A Survey of the Epidemiology and Antibiotic Resistance Patterns of Enteropathogens Isolates in an Iranian Hospital

Abstract

Background: Infectious diarrhea is one of the most frequent diseases among children, especially in developing countries. Objectives: The aim of this study was to determine the etiological agents and drug resistance patterns of common enteric pathogens isolated in an Iranian 1000-bed tertiary care hospital. Patients and Methods:In a retrospective study, we analyzed the etiology and drug resistance patterns of enteric pathogens associated with diarrheal cases. The study was carried out in the Milad hospital of Tehran over two years, from April of 2012 to January of 2014. Stool specimens from patients with diarrhea (n = 7321) were examined for enteric pathogens using routine microbiological culture methods. Strains of Salmonella, Shigella, and enteric pathogenic E. coli (EPEC) were serotyped and their susceptibility to commonly used antimicrobial agents was determined by a disk diffusion method, as recommended by the clinical and laboratory standards institute (CLSI) guidelines. Results: Enteric pathogens were isolated from 310 (4.23%) of the patients. The most frequently isolated microorganisms included enteropathogenic E. coli (EPEC), Salmonella, and Shigella spp. The majority of the isolates of EPEC were resistant to commonly used antibiotics such as ampicillin (85.61%), cefixime (79.41%), and nalidixic acid. Resistance among other enteric pathogens was also prevalent. About 45.70% of the Salmonella isolates were resistant to chloramphenicol, and 87.95% were resistant to sulfamethoxazole/trimethoprim. Resistance of the Shigella isolates to nalidixic acid in comparison to the resistance recorded in previous studies was higher. Conclusions:The results show that enteric bacteria, including EPEC, Salmonella spp., and Shigella spp. are the major causative agents of diarrhea in the hospital. The emergence of antimicrobial resistance among enteric pathogens is an important problem for public health. Considering the threat of emerging antimicrobial resistance among enteric pathogens, a better surveillance system is necessary.

DiarrheagenicEscherichia coliandShigellawith High Rate of Extended-Spectrum Beta-Lactamase Production: Two Predominant Etiological Agents of Acute Diarrhea in Shiraz, Iran

“…had been isolated most frequently in diarrhea cases. 35 The Shigella isolation rate in our study was much higher than that from studies carried out in other Asian countries as well as developed countries (1–5%). 36 , 37 Our result indicates that shigellosis is still an important public health problem in Iran and we should bring more awareness to safety of food, water, and sanitary condition to control and prevent the spread of shigellosis.…”

High frequency of antimicrobial resistance in Salmonella and Escherichia coli causing diarrheal diseases at the Yirimadio community health facility, Mali

“…In Iran, surveillance carried out in a hospital environment over 2 years in Tehran reported a bacterial isolation rate of 4.23% (310/7321) [ 20 ]. This prevalence is lower than ours.…”

“…This difference would be due to the hospital origin of the cases of diarrhea recorded in Tehran against a community origin in our study. E. coli represented 146 cases out of 310, that’s almost half isolated only from children less than 10 years [ 20 ] .…”