Abstract
Antibiotic resistance in bacterial pathogens is a global health challenge linked to high morbidity and mortality. This study was carried out among under-five children attending three major hospitals in Kano State namely: Murtala Muhammad Specialists Hospital (MMSH), Wudil General Hospital (WGH) and Bichi General Hospital (BGH), representing the three senatorial districts. Rectal swab specimens from 400 diarrhoeic and 50 non-diarrhoeic children were collected with a sterile transport swab containing Carry-Blair Medium. These were inoculated onto MacConckey and Salmonella-Shigella Agar and incubated at 37°C for 18-24 hours for isolation of bacteria. Bacterial isolates were subjected to battery of biochemical tests (IMViC and KIA) for the identification of <i>Escherichia coli</i>. Antimicrobial susceptibility test (AST) was carried out on <i>E. coli</i> isolated using modified Kirby-Bauer method. The findings revealed 74% and 66% <i>E. coli</i> recovery from case and control subjects respectively. The AST revealed trimethoprim-sulfamethoxazole 75.1% was the most resisted antibiotic, significantly different between the case subjects (<i>P</i>-value=0.031), 83% were resistant to at least one class of antibiotic, 44.4% resistant to two classes of antibiotics and significantly higher in the control group (<i>P</i>-value=0.006) and 8.0% MDR rate. Female subjects shows higher resistance to the tested antibiotics but the differences were only significant in amoxicillin-clavulanic acid (49.6% versus 32.9%; <i>P</i>-value=0.003) and trimethoprim-sulfamethoxazole (91.7% versus 57.1%; <i>P</i>-value=0.037) in the case and control group respectively. It can be concluded that <i>E. coli</i> is the predominant agent associated with diarrhoea in Kano children and high resistance of trimethoprim-sulfamethoxazole is noteworthy. Hence the need to revise the current diarrhoea treatment regimen for Kano children.
Highlights
Antibiotics have accelerated the reduction of infectious disease, saving lives of millions of people in the developed and developing world [1]
The distribution of E. coli isolation according to the socio-demography and clinical characteristics of diarrhoeic and non-diarrhoeic children in Kano state (Table 2), proportion of female was significantly higher within the case subjects (56.41%, P-value=0.016) and more common in subjects within the age group 0-12months (124/400, 37.6%)
A relatively higher rate of resistance to the tested antibiotics were observed among those recovered from children attending Bichi General Hospital (BGH) (CTX; 13.95%, AMC; 43.02%, CIP; 10.46% and as well as resistance to 2 classes of antibiotics; 45.35%) and Wudil General Hospital (WGH) (CAZ; 23.59%, CN; 6.74%, SXT; 84.27% and as well as resistance to a class of antibiotic; 88.76%) but significant different only obtained in trimethoprimsulfamethoxazole (P-value=0.031)
Summary
Antibiotics have accelerated the reduction of infectious disease, saving lives of millions of people in the developed and developing world [1]. AMR is the resistance developed by microorganism to antimicrobials that was originally effective for treatment of infections caused by those microbes [2, 3]. There has been an increase in the incidence of bacteria resistant to multiple antibiotics commonly used in treatment of infections [5]. Increased antibiotic resistance in pathogens have potentially catastrophic consequences leading to increased morbidity and mortality [5], growing healthcare cost, prolonged hospital stay, as-well as treatment failure for both developing and developed nations [7, 8]. Antibiotic usage play a central role in the emergence of AMR in developing countries as well as worldwide [5]. Escherichia coli has been identified as the main carrier of antibiotic resistance in a between-species comparison of enteric bacteria isolated from faecal samples [7]. Resistant E. coli are classified by WHO as one of the seven bacteria of
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