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Neupane R, Bhathena M, Das G, Long E, Beard J, Solomon H, Simon JL, Nisar YB, MacLeod WB, Hamer DH. Antibiotic resistance trends for common bacterial aetiologies of childhood diarrhoea in low- and middle-income countries: A systematic review. J Glob Health 2023; 13:04060. [PMID: 37475599 PMCID: PMC10359834 DOI: 10.7189/jogh.13.04060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Diarrhoea is the second most common cause of death among children under the age of five worldwide. The World Health Organization (WHO) recommends treating diarrhoea with oral rehydration therapy, intravenous fluids for severe dehydration, and zinc supplements. Antibiotics are only recommended to treat acute, invasive diarrhoea. Rising antibiotic resistance has led to a decrease in the effectiveness of treatments for diarrhoea. Methods A systematic literature review in PubMed, Web of Science, and EMBASE was conducted to identify articles relevant to antibiotic-resistant childhood diarrhoea. Articles in English published between 1990 to 2020 that described antibiotic resistance patterns of common pathogens causing childhood diarrhoea in low- and middle-income countries were included. The studies were limited to papers that categorized children as 0-5 years or 0-10 years old. The proportion of isolates with resistance to major classes of antibiotics stratified by major WHO global regions and time was determined. Results Quantitative data were extracted from 44 articles that met screening criteria; most focused on children under five years. Escherichia coli isolates had relatively high resistance rates to ampicillin and tetracycline in the African (AFR), American (AMR), and Eastern Mediterranean Regions (EMR). There was moderate to high resistance to ampicillin and third generation cephalosporins among Salmonella spp in the AFR, EMR, and the Western Pacific Region (WPR). Resistance rates for ampicillin, co-trimoxazole, and chloramphenicol for Shigella in the AFR started at an alarmingly high rate ( ~ 90%) in 2006 and fluctuated over time. There were limited antibiotic resistance data for Aeromonas, Yersinia, and V. cholerae. The 161 isolates of Campylobacter analysed showed initially low rates of fluoroquinolone resistance with high rates of resistance in recent years, especially in the Southeast Asian Region. Conclusions Resistance to inexpensive antibiotics for treatment of invasive diarrhoea in children under ten years is widespread (although data on 6- to 10-year-old children are limited), and resistance rates to fluoroquinolones and later-generation cephalosporins are increasing. A strong regional surveillance system is needed to carefully monitor trends in antibiotic resistance, future studies should include school-aged children, and interventions are needed to reduce inappropriate use of antibiotics for the treatment of community-acquired, non-invasive diarrhoea. Registration This systematic review was registered in Prospero (registration number CRD42020204004) in August 2020.
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Affiliation(s)
- Raghavee Neupane
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Myra Bhathena
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Gopika Das
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Long
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Beard
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Hiwote Solomon
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jon L Simon
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Yasir B Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, Massachusetts, USA
- National Emerging Infectious Disease Laboratory, Boston University, Boston, Massachusetts, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Prevalence of Multidrug-Resistant Diarrheagenic Escherichia coli in Asia: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11101333. [PMID: 36289991 PMCID: PMC9598397 DOI: 10.3390/antibiotics11101333] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Diarrhea is one of the leading causes of morbidity and mortality in developing countries. Diarrheagenic Escherichia coli (DEC) is an important bacterial agent for diarrhea in infants, children, and international travelers, and accounts for more than 30% of diarrheal cases in children less than 5 years old. However, the choices of antimicrobial agents are now being limited by the ineffectiveness of many first-line drugs, in relation to the emergence of antimicrobial-resistant E. coli strains. The aim of this systematic review and meta-analysis was to provide an updated prevalence of antimicrobial-resistant DEC in Asia. A comprehensive systematic search was conducted on three electronic databases (PubMed, ScienceDirect, and Scopus), where 40 eligible studies published between 2010 and 2022 were identified. Using meta-analysis of proportions and a random-effects model, the pooled prevalence of DEC in Asian diarrheal patients was 22.8% (95% CI: 16.5–29.2). The overall prevalence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing DEC strains was estimated to be 66.3% (95% CI: 58.9–73.7) and 48.6% (95% CI: 35.1–62.1), respectively. Considering antimicrobial drugs for DEC, the resistance prevalence was highest for the penicillin class of antibiotics, where 80.9% of the DEC isolates were resistant to amoxicillin and 73.5% were resistant to ampicillin. In contrast, resistance to carbapenems such as imipenem (0.1%), ertapenem (2.6%), and meropenem (7.9%) was the lowest. The relatively high prevalence estimation signifies that the multidrug-resistant DEC is a public health threat. Effective antibiotic treatment strategies, which may lead to better outcomes for the control of E. coli infections in Asia, are necessary.
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Yue M, Liu D, Li X, Jin S, Hu X, Zhao X, Wu Y. Epidemiology, Serotype and Resistance of Salmonella Isolates from a Children's Hospital in Hangzhou, Zhejiang, China, 2006-2021. Infect Drug Resist 2022; 15:4735-4748. [PMID: 36034174 PMCID: PMC9416490 DOI: 10.2147/idr.s374658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This research investigated the dynamics of antibiotic resistance in Salmonella and the epidemiology of Salmonella infection in children. These data can aid in the prevention and control of the Salmonella epidemic and the diagnosis and treatment of salmonellosis. Methods In this study, we retrospectively reviewed and analysed data regarding epidemiology, clinical symptoms, Salmonella serotypes, and antibiotic resistance from the medical records of patients with Salmonella infections in Hangzhou Children’s Hospital from April 2006 to December 2021. Results A total of 2099 Salmonella isolates were identified during the 16-year study period, and 98.6% (2069) of the isolates were isolated from stool. About 84.5% (1773/2099) of the total Salmonella isolates were detected from May to October. The median age of the 2099 children with Salmonella infection was 1.4 years (17 months) (IQR: 0.9–2.8 years). In 1572 (74.9%) patients, the course of the disease was limited to uncomplicated gastroenteritis. S. Typhimurium (805/2099, 38.4%) was predominant, followed by S. Enteritidis (290/2099, 13.8%). The total number of serotypes and the number of less common serotypes are increasing. Nontyphoid Salmonella that cause invasive infections, including S. Typhimurium, S. Stanley, and S. Choleraesuis, accounted for 60.0% (18/30). The Salmonella strains were resistant to ampicillin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin at percentages of 71.5%, 51.5%, 36.5%, 22.4%, and 14.7%, respectively. No imipenem-resistant strains were identified. 24.8% of the isolates exhibited multidrug resistance (MDR). Conclusion S. typhimurium and S. enteritidis were the dominant serotypes in children (<2 years) with salmonella-infected arrhoea in Hangzhou, China. Ongoing serotype monitoring should be necessitated and dynamic changes in serotypes should be carefully examined to prevent the sudden outbreak of foodborne illness. Salmonella exhibits a higher rate of resistance to common antibiotics, and the risk of multidrug resistance should not be ignored. Therefore, clinicians should administer antibiotics judiciously according to the results of drug sensitivity tests.
