Nasopharyngeal carriage and antibiotic susceptibility of streptococcus pneumoniae among diabetic and nondiabetic patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Respiratory infections are among the common infections in diabetes patients with Streptococcus pneumoniae being one of the common causative organisms. This organism colonizes the nasopharynx with varying frequency which has been stipulated to be higher in patients with diabetes. Elimination of colonization is possible through immunization. This immunization strategy is yet to be applied in Kenya due to paucity of data on the burden of colonization with the organism. Objective: To determine the nasopharyngeal carriage and antibiotic susceptibility of S. pneumonia among diabetic and non-diabetic patients at the Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: A cross-sectional comparative study among diabetic and non-diabetic patients attending the MTRH diabetes and eye clinics respectively. Participants were selected using systematic random sampling from the clinic queue. An interviewer administered questionnaire was used to collect social demographic data and risk factors. Blood samples were taken for measurement of random blood sugar and HbA1c. Nasopharyngeal swabs were taken and immediately delivered into Amies transport media and transported to the laboratory for culture and antibiotic susceptibility testing within 24 hours. Data analysis was done using STATA version 13. Association between nasopharyngeal carriage of S. pneumoniae was assessed using Pearson’s Chi Square test and Fisher’s exact test for categorical variables and unpaired t test and two-sample Wilcoxon test for continuous variables. Results: A total of 124 and 121 participants were enrolled into the diabetes and nondiabetes groups respectively. Of all the participants 149 (60.8%) were female. The mean age was 43.6 with a standard deviation of 16.15 years. Among all participants, carriage of S. pneumoniae was 7.4% (95%CI 4.4, 11.4). Carriage was higher in the diabetes group at 12.1% (95%CI 0.07, 0.19) than the non-diabetes group 2.48% (95%CI 0.01, 0.07) with this difference being statistically significant at p=0.004. Only diabetes was associated with higher odds of carriage (adjusted OR 6.2, p=0.012). There was no association with age, gender, type of cooking fuel used, presence of under 5-year-old or previous antibiotic use. Among participants with diabetes, 66.13% had diabetes for less than 10 years and majority (56.46%) were on insulin with only 17.74% having good glycemic control. Nasopharyngeal carriage of S. pneumoniae was associated with insulin use. There was no association with duration of diabetes or glycemic control. Among the antibiotics used, Amoxicillin was the most frequently used at 67.31% with macrolides only used by 9.61%. Antibiotic resistance was highest for Cotrimoxazole (94.44%) followed by Amoxicillin at 16.7% and Cefuroxime at 11.1%. No resistance was reported to macrolides. Conclusion: Nasopharyngeal carriage of Streptococcus pneumoniae is higher among persons with diabetes and isolates are resistant to routinely used antibiotics with macrolides being spared Recommendations: The ministry of health should adapt policy guidelines to reduce the burden of nasopharyngeal carriage of Streptococcus pneumoniae among patients with diabetes such as vaccination. Streptococcus pneumoniae resistance to Cotrimoxazole is high and its use should be supported by a positive culture and sensitivity result.