ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed, 15 citations in OpenAlex.
- Rural-urban disparities in cardiovascular and other competing risk of death among cancer patients.Journal of advanced research · 2026Article
- Epidemiology and clinical outcomes of carbapenamase-producing organism (CPO) colonization: a tertiary care center experience in Saudi Arabia.BMC infectious diseases · 2026Article
- Asymptomatic faecal carriage of multidrug-resistant and carbapenemase-producing Gram-negative bacteria among inpatients and outpatients in a Kenyan county referral hospital: a cross-sectional study.BMC infectious diseases · 2026Article
- Multi-drug resistant surgical site infections following caesarean delivery: a prospective observational study from urban Uganda.BMC women's health · 2025Observational
- Colonization with antibiotic resistant bacteria in communities and hospitals across six countries, including Bangladesh, Botswana, Chile, Guatemala, India, and Kenya.Scientific reports · 2025Article
- Understanding and addressing β-lactam resistance mechanisms in gram-negative bacteria in Lebanon: A scoping review.Heliyon · 2025Review
- Admission screening for extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales colonization at a referral hospital in Botswana: A one-year period-prevalence survey, 2022-2023.PLOS global public health · 2025Article
- Gastrointestinal carriage of carbapenemase-producing enterobacterales among inpatient and outpatient children in Kenya.Scientific reports · 2024Article
- Long-term antibiotic exposure landscapes and resistant Escherichia coli colonization in a densely populated setting.PloS one · 2024Article
- Incidence of and Risk Factors for Third-Generation Cephalosporin-ResistantInfection and drug resistance · 2024Article
- Using Colonization to Understand the Burden of Antimicrobial Resistance Across Low- and Middle-Income Countries.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Antibiotic Resistance: A Global Problem and the Need to Do More.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
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Authors and funding
13 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundThe spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya.
methodsDuring a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures.
resultsMost (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6-3.37]; P < .001), intubated patients (1.73 [1.03-2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03-2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14-4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03-1.13]; P = .002).
conclusionsWhile CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs.
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