Abstract
BackgroundReduced antimicrobial susceptibility threatens treatment efficacy in sub-Saharan Africa, where data on the burden and correlates of antibiotic resistance among enteric pathogens are limited.MethodsFecal samples from children aged 6 mos—15 yrs presenting with acute diarrhea in western Kenya were cultured for bacterial pathogens. HIV-uninfected children with identified Shigella or Salmonella species or pathogenic Escherichia coli (EPEC, ETEC, EAEC or EIEC) were included in this cross-sectional sub-study. Non-susceptibility to ampicillin, ceftriaxone, ciprofloxacin, cotrimoxazole, and tetracycline was determined using MicroScan Walkaway40 Plus. Multivariable log-binomial regression was used to identify correlates of multi-drug non-susceptibility (MDNS, non-susceptibility to ≥ 3 of these antibiotics).ResultsOf 292 included children, median age was 22.5 mos. MDNS was identified in 62.5% of 318 isolates. Non-susceptibility to cotrimoxazole (92.8%), ampicillin (81.3%), and tetracycline (75.0%) was common. Young age (6–24 mos vs. 24–59 mos adjusted prevalence ratio [aPR] = 1.519 [95% confidence interval: 1.19, 1.91]), maternal HIV (aPR = 1.29 [1.01, 1.66]); and acute malnutrition (aPR = 1.28 [1.06, 1.55]) were associated with higher prevalence of MDNS, as were open defecation (aPR = 2.25 [1.13, 4.50]), household crowding (aPR = 1.29 [1.08, 1.53]) and infrequent caregiver hand-washing (aPR = 1.50 [1.15, 1.95]).ConclusionsYoung age, HIV exposure, acute malnutrition and poor sanitation may increase risk of antibiotic non-susceptible enteric pathogen infections among children in Kenya.
Highlights
Diarrheal diseases account for an estimated 10% of childhood deaths in Sub-Saharan Africa [1]
We found that children with limited access to flushing toilets and those who lived in crowded homes were more likely to have resistance to at least three antibiotics
Bacterial enteric infections such as Shigella species, Salmonella spp., and pathogenic Escherichia coli (E. coli) are leading causes of diarrhea[2,3] and the attribution of diarrhea cases to these bacteria appears to increase as more sensitive diagnostic tools are used[4]. These bacterial pathogens are associated with mortality[2] and linear growth faltering[5], which has cognitive, economic, and health consequences that extend into adulthood[6,7,8]
Summary
Diarrheal diseases account for an estimated 10% of childhood deaths in Sub-Saharan Africa [1] Bacterial enteric infections such as Shigella species (spp.), Salmonella spp., and pathogenic Escherichia coli (E. coli) are leading causes of diarrhea[2,3] and the attribution of diarrhea cases to these bacteria appears to increase as more sensitive diagnostic tools are used[4]. These bacterial pathogens are associated with mortality[2] and linear growth faltering[5], which has cognitive, economic, and health consequences that extend into adulthood[6,7,8]. Reduced antimicrobial susceptibility threatens treatment efficacy in sub-Saharan Africa, where data on the burden and correlates of antibiotic resistance among enteric pathogens are limited
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