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

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

doi:10.1186/s41182-016-0038-1

Akihiro Wada, Mohamed Karama + Show 7 more

Open Access

https://doi.org/10.1186/s41182-016-0038-1

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Abstract

BackgroundThe epidemiology of enteric pathogens has not been well studied in Kenya because of wide disparities in health status across the country. Therefore, the present study describes the prevalence of enteropathogenic bacteria, their seasonal variation, and antibiotic resistance profiles among hospitalized diarrheic children in a suburban region of central Kenya.MethodsFecal samples were collected between July 2009 and December 2013 from a total of 1410 children younger than 5 years, hospitalized with acute diarrhea in Kiambu County Hospital, Kenya. Conventional culture, biochemical, and molecular methods were conducted to identify causative bacterial pathogens and their virulence factors. Antimicrobial susceptibility tests were performed using E-test strips and VITEK-2 advanced expert system (AES) to evaluate the drug-resistance pattern of the isolates.ResultsOf the 1410 isolates, bacterial infections were identified in 474 cases. Diarrheagenic Escherichia coli (DEC) was the most frequently isolated pathogen (86.5%). Other pathogens such as Aeromonas (5.5%), Shigella (4%), Salmonella (3.4%), Providencia (3.2%), Vibrio spp. (1.1%), Yersinia enterocolitica (1.1%), and Plesiomonas shigelloides (0.2%) were also identified. Mixed bacterial infection was observed among 11.1% of the cases. The highest infection rate was found during the dry season (59.3%, p = 0.04). Most of the DEC was found to be multidrug resistant to trimethoprim/sulfamethoxazole 97.6%, amoxicillin 97.6%, erythromycin 96.9%, ampicillin 96.6%, and streptomycin 89%.ConclusionsThis study suggests that DEC is the leading diarrhea-causing bacterial pathogen circulating in central Kenya, and seasonality has a significant effect on its transmission. Proper antibiotic prescription and susceptibility testing is important to guide appropriate antimicrobial therapy.

Highlights

The epidemiology of enteric pathogens has not been well studied in Kenya because of wide disparities in health status across the country
Characteristics of the study population During the period between July 2009 and December 2013, a total of 1416 fecal samples were obtained from children hospitalized in Kiambu County Hospital (KCH) with acute diarrhea accompanied by vomiting (64.7%), dehydration (40.6%), and fever (28.7%) for rotavirus pre-vaccination surveillance study (Table 1)
The present study describes the burden of enteric bacterial pathogens in suburban settings of central Kenya

Summary

Introduction

The epidemiology of enteric pathogens has not been well studied in Kenya because of wide disparities in health status across the country. Despite significant advances in the understanding of pathogenesis and management, globally acute diarrhea remains the second leading cause of death in children under 5 years of age [1]. It is estimated that globally, 800,000 children under the age of 5 years die annually, mostly in sub-Saharan Africa and South Asia [2]. In sub-Saharan Africa including Kenya, urban migration is on the rise, resulting in rapid expansion of cities. Diarrhea remains a wet season disease with bacteria playing a greater role [5], rotavirus has been found to be a single dominant enteric pathogen among children in most of the developed and developing countries [6]. Prevention, active intervention, and response are not well defined at the regional or national level

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