Prevalence, seasonal variation, and antibiotic resistance pattern of enteric bacterial pathogens among hospitalized diarrheic children in suburban regions of central Kenya

Shah, Mohammad Monir; Kathiiko, Cyrus; Wada, Akihiro; Odoyo, Erick; Bundi, Martin; Miringu, Gabriel; Guyo, Sora; Karama, Mohamed; Ichinose, Yuki

doi:10.1186/s41182-016-0038-1

Cited by 51 publications

(57 citation statements)

References 29 publications

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“…The overall prevalence of Shigella and Salmonella isolated in this study was 8.0% [4.6-11.4%] which is lower than compared with studies conducted in Tanzania A single S. Typhi 0.4% 95% CI [0-1.1%] was isolated in this study which is in line with the ndings reported from the same country in Addis Ababa, 0% (31), 1.1% (43), in contrast to our nding higher rates was reported from Sudan 4.0% (40), China 4.3% (27), Addis Ababa, Ethiopia 3.95% (26), Kenya 3.4% (46), Turkey 3% (47), Gondar 1.6% (48), and Hawassa 1.5% (24). This difference might be due to sampling size, weather condition and study subjects age differences.…”

Section: Discussionsupporting

confidence: 91%

The burden of Shigella and Salmonella, Antibiotics Susceptibility Pattern and Associated Risk Factors among Diarrheic Children visited Alamura Health Center Southern Ethiopia: a cross-sectional study

Eyamo

Alemayehu

Tadesse

et al. 2020

Preprint

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Background: Salmonella and Shigella is a major health problem worldwide, in developing countries like Ethiopia, it is responsible for high morbidity and mortality of children. This study aimed to determine the prevalence of Salmonella and Shigella infection, their antibiotic susceptibility pattern and associated risk factor among the diarrheic paediatrics patients that visited Alamura Health Center in southern Ethiopia. Method: A facility-based cross-sectional study was conducted at Alamura Health Center from April 2018 – July 2019. The study was performed on paediatrics below the age of 14 years in which consecutive children with diarrhoea were included for the study. A structured questionnaire was used to collect socio-demographic and clinical data after assent and consent obtained from parents or caretaker. The stool sample cultured as per the standard operating procedure (SOP) of the microbiology laboratory. Antibiogram was performed by Kirby-Bauer disc diffusion method and was interpreted based on the Clinical and laboratory standard institute guideline (CLSI) version 2018. Results: Out of 263 children enrolled in the study, 50.5 % were females. The overall, 21/263 (8 %) 95% CI, (4.6 - 11.4%) Shigella and Salmonella was isolated. Shigella dysenteriae was dominantly isolated 11 (4.2%) followed by 9(3.42%) Shigella spp, and 1(0.38%) Salmonella typhi. Highly resistance to ampicillin (71.4%), augmentin and tetracycline (61.9%) each, whereas highly sensitive to ciprofloxacin (95.2%), ceftriaxone & ceftazidime (85.9%) each, gentamycin (81%), chloramphenicol (76.2%), cefuroxime (66.7%) and cotrimoxazole (52.4%) identified. Those with habit of washing the hands of children after toilet sometimes (AOR = 235.1, 95% CI, 20.9 - 2643.3, P = .000) and store cooked food in open container for later use (AOR = 36.44, 95% CI, 5.82 - 228.06, P = .000) showed statistically significant association. Conclusion: High level of Shigella spp and one Salmonella was isolated from diarrheic children at Alamura Health Center. Shigella dysenteriae was the most dominantly isolated. Ampicillin, augmentin and tetracycline are with high resistance and ciprofloxacin, ceftriaxone, ceftazidime, gentamycin, chloramphenicol, cefuroxime and cotrimoxazole relatively sensitive. Those practised hands wash for their child after defecation for sometimes was 235.1-fold at risk of infection. Similarly, those store foods for later use in an open container was 36.44 times at risk of infection. Therefore, to alleviate this infection the concerned body should focus on giving health education for hand wash after defecation and storing food in a closed container later use is mandatory.

