• Mutinda Josphat Kenyatta University
  • MAINGI JOHN Kenyatta University
  • Kebira Anthony Kenyatta University


Background:This study aimed at determining the prevalence of bacterial agents causing upper respiratory tract infections and their susceptibility patterns to commonly used antibiotics among outpatients in Kitui District Hospital.

Methods: A total of 237 throat swabs were collected between November, 2012 to April, 2013 and innoculated onto Blood agar, MacCkonkey agar and Chocolate agar then incubated at 37 oC for 24 hours. Colony morphology and standard biochemical tests were  performed for identification and confirmation of the isolates based on their Gram staining and cultural characteristics. Antimicrobial sensitivity patterns of the bacteria to antibioticswas determined byKirby-Bauer disc diffusion technique. P values of ≤ 0.05 were considered to have clinical and epidemiological significance.

Results: Pathogens were isolated in 95.4 % of the samples collected’ out of this, 5% were mixed cultures involving Candia albicans and either viridans group streptococci or Staphylococcus aureus. Bacteria isolated were S. aureus with the highest prevalence (44.3%), followed by viridans group streptococci (32.5 %) and Streptococcus pyogenes (13.5%). Resistance of bacterial pathogens to antibiotics in Kitui district hospital was highest in viridans group streptococci (48.2 %) followedby Staphylococcus aureus (40.5%) whileStreptococcus pyogenes had the least resistance (28.1 %) and there were no cases of multi-drug resistance.

Conclusion: The rate of antibiotic resistance was significantly high and proper interventions shouldbe put in place by the relevant government ministry to prevent these infections and their complications.


Key words: Prevalence, susceptibility, antibiotic resistance, multi-drug resistance, URTIs


Author Biography

Mutinda Josphat, Kenyatta University



El-Mahmood AM, Isa H, Mohammed A, Tirmidhi AB. Antimicrobial susceptibility of some respiratory tract pathogens to commonly used antibiotics at the Specialist Hospital, Yola, Adamawa State, Nigeria. J Clin Med Res2010; 2:135-42.

Poole MD, Portugal LG. Treatment of rhinosinusitis in the outpatient setting. Am J Clin Med.2005;118: 45-50.

Imani R, Rouhi H, Ganji F. Prevalence of antibiotic resistance among bacteria isolates of lower respiratory tract infections in COPD Shahrekord. J Med Sci2005; 23:438-40.

Boon PK, Charlene MY, Freda TY, Chee YW. Antibiotic Prescribing for Upper Respiratory Tract Infections in Sarawak District Hospitals. Med J Malaysia 2013; 68: 2

Woodhead M, Blasi F, Ewig S. Guidelines for the management of adult lower respiratory tract infections. EurRespir Dis J2005; 26:1138-80.

Mandell LA, Wunderink RG, Anzueto A. Infectious Diseases Society of America; American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Comm Infect Dis J 2007; 44: 27-72.

Wasserfallen JB, Livio F, Zanetti G. Acute rhinosinusitis; a pharmacoeconomic review of antibacterial use. Pharm. Rev. J.2004; 22: 829-37.

Dunagan WC, Woodward RS, Medoff G. Antibiotic misuse in two clinical situations: positive blood culture and administration of aminoglycosides. Rev Infect Dis1991; 13: 405-12.

Laupland KB, Ross T, Church DL, Gregson DB. Population-based surveillance of invasive pyogenic streptococcal infection in a large Canadian region. ClinMicrobiol Infect2006; 12: 224-30.

Clinical and Laboratory Standards Institute. Abbreviated Identification of Bacteria and Yeast; Approved Guideline, Second Edition 2008; M35-A2.

Bauer AW, Kirby WN, Sheris JC, Tuck M. Antibi¬otic susceptibility testing by standardised single disc method. Am J ClinPathol1966; 36: 493-6.

National Committee for Clinical Laboratory Standards Performance standards for antimicrobial disc susceptibility test. Approved standard. National Committee for Clinical Laboratory Standards2003; 12-13 ( M7-A6).

