Bacterial gastroenteritis in children below five years of age: a cross-sectional study focused on etiology and drug resistance of Escherichia coli O157, Salmonella spp., and Shigella spp.

Mohammad Sharif Uddin,Md Omar Faruk,K M Shariful Islam,Suman Das,Asma Talukder,Md Mijanur Rahman,Md Imranul Hoq

doi:10.1186/s42269-021-00597-9

Abstract

BackgroundGastroenteritis is a common infectious disease in children, which results in high mortality and morbidity, especially in resource-poor countries. This study presents the selected main gastroenteritis causing bacteria, including Escherichia coli O157, Salmonella and Shigella species delineating their prevalence and resistance pattern to the clinically used antibiotics.ResultsA total of 346 stool specimens from children of clinically suspected gastroenteritis below five years have been obtained, and bacterial pathogens were recovered using selective media, biochemical and serologic tests. We found that 35 (10%) of them were confirmed bacterial gastroenteritis (BGE) with either Escherichia coli O157 (14%), Salmonella spp. (43%), and Shigella spp. (43%). Nevertheless, the prevalence of E. coli O157, Salmonella spp., and Shigella spp. in this study were documented as 1.45%, 4.34%, and 4.34%, respectively. Moreover, 2 (40%) of E. coli O157, 4 (26.67%) of Salmonella spp., and 14 (93%) of the Shigella spp. were found as multidrug-resistant. Nonetheless, Shigella spp. isolates showed 100%, 87%, and 73% resistance to cotrimoxazole, ciprofloxacin, and azithromycin respectively, while E. coli O157 showed 80% resistance to cotrimoxazole and 60% to ciprofloxacin and azithromycin. On the contrary, cotrimoxazole, ciprofloxacin, azithromycin, and tetracycline were resistant in 40%, 47%, 27%, and 53% of Salmonella spp. isolates respectively.ConclusionThese findings generate significant insights on the prevalence and antibiotic resistance of the three major gastroenteritis causing bacteria in the study area. Therefore, it will help physicians and policymakers selecting the right antibiotics in essential cases, particularly, reevaluation of recommending cotrimoxazole, ciprofloxacin, and azithromycin in the management of bacterial gastroenteritis.

Highlights

Gastroenteritis is a common infectious disease in children, which results in high mortality and morbidity, especially in resource-poor countries
In this study, a total of 346 watery stool specimens were obtained from children below five years of age, who were clinically suspected as gastroenteritis attended in the two study hospitals, and 10% (35/346) of them were infected with either one of the three targeted bacteria, Shigella spp. (n = 15, 43%), Salmonella spp. (n = 15, 43%), and E. coli O157 (n = 5, 14%), and termed as "positive with bacterial gastroenteritis (BGE)." The BGE positive cases’ median age was 11 months, and 28 (80%), 5 (14.29%), and 2 (5.71%) cases are aged < 1, 1–2, and > 2–4 years, respectively
The prevalence of BGE caused by Shigella spp., Salmonella spp., and E. coli O157 was documented as 4.34% (15/346), 4.34% (15/346), and 1.45% (5/346), respectively (Table 1)

Summary

Introduction

Gastroenteritis is a common infectious disease in children, which results in high mortality and morbidity, especially in resource-poor countries. Kingdom (Tam et al 2012), though they mostly play a role in developing countries where childhood mortality resulting from diarrheal diseases is mostly happened (Guerrant et al 2013). Shigella spp., enterotoxigenic E. coli, Vibrio spp., and Salmonella spp. are the most common causes of bacterial gastroenteritis in developing countries (O’Ryan et al 2014), even though etiologic agents may vary with geographical region. In children under five years, acute gastroenteritis (AGE) is a principal cause of mortality and morbidity, 19% of deaths and 10% of hospital admission (Oppong et al 2020) in resource-poor countries where proper hygiene, sanitation, potable water is deficient, and contaminations from food products are high (Farfán-García et al 2020)

Methods

Results

Discussion

Conclusion