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Section: Discussionsupporting

confidence: 91%

The burden of Shigella and Salmonella, Antibiotics Susceptibility Pattern and Associated Risk Factors among Diarrheic Children visited Alamura Health Center Southern Ethiopia: a cross-sectional study

Eyamo

Alemayehu

Tadesse

et al. 2020

Preprint

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“…The high AMR frequencies for first-line drugs, in particular penicillins, detected in this study are similar to reports of other intestinal, extra-intestinal and environmental isolates of E. coli 22,37 . Of note, the high levels of ciprofloxacin-resistance found in this study at the Asian sites corresponded to high levels reported in clinical cases in India, Bangladesh and Pakistan 17,18,21,23,24,38 .…”

Section: Discussionsupporting

confidence: 89%

“…Of greatest concern are multi-drug resistant (MDR) E. coli (non-susceptible to one or more agents in at least three antimicrobial categories) 16 , particularly those that are fluoroquinolone resistant and/or produce extended-spectrum beta-lactamases (ESBL). While several recent studies have reported increases in ESBLs 17,18 , gentamicin 19,20 , ciprofloxacin [20][21][22][23][24] and revealed diverse AMR profiles, these data have largely come from E. coli responsible for disease in hospital settings. Thus, there remain significant gaps in knowledge of the prevalence of AMR in human intestinal E. coli populations globally, particularly in the developing nations of sub-Saharan Africa and South Asia 25 .…”

Section: Introductionmentioning

confidence: 99%

Drivers of antimicrobial resistance amongst intestinalEscherichia coliisolated from children in South Asia and sub-Saharan Africa

Ingle

Levine

Kotloff

et al. 2017

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Antimicrobial resistance (AMR) dynamics are poorly understood in developing countries, where data on the prevalence of AMR in enteric bacteria are sparse, particularly among children and in the community setting. Here we use a combination of phenotyping, genomics and antimicrobial usage data to investigate patterns of AMR amongst atypical enteropathogenic E. coli (aEPEC) strains isolated from children <5 years old in seven countries (four in sub-Saharan Africa and three in South Asia) over a three-year period. We detected very high rates of AMR, with 65% of isolates displaying resistance to ≥3 drug classes; the rates of AMR were the same amongst strains associated with diarrhea and strains that were carried asymptomatically. Whole genome sequencing identified a diversity of genetic mechanisms for AMR, which could explain >95% of observed phenotypic resistance. Analysis of AMR gene co-occurrence revealed clusters of acquired AMR genes that were frequently co-located on small plasmids and transposons, providing opportunities for acquisition of multidrug resistance in a single step. We used discriminant analysis to investigate potential drivers of AMR within the bacterial population, and found that genetic determinants of AMR were associated with geographical location of isolation but not with phylogenetic lineage of the E. coli strain or disease status of the human host. Comparison with antimicrobial usage data showed that the prevalence of resistance to newer drugs (fluoroquinolones and third-generation cephalosporins) was correlated with usage, which was generally higher in South Asia than Africa. In particular, fluoroquinolone resistance-associated mutations in gyrA were significantly associated with use of these drugs for treatment of diarrheic children. Notably resistance to older drugs such as trimethoprim, chloramphenicol and ampicillin, which are conferred by acquired AMR genes that were frequently clustered together in mobile genetic elements, were common in all locations despite differences in usage; this suggests that reversion to sensitivity is unlikely to occur even if these drugs are removed from circulation. This study provides much-needed insights into the frequencies of AMR in intestinal E. coli in community-based children in developing countries and to antimicrobial usage for diarrhea where the burden of infections is greatest.