Young SEJ. Etiology and epidemiology of infective endocarditis in England and Wales. AntimicrobChemother1987; 20: 7-15.

Manford M, Matharu J, Farrington K. Infective endocarditis ina district general hospital. J.Roy. Soc. Med.1992; 85: 262-6.

McCartney AC. Changing trends in infective endocarditis. ClinPathol1992; 45: 945-8.

Brook I. Microbiology of common infections in the upper respiratory tract. PedeatrInfect Dis 2002; 25: 633-48.

Mouro A, Luci B, Tabacow H, Marines D, Valle M, Jacyr P. Prevalence of upper respiratory tract infections at a tertiary care hospital in the city of São Paulo. Einstein2010; 8: 197-9.

Magnúsdóttir BT, Jónsson JS, Kristinsson KG. Prevalence of Streptococcus pyogenes and methicillin-resistant Staphylococcus aureus in the pharynx of healthy children in the town of Gardabaer. Laeknabladid2008; 94: 447-51.

Akoachere JF, Ndip RN, Chenwi EB, Ndip LM, Njock TE, Anong DN. Antibacterial effect of Zinziberofficinaleand Garcinia kola on respiratory tract patho¬gens. East Afri Med J 2002; 79: 588-91.

Van Gageldonk-Lafeber AB, Marianne ABS, Marie-Louise AH, Marcel FP, Aad IMB,Berry W.Risk factors for acute respiratory tract infections in general practitioner patients in The Netherlands: a case-control study. BMC Infect. Dis.2007; 7: 35

Bisno AL. Acute pharyngitis. N Engl J Med2003; 344: 205–11.

McGregor KF, Spratt BG, Kalia A, Bennett A, Bilek N, Beall B. Multilocus sequence typing of Streptococcus pyogenes representing most known emm types and distinctions among subpopulation genetic structures. Journal of Bacteriol2004; 186: 4285-94.

Choby BA.Diagnosis and treatment of streptococcal pharyngitis. AFP2009; 79: 383–90.

Styers D, Sheehan DJ, Hogan P, Sahm DF. Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann ClinMicrobiolAntimicrob2006;5: 2.

Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002). Diagnos.Microbiiol. Infect Dis2004;50: 59-69.

Heijer CD, van Bijnen EM, Paget WJ, Pringle M, Goossens H, Bruggeman CA, Schellevis FG, Stobberingh EE. Prevalence and resistance of commensal Staphylococcus aureus, including methicillin-resistant S. aureus, in nine European countries: a cross-sectional study. TheLancet of Infect Dis2013; 13: 40-2

Choi CS, Yin CS, Bakar AA, Sakewi Z, Naing NN, Jamal F, Othman N. Nasal carriage of S. aureusamong health adults. MicrobiolImmun Infect 2006; 39: 458-64.

Rebecca W.S. aureus: a cross sectional study of prevalence and and risk factors in one general practice. AFP2012; 41: 325-8.

Bii CC, Yamaguchi H, Kai M, Nagai K, Sugiura Y, Taguchi H, Chakaya JM, Mbugua GG, Kamiya H. Mycoplasma pneumoniae in children with pneumonia in Mbagathi district hospital, Nairobi, Kenya. East Afri Medi J2002; 79: 6.

Hoppe JE. Treatment of oropharyngeal candidiasis in immunocompetent infants: a randomised multicenter study of miconazole gel vsnystatinsuspension. The antifungal study group. Pedeatr Infect Dis1997; 16: 288.

Goins RA, Ascher D, Waecker N. Comparison of fluconazole and nystatin suspension for treatment of oral candidiasis in infants. Pedeatr Infect Dis 2002; 21: 1165-7.

Su CW, Gaskie S, Jamieson B, Triezenberg D. Clinical enquiries: what is the best treatment for oral thrush in healthy infants? SA FamPract2008; 57: 484.

Zhang X. Oestrogen levels on Candida albicans: a potential virulence regulating mechanism. J Infec Diseases2000; 181: 1441- 6.