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Affiliation(s)
- Meina Yue
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Di Liu
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Xiaoyu Li
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Shurui Jin
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Xue Hu
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Xinfeng Zhao
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Yidong Wu
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
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Nipa NJ, Aktar N, Hira HM, Akter F, Jahan D, Islam S, Etando A, Abdullah A, Chowdhury K, Ahmad R, Haq A, Haque M. Intestinal Parasitic Infections Among Pediatric Patients in a Metropolitan City of Bangladesh With Emphasis on Cryptosporidiosis. Cureus 2022; 14:e26927. [PMID: 35865179 PMCID: PMC9293268 DOI: 10.7759/cureus.26927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Gastrointestinal parasitic infections are one of the global health concerns in developing countries like Bangladesh. Among them, Cryptosporidium spp. plays an essential role in causing diarrhea, malnutrition, and poor cognitive function, especially in children. This study was conducted to identify the frequency of Cryptosporidium cases and other parasitic agents. Methods A cross-sectional observational study was conducted among 219 hospitalized children with diarrhea. The conventional microscopic technique was applied for parasitic detection. Particular staining (modified Ziehl-Neelsen) procedure was performed to identify oocysts of Cryptosporidium spp. A polymerase chain reaction (PCR) was performed to determine the SSU rRNA and gp60 gene of Cryptosporidium. Results Cysts of Giardia duodenalis (2.3%), ova of Ascaris lumbricoides (1.4%,), Trichuris trichiura (0.5%), and both A. lumbricoides and T. trichiura (0.9%) were identified in samples through wet mount preparation. The distribution of Cryptosporidium spp. as detected by the staining method and nested PCR was 1.4% and 4.1%, respectively. Conclusion Factors independently associated with Cryptosporidium infection are unsafe water, lack of regular hand washing, and insufficiency of exclusive breastfeeding. This study reports, presumably for the first time, the detection of Cryptosporidium oocysts in Chattogram metropolitan city of Bangladesh.
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Yang JJ, Lee K. Epidemiologic Changes in Over 10 Years of Community-Acquired Bacterial Enteritis in Children. Pediatr Gastroenterol Hepatol Nutr 2022; 25:41-51. [PMID: 35087732 PMCID: PMC8762604 DOI: 10.5223/pghn.2022.25.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/06/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Community-acquired bacterial enteritis (CABE) is a common problem in developed countries. It is important to understand the epidemiologic changes in bacterial pathogens for prevention and treatment. Therefore, we studied the epidemiologic changes in CABE in Korean children. METHODS A total of 197 hospitalized pediatric patients aged <19 years that presented with dysentery symptoms and showed positive polymerase chain reaction results for bacterial species in stool samples, were enrolled in this study for 10 years (June 2010 to June 2020). We classified patients in phase I (06, 2010-06, 2015) and phase II (07, 2015-06, 2020) and analyzed their epidemiologic and clinical characteristics. RESULTS The most common pathogens were Campylobacter species (42.6%) and Salmonella species were the second most common pathogens (23.9%). The abundance of pathogens decreased in the following order: Clostridium difficile (9.6%), Shigella (5.6%), and Clostridium perfringens (5.6%). Escherichia coli O157:H7 was found to be the rarest pathogen (2.0%). Campylobacter species showed an increase in the infection rate from 32.1% in phase I to 49.6% in phase II (p=0.0011). Shigella species showed a decline in the infection rate in phase I from 14.1% to 0.0% in phase II (p<0.001). C. difficile and C. perfringens showed an increase in infection rate in phase II compared to phase I, but the difference was not statistically significant. CONCLUSION The infection rate of Campylobacter species in CABE has been rising more recently, reaching almost 50%. This study may help establish policies for prevention and treatment of CABE in Korean children.
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Affiliation(s)
- Jae Jin Yang
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Kunsong Lee
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
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Samuel Amoo O, Awoderu O, Yisau J, Oladele D, David AN, Raheem T, Uwandu M, Bamidele M, Fesobi TW, AbdusSalam A, Nduaga S, Oparaugo CT, Ajayi M, Ogbonna F, Musa AZ, Adedeji A, Ige F, Ihemanma O, Nuhu B, Okebugwu U, Bello IW, Onuigbo TI, Ikemefuna AS, Oraegbu JI, Agboola H, Idris J, Ajayi A, Salako BL, Smith SI. Assessment of potential factors that support the endemicity of cholera in Nigeria from food handlers, health workers and the environment. MICROBIOLOGIA MEDICA 2021. [DOI: 10.4081/mm.2021.10058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Diarrheal diseases caused by bacterial pathogens are widespread and they result in morbidity and mortality of a lot of people yearly. The aim of this study was to assess the role of the environment, health workers and food handlers as reservoirs of Vibrio cholerae, and other diarrhea causing bacteria. Methods: Healthcare workers were proportionally selected and multistage sampling technique was adopted in selecting food handlers for the study. A total of 374 participants consisting of health workers and food handlers were recruited. Socio-demographic and clinical information were collected using questionnaires, while stool and environmental samples were also collected. Results: More female 55.9 % than male 44.1 % participated in the study and the mean age of participants was 38.7 ± 10.9. A significant number of participants identified poor hygiene practices as the major cause of diarrhea. V. cholerae O1 serotype was not detected in any of the environmental samples nor stool samples of both food handlers and health workers. However, V. cholerae (Non O1/Non O139) was isolated from the stool samples of food handlers and health workers in Kano State implying that they could be serving a source of the continuous dissemination of the pathogen. Other bacterial pathogens that are aetiology of diarrhea including Salmonella spp. Escherichia coli, Klebsiella oxytoca, and Enterobacter spp. were also isolated. Conclusion: It is therefore imperative that food handlers and health workers undergo periodic health checks to ensure they are free of pathogens they could easily transmit through food or to patients.
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Shahbazi G, Rezaee MA, Nikkhahi F, Ebrahimzadeh S, Hemmati F, Namarvar BB, Gholizadeh P. Characteristics of diarrheagenic Escherichia coli pathotypes among children under the age of 10 years with acute diarrhea. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Molina NB, Oderiz S, Vescina C, Córdoba A, Basualdo JÁ, Sparo MD. [First report of diarrheagenic Escherichia coli in pediatric outpatient population with diarrhea in La Plata, Argentina]. Rev Argent Microbiol 2021; 54:15-21. [PMID: 33875293 DOI: 10.1016/j.ram.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 11/11/2020] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
Diarrheagenic Escherichia coli is a heterogeneous group of strains that presents various virulence factors and causes different diarrheal syndromes. The most studied pathotypes are enteropathogenic Escherichia coli (EPEC), enterotoxigenic Escherichia coli (ETEC), enteroaggregative Escherichia coli (EAEC), enteroinvasive Escherichia coli (EIEC) and Shiga toxin-producing Escherichia coli (STEC). The objective was to estimate the frequency of infection of diarrheagenic E. coli pathotypes in children with diarrhea, attended at the Sor María Ludovica Hospital in La Plata, Argentina, during the period May-October 2017. E. coli pathotypes were detected by molecular amplification of eight characteristic virulence genes. The feces of 211 children (76% under 5 years) were studied. Infection with diarrheagenic E. coli was detected in 12.3% of the samples. The pathotypes were EAEC (10.43%), ETEC (1.42%, all of them positive for thermolabile toxin), EPEC (0.95%) and STEC (0.47%, positive for Shiga toxin 2). The EAEC pathotype was prevalent in children of all age groups, while ETEC, EPEC and STEC were only observed in children under 5 years of age. This study constitutes the first report of diarrheagenic Escherichia coli detection in an outpatient pediatric population with diarrhea from La Plata, using molecular amplification techniques. Broader future studies, including the characterization of the isolates with the largest number of genes, asymptomatic controls, different times of the year and population from different geographic areas will be necessary to clarify the relevance of diarrheagenic E. coli infection in children from Argentina.