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“…This was also the case for the ETEC and EAEC pathotypes, but a 382 reverse pattern was observed for STEC and EPEC, in a way that their prevalence was slightly 383 lower during warmer seasons than cooler seasons. These results are in line with previous 384 studies in Mexico (41) and Kenya (42 sampling proportion of 1:2 for provinces. We also sampled provinces in a way that an even 396 distribution of sampled provinces is reached throughout the country.…”

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confidence: 93%

Frequency of fiveEscherichia Colipathotypes in Iranian adults and children with acute diarrhea

Eybpoosh

Mostaan

Gouya

et al. 2019

Preprint

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20Background: knowledge about the distribution of Escherichia Coli (E. coli) pathotypes in Iran is 21 limited to studies with small scale and limited scope. This nation-wide survey aims to provide a 22 more generalizable estimate of pathogenic E. coli distribution in Iran. 23 acute diarrhea cases of 15 provinces. Culture-positive E. coli samples were tested with PCR for 25 detection of five E. coli pathotypes (STEC, ETEC, EPEC, EAEC, and EIEC). Frequency of these 26 pathotypes was estimated for different provinces, age groups, and months/seasons. 27Results: Of 1305 diarrheal samples, 979 were E. coli-positive (prevalence: 75.0%; 95% CI: 72.6, 28 77.3%). Pathogenic E. coli was detected in 659 diarrheal samples (prevalence: 50.5%; 95% CI: 29 47.8, 53.2%). STEC and EIEC was the most and the least frequent pathotypes (35.4% and 0.3%, 30 respectively). ETEC (14.0%) and EPEC (13.1%) were the second and the third frequent 31 pathotypes, respectively. EAEC was not highly prevalent (4.3%). Fars and Razavi Khorasan 32 provinces had the highest and lowest frequencies (88.7% and 34.8%, respectively). E. coli 33 pathotypes were more frequent in warmer (i.e., spring and summer) than cooler (i.e., fall and 34 winter) seasons. The highest frequency of pathogenic E. coli was observed in infants and 35 children under 5 years (73% each). There was no association between sex and pathogenic E. coli 36 infection. 37 Conclusions: Diarrheagenic E. coli may be an important cause of acute diarrhea in adults and 38 children in Iran. STEC and ETEC seem to be widespread and show a peak in warmer seasons. 39 This finding could impact the recommended use of STEC and ETEC vaccines during warmer 3 40 seasons, especially for infants, young children and elderlies. Monitoring the rate of 41 diarrheagenic E. coli infection, E. coli serotypes, and their antibiotic resistance is recommended 42 for evaluations of time-trends and effectiveness of interventions. 43 Author summary 46 Escherichia coli, also known as E. coli is a bacterium of the genus Escherichia that is normally 47 found in the lower intestine of human. Most E. coli strains are harmless, but some can cause 48 infection in the gastrointestinal tract, causing diarrhea. These pathogenic E. coli strains are 49 classified based on their mechanism of pathogenesis. In this regard, five important E. coli 50 strains include Shiga toxin-producing E. coli (STEC), enterotoxigenic E. coli (ETEC), 51 enteropathogenic E. coli (EPEC), enteroaggregative E. coli (EAEC), and enteroinvasive E. coli 52 (EIEC). In a national survey conducted in Jan 2013 till Jan 2014, we collected 1305 diarrheal 53 samples from 15 (out of 31) provinces of Iran. Of these, 979 samples (75%) were E. coli-positive 54in the culture test. Molecular tests showed that 659 samples were pathogenic E. coli, 55 suggesting that 50.5% of the diarrhea cases were induced due to pathogenic E. coli infection. 56 The most prevalent pathogenic E. coli strains in Iran were STEC (35.4%) and ETEC (0.3%), and 57 were more commonly detected in warm...

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Prevalence, seasonal variation, and antibiotic resistance pattern of enteric bacterial pathogens among hospitalized diarrheic children in suburban regions of central Kenya

Cited by 51 publications

References 29 publications

The burden of Shigella and Salmonella, Antibiotics Susceptibility Pattern and Associated Risk Factors among Diarrheic Children visited Alamura Health Center Southern Ethiopia: a cross-sectional study

The burden of Shigella and Salmonella, Antibiotics Susceptibility Pattern and Associated Risk Factors among Diarrheic Children visited Alamura Health Center Southern Ethiopia: a cross-sectional study

Drivers of antimicrobial resistance amongst intestinalEscherichia coliisolated from children in South Asia and sub-Saharan Africa

Frequency of fiveEscherichia Colipathotypes in Iranian adults and children with acute diarrhea

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