Diarrhoeagenic Escherichia coli are not a significant cause of diarrhoea in hospitalised children in Kuwait

Abstract

BackgroundThe importance of diarrhoeagenic Escherichia coli (DEC) infections in the Arabian Gulf including Kuwait is not known. The prevalence of DEC (enterotoxigenic [ETEC], enteropathogenic [EPEC], enteroinvasive [EIEC], enterohemorrhagic [EHEC] and enteroaggregative [EAEC]) was studied in 537 children ≤ 5 years old hospitalised with acute diarrhoea and 113 matched controls from two hospitals during 2005–07 by PCR assays using E. coli colony pools.ResultsThe prevalence of DEC varied from 0.75% for EHEC to 8.4% for EPEC (mostly atypical variety) in diarrhoeal children with no significant differences compared to that in control children (P values 0.15 to 1.00). Twenty-seven EPEC isolates studied mostly belonged to non-traditional serotypes and possessed β and θ intimin subtypes. A total of 54 DEC isolates from diarrhoeal children and 4 from controls studied for antimicrobial susceptibility showed resistance for older antimicrobials, ampicillin (0 to 100%), tetracycline (33 to 100%) and trimethoprim (22.2 to 100%); 43.1% of the isolates were multidrug-resistant (resistant to 3 or more agents). Six (10.4%) DEC isolates produced extended spectrum β-lactamases and possessed genetic elements (blaCTX-M, blaTEM and ISEcp1) associated with them.ConclusionWe speculate that the lack of significant association of DEC with diarrhoea in children in Kuwait compared to countries surrounding the Arabian Gulf Region may be attributable to high environmental and food hygiene due to high disposable income in Kuwait.

Enteroaggregative Escherichia coli in diarrheic children in Egypt: molecular characterization and antimicrobial susceptibility

“…In the present work, only EPEC, ETEC, and EAEC were detected in stool samples, with only EAEC being significantly found in diarrheic children (30.7%) compared with controls (9.3%) (p < 0.01). Compared with our findings, lower prevalence rates of EAEC from diarrheic children have been reported from Iraq (8%), Kuwait (2.6%), Libya (4.1%), and Tunisia (11.3%) [24][25][26][27].…”

“…Prevalence rates between 1% and 24% for EPEC from diarrheic children using PCR techniques have been reported from several countries in North Africa and the Middle East [24][25][26]. In the present investigation, EPEC was detected in 3.2% of diarrheic children in Egypt.…”

“…In addition, we found that more than 78% of EAEC and none of the EPEC and ETEC isolates produced ESBL. A study from Kuwait reported a lower rate for ESBL (28.6%) among EAEC from diarrheic children [24].…”

“…Albert et al investigated the etiology of DEC in hospitalized children with diarrhea in Kuwait [24]. They found no significant difference in the detection of different DEC pathotypes from diarrheic children compared with controls.…”

Escherichia coli Pathotypes in Pakistan from Consecutive Floods in 2010 and 2011

“…3,4 The severity of DEC is well documented in developing countries and the association of different pathotypes determines the outcome of the clinical manifestation of the disease, particularly among children. 5,6 The recent availability of the full genome sequences of the DECs has allowed the identification of genetic markers that can be used to determine the etiological agents. [7][8][9] In this study, we collected stool samples from hospitalized patients and patients admitted to makeshift camps from the three main flood affected provinces of Pakistan during 2010 and 2011 Khyber Pakhtunkhawa (KPK), Punjab, and Sindh, as well as from sporadic diarrheal cases outside flood areas.…”