Antibiotic resistance patterns of intestinal Escherichia coli isolates from Nicaraguan children

Abstract

In developing countries, diarrhoeal diseases are one of the major causes of death in children under 5 years of age. It is known that diarrhoeagenic Escherichia coli (DEC) is an important aetiological agent of infantile diarrhoea in Nicaragua. However, there are no recent studies on antimicrobial resistance among intestinal E. coli isolates in Nicaraguan children. The aim of the present study was to determine the antimicrobial resistance pattern in a collection of 727 intestinal E. coli isolates from the faeces of children in Leó n, Nicaragua, between March 2005 and September 2006. All samples had been screened previously for the presence of DEC by multiplex PCR. Three hundred and ninety-five non-DEC isolates (270 from children with diarrhoea and 125 from children without diarrhoea) and 332 DEC isolates (241 from children with diarrhoea and 91 from children without diarrhoea) were analysed in this study. In general, antimicrobial resistance among the 727 intestinal E. coli isolates was high for ampicillin (60 %), trimethoprimsulfamethoxazole (64 %) and chloramphenicol (11 %). Among individual E. coli categories, enteroaggregative E. coli isolates from children with and without diarrhoea exhibited significantly higher levels of resistance (P,0.05) to ampicillin and trimethoprim-sulfamethoxazole compared to the other E. coli categories. Resistance to ceftazidime and/or ceftriaxone and a pattern of multiresistance was related to CTX-M-5-or CTX-M-15-producing E. coli isolates. The results suggest that E. coli isolates from Nicaraguan children have not reached the high levels of resistance to the most common antibiotics used for diarrhoea treatment as in other countries. INTRODUCTIONIn developing countries, diarrhoeal diseases are one of the major causes of death in children under 5 years of age (Boschi-Pinto et al., 2008;Bryce et al., 2005). Since the disease is generally self-limiting, antimicrobial agents are not usually recommended for treatment of diarrhoea (Gadewar & Fasano, 2005). However, there are some exceptions, i.e. to prevent diarrhoea in travellers (DuPont, 2005), to shorten the course of the disease when the pathogen has been identified and to prevent transmission of the disease (Gadewar & Fasano, 2005;O'Ryan et al., 2005).Diarrhoeagenic Escherichia coli (DEC) strains are among the bacteria most frequently associated with diarrhoea in children from developing countries (O'Ryan et al., 2005;Thapar & Sanderson, 2004). There are six pathotypes of DEC: enterotoxigenic E. coli (ETEC), enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterohaemorrhagic E. coli (EHEC) or verocytotoxin-producing E. coli, enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (Kaper et al., 2004;Nataro & Kaper, 1998). Reports of antibiotic resistance have increased steadily in DEC isolates affecting children and travellers (Djie-Maletz et al., 2008; Estrada-García et al., 2005;Mendez Arancibia et al., 2009;Nguyen et al., 2005; Ochoa et al., 2009;Vila et al., 2001). Resistance to antibiotics such as ampic...

Epidemiology and Clinical Manifestations of Enteroaggregative Escherichia coli

“…The majority of the multidrugresistant strains were identified in children Ͻ5 years old; this may be caused by the higher prevalence of EAEC in this age group and by colonization rather than infection, leading to a long-term carrier state, which may facilitate antibiotic pressure. This statement is supported by another study investigating ESBL production by EAEC strains, which was detected in 1.5% of children with diarrhea and in 4.3% of children without diarrhea (determined by PCR targeting the CTX-M enzyme) (108). This study was performed in 2008 to 2009 in Nicaragua, and EAEC strains were found to have levels of resistance to ampicillin and trimethoprimsulfamethoxazole that were significantly higher than those of EHEC and EPEC strains (P Ͻ 0.005) and to have higher levels of resistance to amoxicillin than ETEC strains (P ϭ 0.021).…”

“…In addition, extended-spectrum beta-lactamase (ESBL) production and increased resistance to quinolones in EAEC strains have been described (108,(115)(116)(117). A study conducted in southern India (118) investigated 64 EAEC strains and reported that 75% of the strains were multidrug resistant, and resistance to ciprofloxacin was found in 63.5% of the strains.…”

Current perspectivesin pathogenesis and antimicrobial resistance of enteroaggregative Escherichia coli

“…Similar studies from China [48] and Nicaragua [49] have shown the trend in emergence of multidrug-resistant strains. Chen et al [48] investigated 347 DEC isolates from southeast China and found the multidrug resistance phenotype for 70.2%; in addition, 91.8% of these strains from Chinese patients were resistant to ampicillin, which was higher than the rate reported from the Nicaraguan study (67.7%) [49] and the Iranian study (62.0%) [50]. The Nicaraguan and Iranian studies also showed similar resistance rates for tetracycline and trimethoprim-sulfamethoxazole (>50%).…”

“…For example, the clinical EAEC isolates show a higher resistance in general to the most commonly used antibiotics compared to the other DECs [48,49,51]. In a Peruvian study of infectious diarrhea in infants, EAEC was found to be the most common DEC, and that it had significantly higher resistance to ampicillin, cotrimoxazole, tetracycline and nalidixic acid than the ETEC and EPEC isolates examined from the study population [7,52].…”

Phylogenetic Analysis of Enteroaggregative Escherichia coli (EAEC) Isolates from Japan Reveals Emergence of CTX-M-14-Producing EAEC O25:H4 Clones Related to Sequence Type 131

“…We previously reported that 36.8% of the aggR gene-positive EAEC strains isolated from diarrheal children in Kagoshima, Japan, were cefotaxime resistant (22), suggesting ESBL production. Subsequently, some CTX-M-producing EAEC strains were reported worldwide (23)(24)(25)(26), including an EAEC-Shiga toxin-producing E. coli (STEC) hybrid clone of O104:H4 that caused a large outbreak in Germany in 2011 (27).…”