Thesis:

Secondary bacterial infections and antimicrobial drug resistance among sars-cov-2 patients admitted in the intensive care units in selected health facilities in mombasa and nairobi counties, kenya

Antibiotics, particularly broad-spectrum antibiotics, have been overused in the treatment of Severe Acute respiratory Syndrome Corona Virus 2. Evidence suggests that this aids the spread of multidrug resistant bacteria. The number of studies in the country that have examined secondary bacterial infections in SARS-COV-2 patients, the proportion of these infections attributable to antimicrobial resistance (AMR), and the deaths related to this resistance are, however, extremely low. This study, therefore, assessed bacterial infections and AMR among SARS-COV-2 patients in Kenya. Specifically, it sought to determine the proportion of secondary bacterial infections among SARS-COV-2 patients, examine the proportions of these infections caused by antibiotic resistant pathogens and assess the mortality associated with secondary bacterial infections due to antibiotic resistant pathogens among SARS-COV-2 patients. Using a sample size of 385, the retrospective chart review targeted 385 SARS-COV-2 patients admitted with secondary bacterial infections at Kenyatta National Hospital, Mbagathi Hospital, Nairobi Hospital, Aga Khan University Hospital, Avenue Hospital and Coast General Teaching and Referral Hospital. The health facilities were purposively sampled while the number of study participants in each facility were proportionately sampled.Each participatint were randomly recruited from the hospital database. Only patients admitted in the ICU and whose records were complete with measurement of outcomes and availed to the research team were included. In addition, their samples must have been tested for antibiotic susceptibility. During the study period which stretched over 21 months period; from 13th March 2020 to December 2021. The correlation between the indiscriminate use of antibiotics with a broad spectrum and secondary infections caused by bacteria among SARS-COV-2 patients was investigated using a logistic linear regression analysis. Proportion of secondary bacterial infections among the SARS-COV-2 patients admitted in the selected health facilities in Mombasa and Nairobi Counties was higher among smokers (p ≤ .05). Antibiotics resistance and mortality was also higher among patients who had secondary bacterial infections (p ≤ .05). Relationship between secondary bacterial infections and antibiotic resistant was also high, a significant majority of patients with secondary bacterial infection developed multi-drug resistance (≤ .05) while at the same time mortality incidences attributed to secondary bacterial infections among SARS-COV-2 patients in ICUs in the selected health facilities in Mombasa and Nairobi Counties was high as well (p ≤ .025). The findings underscore the need for judicious use of antibiotics in treating SARS-CoV-2 patients to mitigate the risk of antibiotic resistance. Healthcare facilities should implement antimicrobial stewardship programs to promote appropriate antibiotic prescribing practices. Further research is warranted to understand the epidemiology of secondary bacterial infections among SARS-CoV-2 patients and their association with antibiotic resistance and mortality in different settings. Public health interventions are necessary to raise awareness among healthcare providers and the general population about the appropriate use of antibiotics and the risks of antibiotic resistance