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Affiliation(s)
- Nora Beatriz Molina
- Centro Universitario de Estudios Microbiológicos y Parasitológicos (CUDEMYP)-CIC, Universidad Nacional de La Plata, La Plata, Argentina.
| | - Sebastián Oderiz
- Sala de Microbiología, Hospital Interzonal de Niños Sor María Ludovica, La Plata, Argentina
| | - Cecilia Vescina
- Sala de Microbiología, Hospital Interzonal de Niños Sor María Ludovica, La Plata, Argentina
| | - Alejandra Córdoba
- Centro Universitario de Estudios Microbiológicos y Parasitológicos (CUDEMYP)-CIC, Universidad Nacional de La Plata, La Plata, Argentina
| | - Juan Ángel Basualdo
- Centro Universitario de Estudios Microbiológicos y Parasitológicos (CUDEMYP)-CIC, Universidad Nacional de La Plata, La Plata, Argentina
| | - Mónica Delfina Sparo
- Centro Universitario de Estudios Microbiológicos y Parasitológicos (CUDEMYP)-CIC, Universidad Nacional de La Plata, La Plata, Argentina
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Cao M, Wang W, Zhang L, Liu G, Zhou X, Li B, Shi Y, Zhu Z, Zhang J. Epidemic and molecular characterization of fluoroquinolone-resistant Shigella dysenteriae 1 isolates from calves with diarrhea. BMC Microbiol 2021; 21:6. [PMID: 33407134 PMCID: PMC7789508 DOI: 10.1186/s12866-020-02050-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background The widespread distribution of antimicrobial-resistant Shigella has become a recurrent challenge in many parts of the developing world. Previous studies indicate that the host of Shigella has expanded from humans to animals. This study aimed to investigate the prevalence of fluoroquinolone resistance and associated molecular characterization of S. dysenteriae 1 isolated from calves. Results All 38 unduplicated S. dysenteriae 1 isolates were collected from calves in Gansu Province from October 2014 to December 2016. According to MLST and PFGE analysis, these isolates were separated into 4 and 28 genotypes, respectively. The most common STs identified were ST228 (34.21%, 13/38) and ST229 (39.47%, 15/38), which were first found in the present study. All isolates harbored virulence genes, and the incidence of the seven virulence genes were ipaH (100%), ipaBCD (92.11%), stx (73.68%), ial (57.89%), sen (28.95%), set1A and set1B (0%). According to the results of antimicrobial susceptibilities, 76.32% (29/38) were resistant to fluoroquinolone and showed multidrug resistance. In a study on the polymorphism of quinolone resistance–determining region (QRDR) of gyrA/B and parC/E genes, we identified two mutations in gyrA (Ser83 → Leu and Asp87 → Asn) and parC (Ser80 → Ile and Ser83 → Leu), respectively. Among them, 55.17% (16/29) of resistant strains had the gyrA point mutations (Ser83 → Leu) and parC point mutation (Ser83 → Leu). Moreover, 41.38% (12/29) of isolates had all five point mutations of gyrA and parC. In addition, the prevalence of the plasmid-mediated quinolone resistance (PMQR) determinant genes was also investigated. All 29 fluoroquinolone-resistant isolates were positive for the aac (6′)-Ib-cr gene but negative for qepA, except for SD001. In addition, only 6 (20.69%, 6/29) isolates harbored the qnr gene, including two with qnrB (6.90%, 2/29) and four with qnrS (13.79%, 4/29). Conclusion Given the increased common emergence of multidrug resistant isolates, uninterrupted surveillance will be necessary to understand the actual epidemic burden and control this infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-020-02050-9.
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Affiliation(s)
- Mingze Cao
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development of the Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Jiangouyan, Qilihe District, Lanzhou, 730050, China.,College of Life Science and Food Engineering, Hebei University of Engineering, Hanshan District, Handan, 056038, China
| | - Weiwei Wang
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development of the Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Jiangouyan, Qilihe District, Lanzhou, 730050, China
| | - Liwei Zhang
- College of Life Science and Food Engineering, Hebei University of Engineering, Hanshan District, Handan, 056038, China
| | - Guanhui Liu
- College of Life Science and Food Engineering, Hebei University of Engineering, Hanshan District, Handan, 056038, China
| | - Xuzheng Zhou
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development of the Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Jiangouyan, Qilihe District, Lanzhou, 730050, China
| | - Bing Li
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development of the Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Jiangouyan, Qilihe District, Lanzhou, 730050, China
| | - Yuxiang Shi
- College of Life Science and Food Engineering, Hebei University of Engineering, Hanshan District, Handan, 056038, China
| | - Zhen Zhu
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development of the Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Jiangouyan, Qilihe District, Lanzhou, 730050, China. .,College of Life Science and Food Engineering, Hebei University of Engineering, Hanshan District, Handan, 056038, China.
| | - Jiyu Zhang
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development of the Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Jiangouyan, Qilihe District, Lanzhou, 730050, China.
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Ugboko HU, Nwinyi OC, Oranusi SU, Oyewale JO. Childhood diarrhoeal diseases in developing countries. Heliyon 2020; 6:e03690. [PMID: 32322707 PMCID: PMC7160433 DOI: 10.1016/j.heliyon.2020.e03690] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/03/2019] [Accepted: 03/25/2020] [Indexed: 12/27/2022] Open
Abstract
Diarrhoeal diseases collectively constitute a serious public health challenge globally, especially as the leading cause of death in children (after respiratory diseases). Childhood diarrhoea affecting children under the age of five accounts for approximately 63% of the global burden. Accurate and timely detection of the aetiology of these diseases is very crucial; but conventional methods, apart from being laborious and time-consuming, often fail to identify difficult-to-culture pathogens. The aetiological agent of an average of up to 40% of cases of diarrhoea cannot be identified. This review gives an overview of the recent trends in the epidemiology and treatment of diarrhoea and aims at highlighting the potentials of metagenomics technique as a diagnostic method for enteric infections.
