Etiology of childhood diarrhoea among under five children and molecular analysis of antibiotic resistance in isolated enteric bacterial pathogens from a tertiary care hospital, Eastern Odisha, India

Abstract

BackgroundAlthough, India has made steady progress in reducing deaths in children younger than 5 years, the proportional mortality accounted by diarrhoeal diseases still remains high. The present hospital based cross sectional study was carried out to understand the prevalence of various bacterial pathogens associated with the diarrhoea cases in under 5 years age group.MethodsDuring, 1st September, 2015 to 30th November 2017, all the childhood diarrhoea cases (≤5 yrs) of SCB Medical College in Odisha, India were included in the study. Stool samples were collected and processed for the isolation of causative bacterial pathogen and the isolated bacterial pathogens were subjected to antibiotic sensitivity testing, molecular analysis of drug resistance. Clinical and demographic data were collected and analyzed.ResultsThree hundred twenty patients were enrolled in the study during the study period from whom 82 bacterial isolates were obtained indicating a proportional causality of 25.6% for bacterial diarrhoea among children in this region. Entero toxigenic E.coli (ETEC) accounted for majority of the cases and and more than 50% of the strains were found to be multi-drug resistant (resistant to more than 3 class of antibiotics). More than 50% of the strains were resistant to current choice of treatment like ciprofloxacin, ofloxacin and ceftriaxone and 2.4% being resistant to Imipenem. ESBL production was also observed in some of the strains and one isolate harboured the NDM-1 gene. Fluoroquinolone resistance was found to be linked with multiple mutations in the QRDR region followed by PMQR determinants.ConclusionThe current study, to the best of our knowledge is first of its kind which demonstrated the etiology of bacterial diarrhoea in children less than 5 years old and identified diarrheogenic E. coli as the predominant enteropathogen in Odisha. Majority of the isolates being multi-drug resistance calls for a continuous surveillance system in the region which will be helpfulin identifying emerging resistance pattern and for developing suitable intervention stategies.

Comparative analysis of virulence determinants, phylogroups, and antibiotic susceptibility patterns of typical versus atypical Enteroaggregative E. coli in India

“…Phylogenetic classes vary in their genotypic and phenotypic characteristics, their profiles of antibiotic resistance and virulence genes [22]. Throughout India, EAEC remains the most prevalent pathotype isolated from diarrheal diseases below age 5 years [23]. In the Global Enteric Multicenter Study (GEMS), a prospective casecontrol study of moderate to severe diarrhea in 0-59 month old children living in Africa and Asia, the attributable fraction of EAEC to moderate and severe diarrhea in Bangladesh was 9.9% among 12-23-month-olds [24].…”

The Potential Treatment of Guava Leaf (Psidium guajava Linn.) For Diarrhea in Children

“…4 Rotavirus and Escherichia coli are the two most common causes of diarrhea in developed countries. 5 According to the World Health Organization 2013, therapy of diarrhea in children is rehydration by giving more fluid, zinc supplementation, and continue breastfeeding. 2 Some studies about using alternative treatment were revealing in Indonesia.…”

Real-time multiplex PCR assay reveals the increased prevalence of Campylobacter spp and diarrhoeagenic Escherichia coli in humans from Vellore, South India

“…coli (ETEC) are frequently seen in developing countries in Sub-Saharan Africa, South Asia, South America and the Pacific Islands. The aetiology of viral diarrhoea is similar between developed and developing countries [1, 4, 5].…”

“…Diarrhoeal diseases are a major contributory factor for morbidity and mortality in low- to middle-income countries and the second leading cause of death in children less than 5 years of age [1–3]. The aetiology of infectious diarrhoea is diverse among regions with changes in economy and hygiene.…”