Antibiotic Susceptibility Profile of Enteric Bacterial Isolates from Stool in Children below Five Years with Diarrhoeal Disease in Muranga County, Kenya
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Date
2019-06
Authors
Mbuthia, Oliver Waithaka
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Diarrhoea is a major cause of morbidity and mortality in developing countries. Bacterial agents are among pathogens implicated to cause diarrhoea in children and are of major concern in public health. Antibiotic use has paradoxically led to bacterial resistance and the situation continues to worsen. The main objective of the study, therefore, was to determine enteric bacterial isolates and their susceptibility to antibiotics from diarrhoeal stool samples among children below five years in Murang`a County. A hospital-based cross-sectional study approach was applied to 163 randomly selected diarrhoeal stool samples from children below five years in Murang`a and Muriranja`s hospitals. Enteric bacterial pathogens were cultured and identified using polymerase chain reaction and biochemical methods. A questionnaire was used to collect information from the guardian. Statistical analyses were performed using STATA v.13. Fisher’s exact test was used to check for evidence of relationship (p<0.05). Regression model analysis was used to estimate the association between pathogenic bacterial isolates and demographic, clinical, and hygienic factors. There were nearly equal distributions in gender 86(52.8%) female vs. 77(47.2%) male, the majority (35.6%) aged within 1 day - 12 months. Clinically, 153(93.9%) had a fever, while 117(71.8%) had a nutritional problem. A total of 188 enteric bacterial isolates belonging to 11 genera were recovered from stool samples of children under investigation. Predominant bacteria from stool samples was nonpathogenic Escherichia coli 85(43.8%), while 13(7.0%) E. coli were positive for virulence genes, including 8(4.3%) positive for both LT and STp Shiga-like or Enterotoxigenic E. coli, 3(1.6%) for eae Enteropathogenic E. coli and 2(1.1%) for Enteroaggregative E. coli gene. Others included: Salmonella 21(10.8%), Pseudomonas 14(7.2%), Shigella 14(7.2%), Klebsiella 12(6.2%), Aeromonas 8(4.1%), Enterobacter 7(3.6%), Proteus 8(4.1%), Citrobacter 3(1.6%), Yersinia 2(1.1%) and Vibrio species 1(0.5%). Children between 1 day - 12 months (OR 0.3, 95% CI 0.1-0.8) were more likely to be infected with pathogenic bacteria than those between 49-60 months. Enteric bacterial isolates were highly diverse in female and among those aged 49-60 months. Female participants (OR 1.8, 95% CI 1.1-3.4) were nearly twice likely to be infected with pathogenic bacteria. Those who presented with watery stool (OR 0.4, 95% CI 0.2-0.9) or mucoid stool (OR 0.3, 95% CI 0.2-0.7) remained associated with pathogenic bacterial infection but less likely to be infected compared to those who presented with watery-blood stained stools. Piped water and storing water with a lid were associated with a less bacterial infection. Almost all the isolates were resistant to Ampicillin, Amoxicillin, Chloramphenicol, Ciprofloxacin, Ceftriaxone, Kanamycin and Cotrimoxazole. Bacterial identification and subsequent antibiotic susceptibility testing from stool samples should be scaled up to confirm and guide therapeutic use thereby minimizing bacterial resistance
Description
A Thesis Submitted in Partial Fulfillment of the Requirements for the Award of the Degree of Master of Science (Infectious Diseases) in the School of Medicine of Kenyatta University. June 2019
Keywords
Enteric Bacterial, Children below Five Years, Diarrhoeal Disease, Muranga County, Kenya