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Affiliation(s)
- Harriet U Ugboko
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - Obinna C Nwinyi
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - Solomon U Oranusi
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - John O Oyewale
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
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Verma S, Venkatesh V, Kumar R, Kashyap S, Kumar M, Maurya AK, Dhole TN, Singh M. Etiological agents of diarrhea in hospitalized pediatric patients with special emphasis on diarrheagenic Escherichia coli in North India. J Lab Physicians 2020; 11:68-74. [PMID: 30983806 PMCID: PMC6437815 DOI: 10.4103/jlp.jlp_123_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infectious diarrhea is leading infectious cause of childhood morbidity, hospitalizations, and mortality particularly in children living in developing countries like India. The etiological agents differ depending on geographical area, and recent data suggest increase in drug resistance to various enteropathogens. AIMS AND OBJECTIVES The aim of the study was to investigate emerging diarrheal agents and antimicrobial resistance profile of bacterial pathogens from children (<12 years of age) hospitalized with acute diarrhea. MATERIALS AND METHODS A cross-sectional, hospital-based observational study was conducted over 1 year in which 100 children <12 years who were hospitalized due to diarrhea were recruited. Diarrhea was defined as the passage of three or more liquid stools in a 24-h period using the World Health Organization guidelines. Samples were processed for detection of various bacterial, viral, and parasitic agents by standard microbiological, serological, and molecular tests. Antimicrobial resistance testing was performed with the Kirby-Bauer disk diffusion method. ELISA was performed for Rotavirus and Escherichia coli O157. Multiplex polymerase chain reaction test was performed to detect diarrheagenic E. coli (DEC). RESULTS Pathogenic diarrheal agents were found in 63% patients. Rotavirus was identified in 52.5%, DEC in 29%, Vibrio cholerae in 4%, Shigella flexneri in 3%, Aeromonas sp. in 1%, Giardia lamblia in 4%, and Entamoeba histolytica in 1% cases. Enteropathogenic E. coli (EPEC) in 19 (65.5%) cases was the most common agent followed by Enteroaggregative E. coli (EAEC) in 5 (17.2%), Enterotoxigenic E. coli (ETEC) in 2 (6%), and Enteroinvasive E. coli (EIEC) in 3 (10.3%) cases. Resistance rates of DEC to first-line therapeutic drugs were high, 97.3% to ampicillin and 95.95% to co-trimoxazole. DEC was susceptible to chloramphenicol in 58.11%, gentamicin in 48.19%, and amikacin in 58.11% cases. Shigella sp. and V. cholerae isolates were 100% sensitive to gentamicin and ofloxacin. CONCLUSION EPEC is the most common DEC pathotype and EAEC, ETEC, and EIEC are also emerging as dominant diarrheal agents. Rotavirus was the most common causative agents of diarrhea especially in children <5 years. Most of the bacterial isolates showed high level of drug resistance to first-line empirical drugs and were multidrug resistant making them unsuitable for empiric treatment. Laboratory monitoring of drug susceptibility of stool isolates appears necessary to formulate antibiotic policy for treating diarrheal illness at the local level. There is an urgent need to strengthen diarrheal surveillance to monitor susceptibility to commonly prescribed antibiotics.
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Affiliation(s)
- Sheetal Verma
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vimala Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kumar
- Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saurabh Kashyap
- Department of Community Medicine, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anand Kumar Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - T N Dhole
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mastan Singh
- Department of Microbiology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Houattongkham S, Yamamoto E, Sithivong N, Inthaphatha S, Kariya T, Saw YM, Vongduangchanh A, Keosavanh O, Hamajima N. Etiologic agents of acute diarrhea in sentinel surveillance sites in Vientiane Capital, Lao People's Democratic Republic, 2012-2015. Eur J Clin Microbiol Infect Dis 2020; 39:1115-1122. [PMID: 31993879 DOI: 10.1007/s10096-020-03827-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 10/23/2022]
Abstract
This study aims to identify the pathogens of diarrhea in Vientiane Capital, Lao People's Democratic Republic (Lao PDR). The data of 2482 patients who visited eight health facilities due to diarrhea in 2012-2015 were retrospectively reviewed. Stool or rectal swabs collected from all patients were tested for bacteria. Children who were under 5 years old were additionally tested for rotavirus. Of 2482 cases, 1566 cases were under 5 years old, and at least one enteropathogen was detected in 475 cases (19.1%). Salmonella species was the most commonly detected bacterial pathogen. Enteropathogenic Escherichia coli (EPEC) and Salmonella species was the major pathogen in the dry season and the wet season, respectively. Eighty-seven patients tested positive for multiple bacteria. Rotavirus was detected in 291 children under 5 years old (32.4%), mostly from October to April. The major bacteria of coinfection with rotavirus were EPEC followed by Salmonella species. Salmonella species was the predominant bacterial pathogen of diarrhea of all ages, and rotavirus was the predominant pathogen among children under 5 years old. Further studies examining other types of pathogens for diarrhea and the introduction of a rotavirus vaccine for children are needed in Lao PDR.
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Affiliation(s)
- Souphatsone Houattongkham
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Epidemiology Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Noikaseumsy Sithivong
- Laboratory Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Arounnapha Vongduangchanh
- Laboratory Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Onechanh Keosavanh
- Epidemiology Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR.,Laboratory Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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13
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Characterization of non-typhoidal Salmonella isolates from children with acute gastroenteritis, Kolkata, India, during 2000-2016. Braz J Microbiol 2020; 51:613-627. [PMID: 31898246 DOI: 10.1007/s42770-019-00213-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/11/2019] [Indexed: 12/22/2022] Open
Abstract
Non-typhoidal Salmonella (NTS) is an important cause of acute gastroenteritis in children. The study was undertaken to determine the isolation rate, serovar prevalence, antimicrobial resistance (AMR) profiles, and molecular subtypes of NTS from a hospital-based diarrheal disease surveillance in Kolkata, India. Rectal swabs were collected from children (< 5 years of age) with acute gastroenteritis from 2000 to 2016. Samples were processed following standard procedures for identification of NTS. The isolates were tested for antimicrobial susceptibility, AMR genes, plasmid profiles, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE) subtypes. A total of 99 (1.0%) Salmonella isolates were recovered from 9957 samples processed. Of the 17 Salmonella serovars identified, S. Worthington (33%) was predominant followed by S. Enteritidis (13%), S. Typhimurium (12%), and others. The isolates showed high resistance towards nalidixic acid (43%), ampicillin (34%), third-generation cephalosporins (32%), and azithromycin (25%), while low resistance was observed for fluoroquinolones (2%). Extended-spectrum beta-lactamase production (blaCTX-M-15 and blaSHV-12 genes) and azithromycin resistance (mphA gene) were common in S. Worthington, while fluoroquinolone resistance (gyrA and parC mutations) was found in S. Kentucky. Diverse plasmid profiles were observed among the isolates. PFGE analysis identified genetically related strains of each serovar in circulation. MLST also revealed phylogenetically clonal isolates of which S. Worthington ST592 and ciprofloxacin-resistant S. Kentucky ST198 were not reported earlier from India. NTS resistant to current drugs of choice poses a potential public health problem. Continuous monitoring of AMR profiles and molecular subtypes of NTS serovars is recommended for controlling the spread of resistant organisms.
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Webale MK, Wanjala C, Guyah B, Shaviya N, Munyekenye GO, Nyanga PL, Marwa IN, Kagoiyo S, Wangai LN, Webale SK, Kamau K, Kitungulu N. Epidemiological patterns and antimicrobial resistance of bacterial diarrhea among children in Nairobi City, Kenya. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2020; 13:238-246. [PMID: 32821354 PMCID: PMC7417493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM Determine the prevalence of enteric bacterial pathogens and their antimicrobial resistance among diarrheic children in Nairobi City, Kenya. BACKGROUND Regardless of enteric bacterial pathogens being a major cause of gastroenteritis in children, their occurrence and antimicrobial resistance patterns reveals regional spatial and temporal variation. METHODS In a cross-sectional study, a total of 374 children below five years presenting with diarrhea at Mbagathi County Hospital were recruited. Stool microbiology test was used to detect enteric bacterial infection. Antimicrobial resistance was determined using the disk diffusion method. RESULTS Diarrheagenic E. coli (36.4%) was the leading species followed by Shigella (3.2%), Salmonella (2.4%), Campylobacter (1.6%), Yersinia (1.3%) and Aeromonas (1.1%) species. Escherichia coli pathotyping revealed that 20.9%, 4.0%, 10.2% and 0.5% of the study participants were infected with enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC) and enteroinvasive E. coli (EIEC) pure isolates while the prevalence of mixed pathotype infections was 0.3% for EAEC/EPEC/ETEC and 0.5% for EAEC/ETEC. Shigella sero-grouping revealed that 0.5%, 0.3%, 1.9%, and 0.5% were infected with Shigella boydii, Shigella dysentriae, Shigella flexneri and Shigella sonnei pure isolates. Shigella species and E. coli co-infection was detected in 2.4% of the children, specifically, 1.1% for EAEC/Shigella boydii, 0.5% for EAEC/Shigella dysentriae and 0.3% in each case of EAEC/Shigella sonnei, EPEC/Shigella flexneri and ETEC/Shigella flexneri co-infections. Most of the isolates were resistant to commonly prescribed antibiotics. CONCLUSION There was a high prevalence of enteric bacterial pathogens and co-infection alters epidemiological dynamics of bacterial diarrhea in children. Continuous antibiotic resistance surveillance is justified because the pathogens were highly resistant to commonly prescribed antimicrobials.
