Prevalence of antimicrobial resistance in Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli isolates among stillbirths and deceased under-five children in Sierra Leone: Data from the Child Health and Mortality Prevention Surveillance sites from 2019 to 2022

Abstract

<title>Abstract</title> <bold>Introduction: </bold><italic>Klebsiella pneumoniae</italic>, <italic>Escherichia coli,</italic> and <italic>Enterobacter cloacae</italic> are associated with most nosocomial infections worldwide. Although gaps remain in knowledge of their susceptibility patterns, these are in antimicrobial stewardship. This study aimed to describe antimicrobial susceptibility profiles of the above organisms isolated from postmortem blood from stillbirths and under-five children enrolled in the Child Health and Mortality Prevention Surveillance (CHAMPS) programme in Sierra Leone. <bold>Methods: </bold>This was a surveillance study of bacteria isolates from postmortem blood cultures taken within 24 hours of death from cases aged 0-59 months between February 2019 and February 2022. This was followed by identification and antibiotic sensitivity testing using Becton Dickinson Phoenix M50 (USA). Descriptive analysis was used to characterize the isolates and their antimicrobial susceptibility patterns. <bold>Results: </bold>Of 367 isolates<bold>, </bold><italic>K. pneumoniae</italic> was the most frequently isolated organism (n= 152; 41.4%), followed by <italic>E. coli</italic> (n= 40; 10.9%) and <italic>E. cloacae</italic> (n=35; 9.5%). Using BACTEC™ FX 40 (USA), 367 isolates were identified from blood using bacteriological methods. Extended Spectrum beta-lactamase (ESBL) was observed in 143 (94.1%) of <italic>K. pneumoniae</italic> isolates and 27 (65.5%) of <italic>E. coli </italic>isolates<italic>.</italic> Carbapenemase resistant organisms (CRO) were seen in 31 (20.4%) of <italic>K. pneumoniae</italic> and 5 (12.5%) of <italic>E. coli </italic>isolates. Multi-drug resistance (MDR) pattern was most prevalent in <italic>E.cloacae</italic> (33/35; 94.3%) followed by <italic>K. pneumoniae</italic> (138/152; 90.8%). <bold>Conclusion: </bold>Our study showed a high prevalence of multidrug resistance among bacterial isolates in the catchment areas under surveillance by the CHAMPS sites in Sierra Leone. This signals the need to enhance antimicrobial stewardship, infection prevention control measures and extensive antimicrobial resistance surveillance.