Environmental reservoirs of multidrug-resistant pseudomonads in a geographical location in Kenya with high community-acquired infections

Abstract

<ns3:p>Background Pseudomonads are gram negative bacteria and readily form biofilms in the environment, allowing long-term colonization and persistence in sinks, water systems. They pose a risk of life-threatening opportunistic infections in immune-compromised individuals. MDR strains, make treatment increasingly difficult. Environmentally persistent MDR strains are typically problematic within healthcare facilities, however, data on MDR pseudomonad reservoirs in settings with community-acquired infections to inform preventive interventions, in resource-constrained settings is scarce. Here, we determined reservoirs and antibiotic susceptibility of <ns3:italic>Pseudomonas</ns3:italic> species in water sources in Kisumu County, Kenya with reported high levels of community acquired pseudomonad infections. Methods We adopted a cross-sectional design, randomly collecting 297 samples from tap heads, sinks, tanks, vendor and household storage containers in six selected sub-locations and one hospital (KCRH)<ns3:italic>.</ns3:italic> Standard microbiological procedures were used for identification and AST of the isolates. Results We isolated <ns3:italic>Pseudomonads</ns3:italic> from 14.1% of the samples collected, predominantly from the community 10.4%. Seven different pseudomonads were identified, with <ns3:italic>Pseudomonas aeruginosa</ns3:italic> predominating 6.7% overall, in the community samples 5.7%, and among isolates from water tanks 21.4%. Pseudomonad isolates were 62% non-susceptible to piperacillin, 57% to tigecycline, 24% meropenem, 21% cefepime, 19% levofloxacin and 14% colistin. Carbapenem resistance was mainly detected in <ns3:italic>P. aeruginosa</ns3:italic> 80% (8/10) from Milimani sub-location 75% (6/8). 45% of the isolates recovered were MDR, mainly community-associated carbapenem-resistant <ns3:italic>P. aeruginosa</ns3:italic> (CRPA) 42%, strains susceptible to colistin. The MDR pseudomonads exhibited high multiple antibiotic resistance indices, ranging from 0.43 to 1. Conclusion This study reveals a higher prevalence of MDR pseudomonads, including CRPA strains in community water sources. These potential conduits of drug resistance present a critical public health threat, especially among immunocompromised. Regular cleaning of water storage facilities, water treatment and implementation of antimicrobial stewardship programs, are required to prevent a rise in AMR and eliminate the environmental reservoirs that put the vulnerable populations at risk.</ns3:p>