization of these issues is what led to the coming together to discuss during the World Week.
She was referring to point prevalence surveys on antibiotic use in 12 hospitals with calculation of antibiotic use prevalence, and identification of the most commonly used antibiotics in different patient populations.
The ongoing WAAW – a global campaign aimed at increasing awareness and understanding of antimicrobial resistance (AMR) and promoting best practices among One Health stakeholders to reduce the emergence and spread of drug-resistant infections – brings together many partners, led by the Ministries of Health, Ministry of Agriculture and Livestock Development, and Ministry of Environment and Forestry.
This year’s theme is: “Act now: Protect Our Present, Secure Our Future.”
The University of Nairobi, through Fleming Fund Kenya Country Grant in collaboration with National Antimicrobial Stewardship Interagency Committee (NASIC) and other stakeholders, are jointly hosting the 13th World Antimicrobial Resistance Awareness Week, which kicked off on November 18 and ends today.
The World Health Organization (WHO) indicated that AMR is a global health priority. It is considered one of the leading public health threats of this century.
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KICKER:
“We must do something, and we must do something now. It’s not all doom and gloom, though it could be if we do nothing,” a policy brief on AMR launched last week really also talks about what Kenya can do.
AT A GLANCE:
- Global data estimates that in 2019, nearly 1.3 million deaths globally were attributed to antimicrobial resistant bacterial infections. Sub-Saharan Africa, had the highest mortality rate from AMR infections in the world, with 24 deaths per 100,000 attributed to AMR.
- Antibiotics are essential in the treatment of bacterial infections, such as pneumonia, urinary tract infections, meningitis, bloodstream infections, and infections of abdominal structures, skin, and bone.
- $US 100 Trillion lost global production by 2050 without immediate action to control AMR.
- A category that represents broad-spectrum antibiotics that should only be used for the treatment of a few specific infections. 43% of antibiotics used in Kenyan hospitals are in the WATCH category.
- 5% of antibiotics used in Kenyan hospitals are in the RESERVE category.
- The global recommendation is that 70% of antibiotics used should be in the ACCESS category. Use of antibiotics in the WATCH category is associated with more resistance.
- We found that in hospitals in Kenya, the most commonly used antibiotics was ceftriaxone which is a WATCH antibiotic.
