Antimicrobial Resistant Escherichia Coli Genes in Children Aged Below Five Years Presenting with Diarrhoea at Thika Level 5 Hospital, Kiambu County, Kenya
Kang'ethe, Kamwati Stanley
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Diarrhoea is one of the leading causes of illness and death among children in developing countries, where an estimated 1.3 billion episodes and 4 to 10 million deaths occur each year in children less than 5 years of age. The study envisioned to determine the genetic basis of extended spectrum β-lactam (ESBL) resistance in E. coli isolated from children aged below 5 years attending Thika Level 5 Hospital Kiambu County in Kenya. Faecal samples were obtained from 384 children presenting with diarrhoea. A questionnaire was used to collect data concerning the age of the child, gender and additional information recorded included on history of hospitalization and antibiotic use. Samples were sub-cultured on MacConkey agar and suspect E. coli isolates identified. Antimicrobial susceptibility profiles were determined for the most common antimicrobials against Gram-negative bacteria. The types and prevalence of Extended-Spectrum βeta-Lactamases were also determined. Polymerase Chain Reaction methods were used for detection of the Extended-Spectrum βeta-Lactamases genes and carriage of integrons. Conjugation experiments were performed to determine the potential of horizontal transfer of resistance genes. The plasmid content for defining diversity of plasmid replicon types was also determined among donors and transconjugants. Approximately 25% of all isolates were resistant to ampicillin, tetracycline, chloramphenicol, streptomycin, amikacin sulphamethoxazole-trimethoprim and amoxicillinclavulanic acid (p=0.0051; OR=2.27; 95% CI: 2.01-2.33). Isolates (50%) had a Minimum Inhibitory Concentration mode50 value within the resistance range except for ceftazidime, Gentamicin, chloramphenicol, Nalidixic acid, Ciproflocin and Kanamycin. Factors identified to predispose children to carry highly resistant isolates included recent history of hospitalization and antimicrobial use and having acute diarrhoea (p=0.0026; OR=4.21; 95% CI: 3.76-4.98 ) There was no significant difference in antimicrobial resistance patterns for isolates from rural and urban children (p=0.049). Carriage of a combination of blaCTX-M+ blaTEM or a combination of blaCTX-M+blaOXA genes was highly associated with resistance to multiple β-lactams (p=0.00015; OR=2.31; 95% CI: 1.99-2.65). Isolates with multiple β-lactamases were also likely to carry integrons encoding resistance to other antimicrobials. Plasmids that mediated resistance to most antimicrobials belonged to incL/M, HI2 and F-type. In conclusion, most of isolates recovered from these children were resistant to first line treatment for diarrhoea and therefore a need to revise the existing empiric treatment of E. coli infections. Resistance was transferrable via conjugation and integrons were significantly implicated in resistance dispersion hence increase in the prevalence of multidrug resistant isolates (p=0.0017; OR: 4.03; 95% CI: 3.81- 4.04). There is a need to encourage parents and doctors to follow the treatment guidelines for diarrhoea in which case, the oral re-hydration therapy zinc and vitamin C rather than antibiotics should be administered in cases of watery bacillary diarrhoea, implement proper antimicrobial use polices and launch national surveillance programs to monitor emergence and spread of MDR isolates.