Control of spread of Methicillin Resistant Staphylococcus aureus (MRSA) in Burns Units

Results of four years' studies from a number of hospitals in Kenya have shown that nosocomial infections in burns units are due to Methicillin Resistant Staphylococcus aureus (MRSA). Through chromosomal DNA and plasmid DNA; the stain is highly resistant to sulphonamide ointment and other antibiotics. 90 per cent of patients admitted in burns units get colonized or infected with MRSA. The strain prolongs the duration of patients in hospitals. The burns degenerate to second and third degree burns; thereby necessitating skin grafting. The environment has been found to be contaminated with this strain with some staff members having chronic throat infections. Minocycline was found to be effective in treating the infected staff members. Cleaning this environment with Sodium dichloroisocyanurate (precepts)/Sodium hypochlorite (JIK) reduced drastically the mechanical transmission of bacteria in the units. The duration of stay of the patient was reduced. This shows that MRSA which is spread in government and private hospitals can cheaply be controlled by the proper use of disinfectants; antiseptics; and use of effective antibiotics when necessary

Human immunodeficiency virus seropositivity in children aged six to eighty-four months at Kenyatta National Hospital

To determine the prevalence of the HIV seropositivity in general paediatric emergency admissions at Kenyatta National Hospital; 552 children were studied systematically for four months in 1991.A clinical history was taken and physical examination conducted. The HIV status was determined by use of organ Teknika's Vironostika viral lysate assay for initial two screenings and then a Behring enzygnost anti-HIV-1 synthetic peptide assays a confirmatory assay.Seventy (12.7) of all the children studied were HIV positive; the mean age of the HIV-positive children was 17.5 months while that of the total study population was 23.5 months. HIV seropositivity was not associated with history or parenteral injections. No haemophilia patient was recruited during the study period; and of all the 18 sicklers recruited; none was HIV positive despite multiple blood transfusions. The WHO paediatric Aids Case definition criteria had moderately low sensitivity (55.7); high specificity (85.9) and low positive predictive value (36.4). This was in agreement with observations noted in other studies in East and Central Africa

Invasive pneumococcal disease in a cohort of HIV-1 infected female prostitutes living in Nairobi

A cohort of predominantly HIV seropositive female prostitutes has been followed for a two year period. 54 episodes of invasive pneumococcal disease (ISpD) have been diagnosed in 41 patients; of which 28 were bacteraemic. All patients were seropositive for HIV. Pneumonia was the most common presentation in 34(64); then maxillary sinusitis in 11 (21) and occult bacteraemia in 8 (15). Nine of the patients (22) had proven recurrent disease despite appropriate therapy; most of these episodes were with different serotypes suggesting that this is reinfection rather than relapse. The mean CD4 count of first episode ISpD was 325 showing that that this is an early HIV-related problem. The estimated inicdence rate was 30/1000 person years of observation and it was the most common life-threatening problem seen in the cohort in the study period. All patients survived with standard penicillin or ampicillin treatment. The pneumococcus is an important but under-recognised cause of HIV-related disease in Africa. Presentation can be atypical but the response to appropriate therapy good

Aetiogical agents of diarrhea in children living in a malaria epidemic area of Kenya

One hundred and four fecal specimen of children under five years reporting to Malindi Hospital were analysed for diarrhoegenic agents. These included bacterial; viral and parasitic agents which may cause diarrhoea. Conventional methods were employed in this study. The children were also examined for malaria parasites. consistency of the stool samples was loose 49; watery 26; formed 16; mucoid 9 and 3 of the specimen had traces of blood. 29 of the children were positive for malaria. Detection of diarrhoegenic agents was as follows;- 1. Bacteria 34; the highest of these being pathogenic Escherichia coli 39; Salmonella 28; Shigella 28 and Vibrio parahaemolyticus 3; 2. Rotaviruses 28; 3. Parasites 10 which included Ascaris lumbricoides 44; Trichuris trichura 33; Giardia lamblia 22 and Entamoeba coli 11. Mixed infections were observed in 7 of the subjects. Aetiological agents of diarrhoea could not be detected in 30 of the specimen

Minimum inhibitory concentration of antibiotics against bacteria associated with childhood diarrhoea in children attending a district hospital in Kenya

A study to determine the in vitro activity of antibiotics to bacterial pathogens isolated from diarrhoea stools of 125 patients reporting to the Paediatric Filter Clinic at Malindi District Hospital with acute diarrhoea was done. The ages of the patients ranged from one to five years. Samples of diarrhoea stools were collected before drug administration. 33 strains of Enterobacteriacea comprising 12 strains of pathogenic Escherichia coli; 13 strains of Salmonella SPP and 8 strains of Shigella SPP were isolated and minimum inhibitory concentration of five antibiotics determined. 5 pure antibiotic powders; namely; ampicillin; tetracycline; kanamycin; trimethoprim-sulfamethoxazole and nalidixic acid were tested using the agar dilution method (Muellerinton agar). The minimum inhibitory concentration (MIC) of the 5 antibiotics used ranged between 8#gml-1 and 128#gml-1 excep for t trimethoprin-sulfamethoxazole which had a MIC range of 0.25#gml-1 to 16#gml-1. Hyper resistance of the isolates was observed for ampicillin; tetracycline; kanamycin and nalidixic acid. The results of this work suggest that there is circulation of resistant strains of bacteria causing diarrhoea within the community around Malindi