Monitoring Multi-Drug Resistant Klebsiella pneumoniae In Kitagata Hot spring,Sheema District South Western Uganda: A public Health Implication
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Date
2023-09
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Kampala International University
Abstract
Background: The alarming prevalence of Klebseilla pneumoniae in most recreational places such as hot spring waters is concerning, yet this superbug is associated with accelerated dissemination of multi-drug resistance genes. The present study aimed at determining the spatial temporal prevalence of multi-drug resistant K. pneumoniae in Kitagata hot spring, Sheema district, Southwestern Uganda.
Methods: A laboratory based, descriptive longitudinal study design was conducted between May and July, 2023. Eighty water samples were collected in the morning and evening from purposively selected points of the hot spring at an interval of 1 week during the rainy and dry season. Temperatures at each point were measured prior to sample collection and two samples at varying depth were obtained. Five millitres of each homogenized sample was pre-enriched in brain heart infusion broth and then presumptive identification of K. pneumonia isolates was done both blood and violet red bile agars. Kirby Bauer disk diffusion method was performed followed by phenotypic detection of both extended spectrum beta lactamases (ESBL) and carbapenemase (CR) production. Polymerase chain reaction was performed to detect resistance genes; blaTEM, blaCTX-M and blaKPC. Data was analyzed using SPSS-20 to obtain chi square tests and Person’s product moment correlation coefficient using regression analysis. Statistical significance was considered at p ≤ 0.05.
Results: 30.0% K. pneumonia was isolated from Kitagata hot spring of which all isolates were categorized as multi-drug resistant. 100% isolates exhibited extreme resistance to ampicillin, rifampicin, ceftazidime, and then followed by azithromycin (79.2%). 95.8% harbored blaTEM genes alone and both blaTEM and blaCTX genes, followed by blaKPC alone (33.3%) and 25% carried all the three resistance genes. The dry season had a higher prevalence of K. pneumoniae (35.0%) as compared to the wet season (25.0%). MDR K. pneumoniae significantly increased overtime during the course of the study. The carriage of the three studied resistance genes in the isolates was positively correlated with the second phase of sample collection and dry season while negatively correlated with temperature except isolates that harbored either blaTEM only or blaTEM+KPC +CTX genes.
Conclusions: Kitagata hot spring serves as hot spot for continuous dissemination and acquisition multi-drug resistant K. pneumoniae harboring resistance genes that encode for ESBL and CR production. The health sector should establish a continuous monitoring and surveillance system and sturdy antimicrobial resistance stewardship programs to provide health education to the community.