Brusca MI. The impact of oral contraceptives on women’s periodontal health and subgingival occurrence of periodontopathogens and Candida spp. J Periodontol2010; 81: 1010- 8.

Williams D, Lewis M. Pathogenesis and treatment of oral candidiasis.J Oral Microbi.2011; 3: 1-3

Naglik JR, Moyes DL, Wächtler B, Hube B. Candida albicans interactions with epithelial cells and mucosal immunity. Microbiol Infect2011; 13: 963–76.

Peleg AY, Deborah AH, Eleftherios M. Medically important bacterial–fungal interactions. Nat Rev Microbiol2010; 8: 340-9.

Kourkoumpetis, Themistoklis, Candida infection and colonization among non-trauma emergency surgery patients. Virul2010; 1: 359-66.

arsson M, Kronvall G, Nguyen TKC, Karlsson I, Hoang DC, Tomson G, Falkenberg T. Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community. Trop Med Inter Health2000; 5: 711-21.

Ndip RN, Ntiege EA, Ndip LM, Nkwelang G, Akoachere TK, Nkuo AT. Antimicrobial Resistance of Bacterial Agents of the Upper Respiratory Tract of School Children in Buea, Cameroon. JHPN2008; 26: 397-404.

Zafar A, Hussain Z, Lomama E, Sibiie S, Irfan S, Khan E. Antibiotic susceptibility of pathogens isolated from patients with community-acquired respiratory tract infections in Pakistan. J Ayub MedCollab2008; 20: 7-9.

Kastner U, Guggenbichler JP. Influence of macrolide antibiotics on promotion of resistance in the oral flora of children.Infection.2001; 29: 251-6.

Bruckner LB, Korones DN, Karnauchow T, Hardy DJ, Gigliotti F. High incidence of penicillin resistance among alpha-hemolytic streptococci isolated from the blood of children with cancer. Journal of Pediatr2002; 140: 20-6.

Tazumi A, Maeda Y, Goldsmith CE, et al.Molecular characterization of macrolide resistance determinants (erm(B) and mef(A) in Streptococcus pneumoniae and viridans group streptococci (VGS) isolated from adult patients with cystic fibrosis (CF). J.AntimicrobChemother2009; 64: 501-6

Brook I. Microbiology and principles of antimicrobial therapy for head and neck infections. Infect Dis Clin J N Am 2007; 21: 355–91.

Mary KY, Lurel G, Francoise PR, Brooks GF. Characterization of antimicrobial resistance in S. pyogenesisolates from the San Francisco Bay Area of Northern California. JClinMicrobiol1999; 37: 1727- 31.

Passali D, Lauriello M, Passali GC, Passali FM, Bellusi L. Group A Streptococcus and its antibiotic resistance. ACTA OtorhinolaryngologicaItalica2007; 27: 27-32.

Nevio C. S. pyogenesis well and alive. BC Medical Journal2009; 51: 122-7

Onanuga A, Oyi AR, Olayinka BO, Onaolapo JA. Prevalence of community- associated multi-resistant Staphylococcus aureusamong healthy women in Abuja, Nigeria. Afri J Biotech2005; 4: 942-5.

Zeba B. Overview of β-lactamase incidence on bacterial drug resistance. Afri J Biotech2005; 4: 1559-62.

Nwanze P, Nwaru LM, Oranusi S, Dimkpa U, Okwu MU,Babatunde BB, Anke TA, Jatto W, Asagwara CE. Urinary tract infection in Okada village: Prevalence and antimicrobial susceptibility pattern. Sci Res Ess2007; 2: 112-6.

Owens RC, Ambrose PG. Antimicrobial safety: focus on fluoroquinolones. Clin Infect Diseases2005; 41: 144-57.

Bilgrami I, Roberts JA, Wallis SC, et al. Dosing in critically ill patients with sepsis receiving high volume continuous venovenous hemofiltration. Antimicrob Agents Chemother 2010; 54: 2974-8.

Guleria VS, Sharma N, Amitabh S, Nair V. Ceftriaxone-induced hemolysis. Indian J Pharm2013; 45: 530-1.






Original Article