Emerging Antimicrobial Resistance Patterns of Enteric Pathogens Isolated from Children under 5 years in EAPHLNP Satellite Sites in Kenya

Abstract

Introduction: The emergence of resistance to antimicrobial agents in bacterial pathogens is a worldwide
problem that has been associated with inappropriate use in human and veterinary medicine.
Epidemiological studies from several African countries by the year 2001 established that, diarrhoea
was the most common illness reported by the United States military service members deployed to
Africa for strategic training and contingency operations. Out of 15,000 US military personnel who
participated, more than 500 service members were affected by acute diarrhoea [7].

Objective: To determine the susceptibility of common circulating enteric bacterial pathogens to antimicrobials.

Methodology: Between 12th February 2013 and 30th July 2014, a total of 420 children under 5 years of age with diarrhea were analyzed for bacterial enteric pathogens of which E. coli isolates were characterized by Polymerase Chain Reaction for the presence of virulence genes.

Results:  Patients from whom bacterial enteric pathogens were isolated and identified from the 5 satellite sites were= 145, Wajir = 21, Malindi= 42, Kitale = 34, Machakos = 18 and Busia = 30 County Referral Hospitals. Antibiotic susceptibility testing was done on all isolates: pathogenic E. coli = 55, Salmonella =23 and Shigella =72 using disk-diffussion methods containing Ampicillin, Cefotaxime, Tetracycline, Erythromycin Gentamicin, Chloramphenicol, Trimethoprim / Sulphamethoxazole, Ciprofloxacin, Furasolidine and Nalidixic acid. E. coli, Shigella and Salmonella isolates showed up to 100% level of resistance to ampicillin, trimethoprin / sulphamethoxazole and erythromycin.
Furthermore, pathogenic E. coli revealed tetracycline resistance ranging from 67% to 76% in all sites. Emerging resistance to ciprofloxacin ranged from 14.3% in Wajir to 50.0% in Machakos and gentamycin resistance ranged from 20% in Kitale to 100% in Wajir. Salmonella isolates showed levels of resistance ranging from 25% to 100% in Busia and 14% to 100% in Wajir for all the antimicrobials tested.
Conclusion: Our findings on diarrhea due to enteric bacteria show that a high percentage is caused by antimicrobial-resistant strains, thus illustrating the effect of long-standing unregulated antimicrobial use. Most enteric pathogens easily share genes for antimicrobial  resistance. There was emerging resistance to newly prescribed antibiotics. This may have policy implications on the use of antibiotics in Kenya