{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:12:46Z","timestamp":1789985566724,"version":"4.0.1"},"reference-count":55,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T00:00:00Z","timestamp":1697241600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T00:00:00Z","timestamp":1697241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Kenyatta National Hospital","award":["KNH\/R&P\/23K\/23\/6."],"award-info":[{"award-number":["KNH\/R&P\/23K\/23\/6."]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Clin Microbiol Antimicrob"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bacterial infections in COVID-19 patients, especially those caused by multidrug-resistant gram-negative strains, are associated with increased morbidity, hospital stay and mortality. However, there is limited data on the epidemiology of extended-spectrum \u03b2-lactamase (ESBL)-producing bacteria in COVID-19 patients. Here, we assessed the prevalence and the factors associated with ESBL-producing gram-negative bacterial (GNB) infections among severely ill COVID-19 patients admitted in\u00a0Kenyatta National Hospital (KNH), Kenya.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We adopted a descriptive cross-sectional study design for patients admitted between October 2021 and February 2022, purposively recruiting 120 SARS-CoV- 2 infected participants based on clinical presentation. Demographics and clinical characteristics data were collected using structured questionnaires and case report forms. Clinical samples were collected and analyzed by standard microbiological methods in the KNH Microbiology laboratory and the Centre for Microbiology\u00a0Research, Kenya Medical Research Institute.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GNB infections prevalence was 40.8%, majorly caused by ESBL\u2014producers (67.3%) predominated by\u00a0\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (45.5%). Generally, 73% of the ESBL producers harboured our target ESBL genes, mainly CTX-M-type (59%, 17\/29) in\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      \u00a0(76.9%, 20\/26)\n                      <jats:italic>.<\/jats:italic>\n                      GNB harbouring TEM-type (83%, 10\/12) and SHV-type (100%, 7\/7) genes showed ESBLs phenotypes and inhibitor resistance, mainly involving clavulanate, but most of them remained susceptible to tazobactam (60%, 6\/10). SHV-type genes carrying ESBL producers showed resistance to both cefotaxime (CTX) and ceftazidime (CAZ) (\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ), CAZ (\n                      <jats:italic>E. coli<\/jats:italic>\n                      ) or CTX (\n                      <jats:italic>E. cloacae complex<\/jats:italic>\n                      \u00a0and\u00a0\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ). About 87% (20\/23) of isolates encoding CTX-M-type \u03b2-lactamases displayed CTX\/ceftriaxone (CRO) resistance phenotype. About 42% of isolates with CTX-M-type \u03b2-lactamases only hydrolyzed ceftazidime (CAZ)\n                      <jats:italic>.<\/jats:italic>\n                      \u00a0Isolates with OXA-type \u03b2-lactamases were resistant to CTX, CAZ, CRO, cefepime and aztreonam. Patients with comorbidities were 10 times more likely to have an ESBL-producing GNB infection (aOR\u2009=\u20099.86, 95%CI 1.30 \u2013 74.63, p\u2009=\u20090.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      We report a high prevalence of ESBL-GNB infections in severely ill COVID-19 patients, predominantly due to\u00a0\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      \u00a0harbouring CTX-M type ESBL genes. The patient\u2019s underlying comorbidities increased the risk of ESBL-producing GNB infection. In COVID-19 pandemic, enhanced systematic and continuous surveillance of ESBL-producing GNB, strict adherence to infection control measures and antimicrobial stewardship policies are warranted in the current study setting.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12941-023-00641-8","type":"journal-article","created":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T11:02:38Z","timestamp":1697281358000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Extended-spectrum \u03b2-lactamase- producing gram-negative bacterial infections in severely ill COVID-19 patients admitted in a national referral hospital, Kenya"],"prefix":"10.1186","volume":"22","author":[{"given":"Jeniffer Munyiva","family":"Mutua","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Mwaniki","family":"Njeru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abednego Moki","family":"Musyoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,14]]},"reference":[{"issue":"1","key":"641_CR1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12985-022-01783-5","volume":"19","author":"W Gu","year":"2022","unstructured":"Gu W, et al. 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We sought consent for patient\u2019s participation in the study through the patient\u2019s guardians or their legally approved representatives.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"91"}}