Strengthening surveillance systems for Antimicrobial Resistance in Urinary Tract infections in Kenya – Report from Fleming Fund fellowship programme

Background: Urinary Tract Infection (UTI) is one of the most common reasons for outpatient attendance and antibiotic use worldwide. Tackling the problem of antimicrobial resistance (AMR) in Low- and Middle-Income Countries such as Kenya requires laboratory surveillance systems that can correctly identify bacterial pathogens from urine samples and perform antimicrobial susceptibility testing (AST). In Kenya, there are many shortcomings in public-sector microbiology laboratories, including limited professional expertise in the clinical interpretation of urine samples. Methods: This project aimed to deliver training on identification and AST for staff at five hospital laboratories participating in the Kenyan AMR surveillance network. We made local needs assessments, delivered practical training sessions face-to-face and administered written and practical competency assessments for all participants. Results: Trainings were conducted between November 2021 and January 2022 with a total of 13 laboratory staff trained. Participants had previously received a median of 2.3 months (IQR 1-7 months) of training time in microbiology. There was a substantial improvement in written assessment scores from a median of 46/100 pre-training (IQR 36-64) to a median of 90/100 post-training (IQR 85-92). The largest improvements were seen amongst staff with the lowest prior levels of microbiology training (MLS Diploma), though improvements were also seen for staff with BSc and MSc qualifications. Practical assessment included use of standardized organisms – all participants performed well in this practical assessment. Conclusion: We found that prior to the training, all staff performed relatively poorly on a standardized assessment regarding knowledge and processing of urine samples. However, all staff substantially improved following this 5-day training delivered by a single trainer. We estimated that the cost of delivering this training for one hospital was approximately KES 500,000. Training microbiology staff in the accurate processing of urine sample will be an important activity for a Kenyan AMR surveillance system. These training materials, if delivered by an experienced trainer, can achieve a clear improvement in knowledge levels and practical competence.