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Affiliation(s)
| | - Christine Wanjala
- School of Public Health, Biomedical Sciences and Technology, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Bernard Guyah
- School of Public Health, Biomedical Sciences and Technology, Maseno University, Maseno, Kenya
| | - Nathan Shaviya
- School of Public Health, Biomedical Sciences and Technology, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | | | | | | | - Sammy Kagoiyo
- School of Health Sciences, Kirinyaga University, Kutus, Kenya
| | | | - Sella K. Webale
- School of Public Health, Biomedical Sciences and Technology, Maseno University, Maseno, Kenya
| | - Kenny Kamau
- School of Health Sciences, Kirinyaga University, Kutus, Kenya
| | - Nicholas Kitungulu
- School of Biological Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya
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15
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Saka HK, Dabo NT, Muhammad B, García-Soto S, Ugarte-Ruiz M, Alvarez J. Diarrheagenic Escherichia coli Pathotypes From Children Younger Than 5 Years in Kano State, Nigeria. Front Public Health 2019; 7:348. [PMID: 31828054 PMCID: PMC6890574 DOI: 10.3389/fpubh.2019.00348] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022] Open
Abstract
Diarrheagenic Escherichia coli (DEC) is one of the leading causes of gastrointestinal disorders worldwide and an important public health challenge. DEC infection is often underdiagnosed during routine microbiological analysis, especially in resource constrained settings; the use of molecular tests could however help to determine the distribution of DEC and its clinical significance. Here, a study to assess the prevalence of DEC in clinical samples from patients <5 years attending three hospitals in Kano state, Nigeria, was carried out. Samples from 400 patients and 50 controls were collected and screened for E. coli. Compatible colonies from 248 individuals (215 patients and 33 controls) were characterized using biochemical test, a set of real-time PCRs for detection of nine virulence factors (VF: eae, bfpA, elt, est, stx1, stx2, ehxA, aggR, and invA) associated with five DEC pathotypes (EPEC, ETEC, EHEC, EAEC, and EIEC) and antimicrobial susceptibility tests. One or more VFs typical of specific pathotypes were detected in 73.8% (183/248) of the isolates, with those associated with EAEC (36.3%), ETEC (17.3%), and EPEC (6.0%) being the most common, although proportion of specific pathotypes differed between hospitals. est was the only VF detected in a significantly higher proportion in cases compared to controls (P = 0.034). Up to 86.9% of DEC were resistant to at least one class of antibiotics, with trimethoprim-sulfamethoxazole being the least effective drug (77.6% resistance). Our results demonstrate the widespread circulation of different DEC pathotypes that were highly resistant to trimethoprim-sulfamethoxazole among children in Kano state, and highlight the need of characterizing the causative agents in cases of gastrointestinal disorders.
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Affiliation(s)
- Habeeb Kayode Saka
- Nigerian Stored Products Research Institute, Kano, Nigeria.,Department of Microbiology, Bayero University, Kano, Nigeria
| | - Nasir Tukur Dabo
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - Bashir Muhammad
- Department of Microbiology, Bayero University, Kano, Nigeria
| | - Silvia García-Soto
- VISAVET Animal Health Surveillance Centre, Universidad Complutense, Madrid, Spain
| | - Maria Ugarte-Ruiz
- VISAVET Animal Health Surveillance Centre, Universidad Complutense, Madrid, Spain
| | - Julio Alvarez
- VISAVET Animal Health Surveillance Centre, Universidad Complutense, Madrid, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
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16
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Berger D, Smith F, Sabesan V, Huynh A, Norton R. Paediatric Salmonellosis-Differences between Tropical and Sub-Tropical Regions of Queensland, Australia. Trop Med Infect Dis 2019; 4:tropicalmed4020061. [PMID: 30974844 PMCID: PMC6630408 DOI: 10.3390/tropicalmed4020061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Salmonellosis is an important cause of morbidity in tropical regions.This study aims to describe the epidemiology of non-typhoidal Salmonellae (NTS) in children presenting to public hospitals in Queensland, Australia, over the past 20 years, with a focus on differences between tropical and sub-tropical zones in the region. This is a retrospective and descriptive cohort study of 8162 NTS positive samples collected in 0–17-year-olds from the Queensland public hospital pathology database (Auslab) over a 20-year period from 1997 to 2016. There were 2951 (36.2%) positive NTS samples collected in tropical zones and 5211 (63.8%) in the sub-tropical zones of Queensland, with a total of 8162 over the region. The tropical zone contributed a disproportionately higher number of positive NTS samples by population sub-analysis. Of the specimens collected, 7421 (90.92%) were faecal, 505 (6.2%) blood, 161 (1.97%) urine, 13 (0.16%) cerebrospinal fluid (CSF) and 62 of other origin. Other categories of specimen types isolated include swab, fluid, aspirate, lavage, bone, tissue, isolate and pus, and these were not included in sub-analysis. The most commonly identified serovars were Salmonella Typhimurium, Salmonella Virchow and Salmonella Saintpaul. This is the first and largest study that emphasises the high burden of invasive and non-invasive NTS infections resulting in hospital presentations in the paediatric population of tropical north Queensland, compared to the sub-tropics.
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Affiliation(s)
- Daria Berger
- Department of Paediatrics, Townsville Hospital, Townsville 4814, Australia.
| | - Felicity Smith
- College of Public Health and Tropical Medicine, James Cook University, Townsville 4814 Australia.
| | - Vana Sabesan
- Department of Paediatrics, Townsville Hospital, Townsville 4814, Australia.
| | - Aimee Huynh
- Department of Paediatrics, Townsville Hospital, Townsville 4814, Australia.
| | - Robert Norton
- Department of Microbiology and Pathology, Townsville Hospital, Townsville 4814, Australia.
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17
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Zhou Y, Mao L, Yu J, Lin Q, Luo Y, Zhu X, Sun Z. Epidemiology of Clostridium difficile infection in hospitalized adults and the first isolation of C. difficile PCR ribotype 027 in central China. BMC Infect Dis 2019; 19:232. [PMID: 30845918 PMCID: PMC6407249 DOI: 10.1186/s12879-019-3841-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 02/21/2019] [Indexed: 02/08/2023] Open
Abstract
Background Clostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China. Methods Stool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well. Results From June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure (p = 0.001, OR = 5.035) and kidney disease (p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala). Conclusions Knowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China. Electronic supplementary material The online version of this article (10.1186/s12879-019-3841-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu Zhou
- Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, 310014, Hangzhou, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Jing Yu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Xuhui Zhu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China.
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China.
