Bacterial and Parasitic Co-Infections, Antimicrobial Susceptibility and ESBL Genes Carriage in Bacteria Isolated from Children below 5 Years with Diarrhea Attending Mukuru Slum Health Clinics

Abstract

Diarrhea comes second as the most frequent cause of deaths in children younger than five years in developing countries. In Kenya, the overall two-week period incidence of diarrhea in children is 17.1%. This study aimed at investigating prevalence of bacterial-parasitic co-infections and antimicrobial resistance in children below 5 years presenting with diarrhea at Mukuru Kwa slum health clinics in Nairobi County, 25 km East of Nairobi city, Kenya. One hundred and seventy-four stool samples of children presenting with diarrhea were collected and analysed for enteric bacterial pathogens, protozoans and helminths. Pathogenic enteric bacteria were isolated using differential media and API20E kits. Antimicrobial susceptibility tests were determined using Kirby-Bauer disk diffusion method. PCR method was used for Pathotyping of E. coli isolates and screening for Extended Spectrum Beta Lactamase enzymes. Parasites were detected by direct wet mounts and formal ether method. E. coli was the leading bacteria isolated in 98 (47.3%) cases. Thirteen (13.3%) were pathogenic. Two pathotypes of E. coli were observed - Enteroaggregative E. coli was found in 9 cases and accounted for 9.2%. Prevalence of enteropathogenic E. coli was at 4.1% with 4 cases. Salmonella spp was found in 12 cases (5.8%) of which 5 cases had Salmonella typhimurium at 41.7%, Salmonella enteritidis in 4 cases at 33.3%, and Salmonella typhi in 3 cases at 25% of total Salmonella isolates. Prevalence of Serratia marcescens was at 1.4% having been found in 3 cases, Aeromonas sobria in 2 cases at 1.0% and Providencia spp in only one case at 0.5%. Other enterics isolated include Proteus spp, Klebsiella spp, Pseudomonas spp, Enterobacter spp, Citrobacter spp and Morganella morganii. Entamoeba coli and Entamoeba histolytica were isolated together in two samples, having a co-infection with Salmonella typhi in one of the cases. Cryptosporidium parvum was isolated from one sample. ESBL carriage was at 10.1%. The highest proportion of ESBL genes was blaTEM-1 gene in 8 isolates at 3.9%, blaoxa-48 gene was second highest at 2.9%. blaCTX-M-15 gene was at 1.9% and blashv-1 gene at 1.5%. At a prevalence of 2.29%, co-infection and co-infestation was not a major factor in cases of childhood diarrhea studied. The major concern in this study is resistance of enteric bacterial pathogens in childhood diarrhea leading to Multi drug resistance (MDR) isolates at 17%. They are an important etiology, making these also a likely cause of recurring childhood diarrhea in this study. Improved public health measures, proper sanitation, clean water supply and interventions with bacterial targeted vaccinations should be included in the mandatory childhood vaccinations. Evidence based prescriptions by AST data should be employed to reduce the rate of AMR in children.