DiarrheagenicEscherichia coliandShigellawith High Rate of Extended-Spectrum Beta-Lactamase Production: Two Predominant Etiological Agents of Acute Diarrhea in Shiraz, Iran

Abstract

This study was conducted to find the etiology of acute diarrhea in Iranian children and determine the antimicrobial resistance patterns. The pathogenic bacteria were recovered from 110/269 (40.9%) diarrheal fecal samples with the following profiles: the most predominant pathogen was diarrheagenic Escherichia coli (DEC) (43.6%), comprising enteroaggregative E. coli (23.6%), enteropathogenic E. coli (10.9%), enteroinvasive E. coli (5.5%), and enterotoxigenic E. coli (3.6%); Shigella spp. (37.3%), Salmonella spp. (12.7%) and Campylobacter jejuni (6.4%) were ranked second and fourth in terms of prevalence, respectively. The rates of extended-spectrum beta-lactamase (ESBL) production were 66.7% and 53.7% in DEC and Shigella, respectively. Resistance to ampicillin (AMP) (95.1%), trimethoprim/sulfamethoxazole (SXT) (73.2%), azithromycin (ATH) (21.9%), and ciprofloxacin (CIP) (14.6%) was observed among Shigella isolates. Multidrug resistance phenotype was observed in 24.4% (10/41) of Shigella isolates, with the most common pattern of resistance to cefotaxime, ceftriaxone, ceftazidime, AMP, SXT, and ATH. This study indicates an alarming increase in the ESBL production of DEC and Shigella spp. and identifies them as the two most prevalent diarrhea-causing enteropathogens in the region. The results show that CIP could be an alternative to third-generation cephalosporins against these two pathogens. Therefore, it is proposed that further investigation be done in the pursuit of alternative antibiotics that are effective against the resistant cases. For instance, one study could look into the comparative clinical effectiveness of third-generation cephalosporins versus CIP, the latter not being presently the drug of choice for the treatment of acute diarrhea in children in Iran.

<p>Distribution of Genes Encoding Virulence Factors and the Genetic Diversity of Enteroinvasive <em>Escherichia coli</em> (EIEC) Isolates from Patients with Diarrhea in Ahvaz, Iran</p>

“…This was in agreement with the findings in the previous study from Shiraz (5.5%). 17 Compared with our findings, lower prevalence rates of EIEC have been reported from Northern Iran (0.5%), 18 Nigeria and Vietnam (0.8%). 19,20 The high frequencies of the ipaH gene could explain frequencies of fever, vomiting, and dehydration in infected children.…”

“…Of 13 strains of EIEC, 84.6% (n=11) isolated from children under the age of 2 years (P<0.05). Children were categorized into five different groups according to their age: (0-12), (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), (35-48), and (49-60) months. Distribution of EIEC strains according to age, gender, and clinical symptoms are shown in Table 3.…”

Multi-drug-resistant diarrheagenic Escherichia coli pathotypes in pediatric patients with gastroenteritis from central Iran

“…India, DEC was the most common agent found (14)(15)(16). Pediatricians should therefore request standard microbiological methods for determination of the pathogens involved and for designing subsequent therapy.…”

<p>Multi-Drug-Resistant Diarrheagenic <em>Escherichia coli</em> Pathotypes in Pediatric Patients with Gastroenteritis from Central Iran</p>

“…Considering a study which it was done in the past, we showed that DEC (n=32, 13.9%) was second only to Campylobacter jejuni (n=45, 19.5%; p = 0.003) as the most abundant agent of diarrhea in pediatric patients, whereas in Shiraz (Iran) and India, DEC was the most common agent found. [14][15][16] Pediatricians should therefore…”