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18
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Wei Z, Xu X, Yan M, Chang H, Li Y, Kan B, Zeng M. Salmonella Typhimurium and Salmonella Enteritidis Infections in Sporadic Diarrhea in Children: Source Tracing and Resistance to Third-Generation Cephalosporins and Ciprofloxacin. Foodborne Pathog Dis 2019; 16:244-255. [PMID: 30779595 DOI: 10.1089/fpd.2018.2557] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to trace the transmission source of Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis strains associated with enteric infections in Shanghainese children, and understand the molecular mechanism of resistance to third-generation cephalosporins and ciprofloxacin. MATERIALS AND METHODS The profiles of pulsed-field gel electrophoresis (PFGE) were compared among the isolates from children, animal, and environment. Antimicrobial susceptibility was determined using the minimal inhibitory concentrations and Kirby-Bauer disk diffusion method. Extended-spectrum β-lactamase (ESBL) producing isolates mediated by resistance genes were identified using polymerase chain reaction and sequencing. RESULTS Based on PFGE patterns, 49 (33.1%) of 148 human Salmonella Typhimurium isolates located in the dominant PFGE clusters were genetically related to the isolates from poultry source, environment water, aquatic products, and reptiles, whereas 97 (97.0%) of 100 human Salmonella Enteritidis isolates were genetically related to isolates from poultry and water. The rates of resistance to ceftriaxone among clinical Salmonella Typhimurium and Salmonella Enteritidis isolates were 42.0% and 14.2%, respectively. Besides, 35.1% of Salmonella Typhimurium isolates displayed resistance to ciprofloxacin; 64.9% of Salmonella Typhimurium isolates and 97.0% of Salmonella Enteritidis isolates displayed reduced susceptibility to ciprofloxacin. Of 64 ESBL/AmpC-producing strains, CTX-M, TEM, DHA, and CMY were detected at frequencies of 86.0%, 62.5%, 7.8%, 3.1%, and 3.1%, respectively. CONCLUSIONS The transmission sources of Salmonella Typhimurium and Salmonella Enteritidis infections in Shanghainese children were diverse. The high prevalence of resistance to third-generation cephalosporins and ciprofloxacin mediated by multiple molecular mechanisms needs continuous monitoring and intervention.
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Affiliation(s)
- Zhougqiu Wei
- 1 Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Xuebin Xu
- 2 Department of Microbiology, Shanghai Municipal Center For Disease Control and Prevention, Shanghai, China
| | - Meiying Yan
- 3 National Institute for Communicable Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Hailing Chang
- 1 Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Yuefang Li
- 1 Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Biao Kan
- 3 National Institute for Communicable Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Mei Zeng
- 1 Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
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Vubil D, Acácio S, Quintò L, Ballesté-Delpierre C, Nhampossa T, Kotloff K, Levine MM, Alonso P, Nataro JP, Farag TH, Vila J, Mandomando I. Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by Shigella in children less than 5 years in Manhiça District, rural Mozambique. Infect Drug Resist 2018; 11:2095-2106. [PMID: 30464552 PMCID: PMC6219103 DOI: 10.2147/idr.s177579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by Shigella was studied among children <5 years of age residing in Manhiça District, Southern Mozambique. MATERIALS AND METHODS Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with Shigella positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome. RESULTS A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. Shigella was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. Shigella was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (P=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (P<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86-9.24) among children aged 12-23 months. Clinical symptoms associated to Shigella among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby's food, and mother as caretaker were the protective factors against acquiring diarrhea caused by Shigella. Antibiotic treatment on admission was associated with a positive children outcome. CONCLUSION Shigella remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to Shigella.
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Affiliation(s)
- Delfino Vubil
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
| | - Sozinho Acácio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
- Instituto Nacional de Saúde (INS), Maputo, Mozambique,
| | - Llorenç Quintò
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
- Instituto Nacional de Saúde (INS), Maputo, Mozambique,
| | - Karen Kotloff
- Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Myron M Levine
- Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Pedro Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Tamer H Farag
- Center for Vaccine Development (CVD), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Microbiology, Centre for Biomedical Diagnosis, Hospital Clinic, Barcelona, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,
- Instituto Nacional de Saúde (INS), Maputo, Mozambique,
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20
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Tian L, Sun Z, Zhang Z. Antimicrobial resistance of pathogens causing nosocomial bloodstream infection in Hubei Province, China, from 2014 to 2016: a multicenter retrospective study. BMC Public Health 2018; 18:1121. [PMID: 30219056 PMCID: PMC6138887 DOI: 10.1186/s12889-018-6013-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on the pathogens responsible for nosocomial bloodstream infection (BSI) and their antimicrobial resistance (AMR) in Hubei province are limited. This study was conducted to determine the major pathogens causing BSI and to characterize their AMR. METHODS Data from the China Antimicrobial Resistance Surveillance System (CARSS) from 2014 to 2016 were analyzed retrospectively. RESULTS Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae were the most common pathogens responsible for nosocomial BSI. Individuals aged 0-5 years and ≥ 40 years old were the major demographics at risk of infection by E. coli, K. pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae, while individuals aged 0-5 years were the major demographic at risk of infection by S. aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae and Stenotrophomonas maltophilia. The frequencies of E. coli and K. pneumoniae isolates resistant to cefotaxime were 59.1% and 24.3%, respectively, and the frequencies of resistant isolates to ceftazidime were 42.9% and 27.2%, respectively. From 2014 to 2016, the frequency of extended-spectrum β-lactamase (ESBL)-positive E. coli declined from 29.07 to 24.5%, and the frequency of ESBL-positive K. pneumoniae declined from 18.64 to 12.33%. The frequency of carbapenem-resistant (CR) E. coli was below 0.5%, but 1-10% of K. pneumoniae isolates were CR. CONCLUSIONS The emergence of methicillin-resistant S. aureus and the expansion of ESBL and fluoroquinolone resistance among Gram-negative Enterobacteriaceae increased AMR severity. Carbapenemase-producing K. pneumoniae isolates responsible for nosocomial BSI increased year over year and effective infection control measures should be taken to prevent them from spreading.
