IntroductionAntimicrobial resistance (AMR) is a growing public health problem in low-to-middle income countries which have a high burden of infectious diseases. Poor antimicrobial stewardship in these regions has resulted in a rise in reported cases of AMR creating a need for country specific data to inform policy on the strategies of combating AMR. Here we show antimicrobial susceptibility patterns of Shigella, and E. coli isolated from stools of children under 5 years of age and adults. MethodsThe study was nested under an enterotoxigenic Escherichia coli (ETEC) vaccine clinical trial and diarrhoea surveillance. Stool samples were collected at baseline, during scheduled visits and whenever the participants presented with diarrhoea as per study design. Following microbiological techniques for culture and microorganism identification, pure colonies were run on the BD Phoenix™ 100 for identification and antimicrobial susceptibility. For ETEC identification, colony PCR was done on all E. coli positive samples using heat-labile toxin and stable toxin specific primers, respectively.ResultsAmong the 211 samples analysed, 52.5% were from individuals with diarrhoea. Un-typed E. coli were the most common organism isolated (63.6%), followed by ETEC (12.7%) and 4.8% were Shigella sp. Majority of the organisms isolated were either susceptible or intermedial (80-100%) to all tested antibiotics except for Trimethoprim/Sulfamethoxazole which showed a high resistance of 82 – 93%. We also observed some multi-drug resistance (3.5%) among all organisms tested to the different antibiotics.ConclusionsThe observed high prevalence of co-trimoxazole resistance and intermedial susceptibility to fluoroquinolones among ETEC, Shigella and other un-typed E. coli isolates, is critical for informing policy on the urgent need for antimicrobial stewardship and strengthening of AMR surveillance systems in Zambia.
Background Enterotoxigenic Escherichia coli (ETEC) is one of the top aetiologic agents of diarrhea in children under the age of 5 in low-middle income countries (LMICs). The lack of point of care diagnostic tools for routine ETEC diagnosis results in limited data regarding the actual burden and epidemiology in the endemic areas. We evaluated performance of the novel Rapid LAMP based Diagnostic Test (RLDT) for detection of ETEC in stool as a point of care diagnostic assay in a resource-limited setting. Methods We conducted a cross-sectional study of 324 randomly selected stool samples from children under 5 presenting with moderate to severe diarrhea (MSD). The samples were collected between November 2012 to September 2013 at selected health facilities in Zambia. The RLDT was evaluated by targeting three ETEC toxin genes [heat labile toxin (LT) and heat stable toxins (STh and STp)]. Quantitative PCR was used as the “gold standard” to evaluate the diagnostic sensitivity and specificity of RLDT for detection of ETEC. We additionally described the prevalence and seasonality of ETEC. Results The study included 324 participants, 50.6% of which were female. The overall prevalence of ETEC was 19.8% by qPCR and 19.4% by RLDT. The children between 12 to 59 months had the highest prevalence of 22%. The study determined ETEC toxin distribution was LT 28/321(9%), ST 18/321(6%) and LT/ST 16/321(5%). The sensitivity and specificity of the RLDT compared to qPCR using a Ct 35 as the cut-off, were 90.7% and 97.5% for LT, 85.2% and 99.3% for STh and 100% and 99.7% for STp, respectively. Conclusion The results of this study suggest that RLDT is sufficiently sensitive and specific and easy to implement in the endemic countries. Being rapid and simple, the RLDT also presents as an attractive tool for point-of-care testing at the health facilities and laboratories in the resource-limited settings.
Background Enterotoxigenic Escherichia coli (ETEC) is one of the top aetiologic agents of diarrhea in children under the age of 5 in low-middle income countries (LMICs). The lack of point of care diagnostic tools for routine ETEC diagnosis results in limited data regarding the actual burden and epidemiology in the endemic areas. We evaluated performance of the novel Rapid LAMP based Diagnostic Test (RLDT) for detection of ETEC in stool as a point of care diagnostic assay in a resource-limited setting. Methods We conducted a cross-sectional study of 324 randomly selected stool samples from children under 5 presenting with moderate to severe diarrhea (MSD). The samples were collected between November 2012 to September 2013 at selected health facilities in Zambia. The RLDT was evaluated by targeting three ETEC toxin genes [heat labile toxin (LT) and heat stable toxins (STh, and STp)]. Quantitative PCR was used as the “gold standard” to evaluate the diagnostic sensitivity and specificity of RLDT for detection of ETEC. We additionally described the prevalence and seasonality of ETEC. Results The study included 50.6% of participants that were female. The overall prevalence of ETEC was 19.8% by qPCR and 19.4% by RLDT. The children between 12 to 59 months had the highest prevalence of 22%. The study determined ETEC toxin distribution was LT (49%), ST (34%) and LT/ST (16%). The sensitivity and specificity of the RLDT compared to qPCR using a Ct 35 as the cutoff, were 90.7% and 97.5% for LT, 85.2% and 99.3% for STh and 100% and 99.7% for STp, respectively. Conclusion The results of this study suggest that RLDT is sufficiently sensitive and specific and easy to implement in the endemic countries. Being rapid and simple, the RLDT also presents as an attractive tool for point-of-care testing at the health facilities and laboratories in the resource-limited settings.
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