Characterization of Enteric Isolates in Blood and Stool Specimens among Outpatients Presenting with Fever Symptoms in Crescent Medical Aid Facility, Nairobi County, Kenya

Bacterial pathogens, which are acquired through consumption of contaminated water and food are a major contributor of morbidity and mortality and thus a public health concern in developing countries and this is brought about by the bacterial resistance to antimicrobial drugs used. Salmonella enterica serotype typhi causes enteric fever which is a waterborne and foodborne disease. A cross-sectional study was conducted in two clinics setting among the residents of Mukuru slum, Nairobi County on outpatients who had fever-like symptoms upon consent. A total of one hundred and fifty patients were sampled and their blood and stool samples collected. Subsequently, laboratory analysis was carried out characterize bacterial isolates and its antibiotic susceptibility profiles. From the culture of the stool and blood samples, 27 positive cultures of bacterial pathogens were detected with both gram positive (28.3%) and gram negative (71.7%) bacteria’s. The blood isolate included Staphylococcus aureus (2.7%), Proteus mirabilis (0.7%) and Escherichia coli (0.7%). The isolates from the stool culture were Escherichia coli (18%) and Shigella dysentriae (4.7%). Using Salmonella antigen test, 73 (39.3%) samples tested positive for typhoid but none of the isolates of Salmonella typhi was seen in both blood and stool cultures. All the isolates indicated moderate to high resistance to ampicillin-cloxacillin (23.3%), tetracycline (6.7%) and cefuroxime (8%), while the isolates were highly susceptibility to gentamicin (23.3%), chloramphenicol (13.3%) and ciprofloxacin (22%). In conclusion, despite the fact Mukuru slums is not a malaria endemic region, the main cause of invasive bacteremia in patients presenting with fever-like symptoms is not S. typhi and therefore, there is need for improved diagnostic methods in patients presenting fever-like symptoms and should also be screened for other bacterial pathogens in addition to Salmonella in order to enhance proper treatment and overall control of multi-drug resistance because of misdiagnosis and improper prescription of antibiotics.