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Affiliation(s)
- Lei Tian
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ziyong Sun
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhen Zhang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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21
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Wang S, Yang F, Li D, Qin J, Hou W, Jiang L, Kong M, Wu Y, Zhang Y, Zhao F, Fang Y, Miao Y, Xu L, Chen J, Bao Z, Olszewski MA, Zhao H, Zhang Y. Clinical application of a multiplex genetic pathogen detection system remaps the aetiology of diarrhoeal infections in Shanghai. Gut Pathog 2018; 10:37. [PMID: 30214488 PMCID: PMC6134694 DOI: 10.1186/s13099-018-0264-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023] Open
Abstract
Background Culture-based diagnostic methods cannot achieve rapid and precise diagnoses for the identification of multiple diarrhoeal pathogens (DPs). A high-throughput multiplex genetic detection system (HMGS) was adapted and evaluated for the simultaneous identification and differentiation of infectious DPs and a broad analysis of DP infection aetiology. Results DP-HMGS was highly sensitive and specific for DP detection compared with culture-based techniques and was similar to singleplex real-time PCR. The uniform level of sensitivity of DP-HMGS for all DPs allowed us to remap the aetiology of acute diarrhoeal infections in Shanghai, correcting incidences of massively underdiagnosed DP species with accuracy approaching that of sequencing-based methods. The most frequent DPs were enteropathogenic Escherichia coli, rotavirus and Campylobacter jejuni. DP-HMGS detected two additional causes of infectious diarrhoea that were previously missed by routine culture-based methods: enterohemorrhagic E. coli and Yersinia enterocolitica. We demonstrated the age dependence of specific DP distributions, especially the distributions of rotavirus, intestinal adenovirus and Clostridium difficile in paediatric patients as well as those of dominant bacterial infections in adults, with a distinct “top 3” pattern for each age group. Finally, the multiplexing capability and high sensitivity of DP-HMGS allowed the detection of infections co-induced by multiple pathogens (approximately 1/3 of the cases), with some DPs preferentially co-occurring as infectious agents. Conclusions DP-HMGS has been shown to be a rapid, specific, sensitive and appropriate method for the simultaneous screening/detection of polymicrobial DP infections in faecal specimens. Widespread use of DP-HMGS is likely to advance routine diagnostic and clinical studies on the aetiology of acute diarrhoea. Electronic supplementary material The online version of this article (10.1186/s13099-018-0264-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiwen Wang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Feng Yang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Dong Li
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Juanxiu Qin
- 5Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200135 China
| | - Weiwei Hou
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Lian Jiang
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Mimi Kong
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yong Wu
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yuchen Zhang
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Fuju Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yi Fang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yingxin Miao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Lingli Xu
- Shanghai ABSciex Analytical Instrument Trading Co., Ltd., Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Michal A Olszewski
- 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System and Research Service, VA Ann Arbor Health Systems, Ann Arbor, MI USA
| | - Hu Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yanmei Zhang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
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Wei HS. Bacterial diarrhea in hospitalized children: Pathogen distribution and drug resistance. Shijie Huaren Xiaohua Zazhi 2018; 26:680-686. [DOI: 10.11569/wcjd.v26.i11.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To study the pathogen distribution and drug resistance in hospitalized children with bacterial diarrhea to guide the selection of appropriate antimicrobial drug regimen for the clinical treatment of bacterial diarrhea in children.
METHODS A total of 1107 children with bacterial diarrhea treated at our hospital from May 2012 to October 2017 were retrospectively analyzed. According to the clinical data of all children (including medical records, laboratory examination results, fecal pathogen detection results, and drug susceptibility test results), the distribution and composition of pathogenic bacteria, clinical symptoms, the drug resistance of main pathogenic bacteria, therapeutic effects, and prognosis were analyzed.
RESULTS In feces from 1107 children with bacterial diarrhea, 206 strains of pathogenic bacteria were isolated, including 39 cases of Gram-positive bacteria (such as Staphylococcus aureus) and 167 cases of Gram-negative bacteria (such as shigella, pathogenic Escherichia coli, and salmonella). The detection rate of pathogenic bacteria in the feces was the highest in children aged < 1 year, and the detection rate decreased with the increase of age. Pathogenic bacteria were detected throughout the year, especially in summer. There was a statistically significant difference (P < 0.05) in clinical symptoms (such as fever, abdominal pain, defecation, and rehydration) between bacterial diarrhea caused by Escherichia coli and Staphylococcus aureus. The rate of resistance of main Gram-positive bacteria to antimicrobial drugs moxifloxacin, vancomycin, and linezolid was less than 30%, and the rate of resistance of Gram-negative bacteria to antibiotics ceftazidime, trimethoprim/sulfamethoxazole, meropenem, and imipenem was less than 30%. The cure rate of bacterial diarrhea was 96.48% (1068/1107) after one week of treatment with antibiotics and selective antibacterial agents.
CONCLUSION The pathogen distribution in children with bacterial diarrhea is complex, and clinicians should select antimicrobial drugs with a resistance rate less than 30% based on drug susceptibility test results.
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Affiliation(s)
- Han-Song Wei
- Clinical Laboratory, Hospital of Ninghe District, Tianjin 301500, China
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23
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Abstract
Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms resolve generally without specific therapy. Searching for the etiology of gastroenteritis is not usually needed; however, it may be necessary if antimicrobial treatment is considered. The latter is left to the physician evaluation in the absence of clear indications. Antimicrobial treatment should be considered in severely sick children, in those who have chronic conditions or specific risk factors or in specific settings. Traveler’s diarrhea, prolonged diarrhea, and antibiotic-associated diarrhea may also require antibiotic therapy. Depending on the severity of symptoms or based on risk of spreading, empiric therapy may be started while awaiting the results of microbiological investigations. The choice of antibiotic depends on suspected agents, host conditions, and local epidemiology. In most cases, empiric therapy should be started while awaiting such results. Empiric therapy may be started with oral co-trimoxazole or metronidazole, but in severe cases parenteral treatment with ceftriaxone or ciprofloxacin might be considered.
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Affiliation(s)
- Eugenia Bruzzese
- Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Via S. Pansini 5, Naples, 80131, Italy
| | - Antonietta Giannattasio
- Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Via S. Pansini 5, Naples, 80131, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Via S. Pansini 5, Naples, 80131, Italy
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Zhou Y, Zhu X, Hou H, Lu Y, Yu J, Mao L, Mao L, Sun Z. Characteristics of diarrheagenic Escherichia coli among children under 5 years of age with acute diarrhea: a hospital based study. BMC Infect Dis 2018; 18:63. [PMID: 29390982 PMCID: PMC5796495 DOI: 10.1186/s12879-017-2936-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 12/21/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Diarrhea is the leading infectious cause of childhood morbidity and mortality. Among bacterial agents, diarrheagenic Escherichia coli (DEC) is the major causal agent of childhood diarrhea in developing countries, particularly in children under the age of 5 years. Here, we performed a hospital-based prospective study to explore the pathotype distribution, epidemiological characteristics and antibiotic resistance patterns of DEC from < 5-year-old diarrheal children. METHODS Between August 2015 and September 2016, 684 stool samples were collected from children (< 5 years old) with acute diarrhea. All samples were cultured and identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) and biochemical tests. PCR was used for subtyping, and enteropathogenic E. coli (EPEC) isolates were identified simultaneously with serology. Furthermore, antimicrobial sensitivity tests and sequencing of antibiotic resistance-related genes were conducted. RESULTS DEC strains were identified in 7.9% of the 684 stool samples. Among them, the most commonly detected pathotype was EPEC (50.0% of DEC), of which 77.8% were classified as atypical EPEC (aEPEC). Age and seasonal distribution revealed that DEC tended to infect younger children and to occur in summer/autumn periods. Multidrug-resistant DEC isolates were 66.7%; resistance rates to ampicillin, co-trimoxazole, cefazolin, cefuroxime, cefotaxime, and ciprofloxacin were ≥ 50%. Among 5 carbapenem-resistant DEC, 60.0% were positive for carbapenemase genes (2 blaNDM-1 and 1 blaKPC-2). Among 30 cephalosporin-resistant DEC, 93.3% were positive for extended-spectrum β-lactamase (ESBL) genes, with blaTEM-1 and blaCTX-M-55 being the most common types. However, no gyrA or gyrB genes were detected in 16 quinolone-resistant isolates. Notably, aEPEC, which has not received much attention before, also exhibited high rates of drug resistance (81.0%, 66.7%, and 14.3% for ampicillin, co-trimoxazole , and carbapenem resistance, respectively). CONCLUSIONS EPEC was the most frequent DEC pathotype in acute diarrheal children, with aEPEC emerging as a dominant diarrheal agent in central China. Most DEC strains were multidrug-resistant, making even ciprofloxacin unsuitable for empiric treatment against DEC infection. Among carbapenem-resistant DEC strains, those harboring blaNDM-1 and blaKPC-2 were the main causal agents. blaTEM-1 and blaCTX-M-55 were the major genetic determinants associated with high levels of cephalosporin resistance.
