The Hospital as a reservoir of antibiotic resistance in low resource settings

Low resource settings are disproportionally hit by the worldwide wave of antimicrobial resistance and due to weak infection prevention policies, hospitals are hotbeds for the spread of antimicrobial resistance. Although previously disregarded as a bystander, the hospital innate environment recently has been identified as a source of clinically relevant pathogens and multidrug resistant Gram-negative bacteria such as Klebsiella pneumoniae survive well in the hospital environment and – in low resource settings - are a frequent cause infections affecting vulnerable patients such as neonates. Given the unselected use of disinfectants, there is growing concern that Gram-negative organisms such as K. pneumoniae will acquire resistance to these products. The present PhD project aims to study the hospital as a reservoir of antimicrobial resistance in low resource settings. Study sites will be a rural referral hospital in Burkina Faso and a tertiary care urban hospital in Benin. Chapter I assesses the presence, density and predilection of Gram-negative bacteria (with focus on multidrug resistant K. pneumoniae) in the innate environment of the neonatal ward. Chapter II compares the genetic profiles of these organisms with those recovered from blood cultures in neonates at the hospital in Benin. Chapter III assesses use of disinfectants by healthcare workers in both settings by means of an observational study and a Knowledge, Attitude and Practice survey. Finally, chapter IV will optimize, validate and use an invitro test method to assess the resistance to disinfectants by K. pneumoniae bacteria recovered in Chapters I and II.