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Affiliation(s)
- Yu Zhou
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Xuhui Zhu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Hongyan Hou
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Yanfang Lu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Jing Yu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Lie Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, China.
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Mbuthia OW, Mathenge SG, Oyaro MO, Ng'ayo MO. Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya. Pan Afr Med J 2018; 31:88. [PMID: 31011389 PMCID: PMC6462152 DOI: 10.11604/pamj.2018.31.88.15644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/20/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education. METHODS A cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable. RESULTS There were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%). CONCLUSION Salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001).
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Affiliation(s)
| | | | - Micah Ongeri Oyaro
- Human Pathology Department, Immunology Unit, University of Nairobi, Nairobi Kenya
| | - Musa Otieno Ng'ayo
- Centre of Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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26
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Uribe-Beltrán MDJ, Ahumada-Santos YP, Díaz-Camacho SP, Eslava-Campos CA, Reyes-Valenzuela JE, Báez-Flores ME, Osuna-Ramírez I, Delgado-Vargas F. High prevalence of multidrug-resistant Escherichia coli isolates from children with and without diarrhoea and their susceptibility to the antibacterial activity of extracts/fractions of fruits native to Mexico. J Med Microbiol 2017; 66:972-980. [PMID: 28742000 DOI: 10.1099/jmm.0.000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This paper aims to evaluate the antimicrobial resistance of Esherichia coli isolates from children under 5 years old, with and without diarrhoea, who were hospital outpatients in Culiacan, Sinaloa, Mexico. It also looks at the antimicrobial activity of fruit extracts against selected multidrug-resistant (MDR) E. coli strains. METHODOLOGY A total of 205 E. coli isolates from stool samples were collected from 94 children under 5 years old who were outpatients from two hospitals in the city of Culiacan, Sinaloa, Mexico, during the autumn/winter of 2003/04; their resistance profiles to 19 commercial antimicrobials were investigated using the Kirby-Bauer method. The antibacterial activities of extracts/fractions of fruits (i.e. uvalama, Vitex mollis; ayale, Crescentia alata; and arrayan, Psidium sartorianum) were evaluated using the broth microdilution method. RESULTS All E. coli isolates were susceptible to amikacin, nitrofurantoin and meropenem, and approximately 96 % were resistant to at least one antimicrobial, especially carbenicillin (93.2 %), cefuroxime sodium (53.7 %), ampicillin (40 %) and trimethoprim/sulfamethoxazole (35.1 %). Likewise, the frequency of MDR strains (44.9 %) was high, and no significant association with diarrhoea symptoms was found. Remarkably, all fruit extracts/fractions showed antibacterial activity against some, but not all, MDR isolates. The lowest minimal inhibitory concentration values were for the hexane fraction of arrayan (0.25 mg ml-1). CONCLUSION A high number of antimicrobial-resistant E. coli (especially to β-lactams and sulfonamides) and MDR isolates were detected in children under 5 years old, irrespective of diarrhoea symptoms; this is novel information for Culiacan, Sinaloa, Mexico. Moreover, our results showed that the studied fruit extracts/fractions are potential alternative or complementary treatments for MDR E. coli strains.
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Affiliation(s)
| | - Yesmi Patricia Ahumada-Santos
- School of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan, Sinaloa, Mexico
| | - Sylvia Páz Díaz-Camacho
- School of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan, Sinaloa, Mexico
| | - Carlos Alberto Eslava-Campos
- School of Medicine, National Autonomous University of Mexico, Ciudad Universitaria, Coyoacan, 04510 Ciudad de Mexico, Mexico.,Laboratory of Bacterial Pathogenicity, Hemato Oncology and Research Unit, Hospital Infantil de Mexico Federico Gomez, 06720 Ciudad de Mexico, Mexico
| | - Jesús Ernesto Reyes-Valenzuela
- School of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan, Sinaloa, Mexico
| | - María Elena Báez-Flores
- School of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan, Sinaloa, Mexico
| | - Ignacio Osuna-Ramírez
- School of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan, Sinaloa, Mexico
| | - Francisco Delgado-Vargas
- School of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan, Sinaloa, Mexico
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Bai L, Wang L, Yang X, Wang J, Gan X, Wang W, Xu J, Chen Q, Lan R, Fanning S, Li F. Prevalence and Molecular Characteristics of Extended-Spectrum β-Lactamase Genes in Escherichia coli Isolated from Diarrheic Patients in China. Front Microbiol 2017; 8:144. [PMID: 28243225 PMCID: PMC5303722 DOI: 10.3389/fmicb.2017.00144] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/19/2017] [Indexed: 12/03/2022] Open
Abstract
Background: The emergence and spread of antimicrobial resistance has become a major global public health concern. A component element of this is the spread of the plasmid-encoded extended-spectrum b-lactamase (ESBL) genes, conferring resistance to third-generation cephalosporins. The purpose of this study was to investigate the molecular characteristics of ESBL-encoding genes identified in Escherichia coli cultured from diarrheic patients in China from 2013 to 2014. Materials and Methods: A total of 51 E. coli were confirmed as ESBL producers by double-disk synergy testing of 912 E. coli isolates studied. Polymerase chain reaction (PCR) and DNA sequencing were performed to identify the corresponding ESBL genes. Susceptibility testing was tested by the disk diffusion method. Plasmids were typed by PCR-based replicon typing and their sizes were determined by S1-nuclease pulsed-field gel electrophoresis. Multi-locus sequence typing (MLST) and phylogrouping were also performed. Broth mating assays were carried out for all isolates to determine whether the ESBL marker could be transferred by conjugation. Results: Of the 51 ESBL-positive isolates identified, blaCTX-M, blaTEM, blaOXA, and blaSHV were detected in 51, 26, 3, 1 of these isolates, respectively. Sequencing revealed that 7 blaCTX-M subtypes were detected, with blaCTX-M-14 being the most common, followed by blaCTX-M-79 and blaCTX-M-28. Of the 26 TEM-positive isolates identified, all of these were blaTEM-1 genotypes. All isolates contained one to three large plasmids and 10 replicon types were detected. Of these, IncFrep (n = 50), IncK/B (n = 31), IncFIB (n = 26), IncB/O (n = 14), and IncI1-Ir (n = 8) replicon types were the predominating incompatibility groups. Twenty-six isolates demonstrated the ability to transfer their cefotaxime resistance marker at high transfer rates. MLST typing identified 31 sequence types and phylogenetic grouping showed that 12 of the 51 donor strains belonged to phylogroup B2. Conclusion: This study highlights the diversity of the ESBL producing E. coli and also the diversity of ESBL genes and plasmids carrying these genes in China, which poses a threat to public health.
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Affiliation(s)
- Li Bai
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment Beijing, China
| | - Lili Wang
- Institute for Nutrition and Food Hygiene, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control Beijing, China
| | - Xiaorong Yang
- Center for Disease Control and Prevention of Sichuan Province Sichuan, China
| | - Juan Wang
- College of Veterinary Medicine, Northwest A&F University Xianyang, China
| | - Xin Gan
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment Beijing, China
| | - Wei Wang
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment Beijing, China
| | - Jin Xu
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment Beijing, China
| | - Qian Chen
- Institute for Nutrition and Food Hygiene, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control Beijing, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney NSW, Australia
| | - Séamus Fanning
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk AssessmentBeijing, China; UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Sports Science, University College DublinBelfield, Ireland
| | - Fengqin Li
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment Beijing, China
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