Diarrhoeagenic Escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in India

Abstract

Intestinal nosocomial infections remain a major concern in paediatric wards leading to increased morbidity and mortality. This study determined the aetiological and epidemiological profile of nosocomial diarrhoea (ND) among children admitted to a hospital in India. During the period of January 2008 to June 2009, we consecutively enrolled 100 children between the age of 2 months and 14 years who developed ND as defined by the Centers for Disease Control and Prevention. A control group of patients matched for age and severity score but with no diarrhoea at admission or during their hospital stay (n550) were also enrolled. Stool samples were cultured for various pathogens using standard protocols. Clostridium difficile toxins and rotavirus antigen were detected using commercial ELISAs. Detection of diarrhoeagenic Escherichia coli was carried out by multiplex PCR assay. All patient details were noted. In this study, males predominated (77 %), and 56 % children were ,1 year of age and 96 % were ,5 years. The mean duration of diarrhoea and hospitalization in the case group was 3.2 days and 27.5 days, respectively. Malignancy and nasogastric tube usage were significant underlying factors for the development of ND. Diarrhoeagenic E. coli was the commonest agent (47 %: enterotoxigenic E. coli, enteroaggregative E. coli and enteropathogenic E. coli were isolated in 22, 18 and 7 % of patients, respectively). C. difficile toxin was seen in 9 % of cases, whilst rotavirus was found in 8 % of cases. Although rotavirus and C. difficile are major causative agents of hospital-acquired diarrhoea in the developed world, in this setting diarrhoeagenic E. coli was responsible for the majority of cases of hospital-acquired diarrhoea. ND was most common in children aged ,5 years.

Molecular characterization of diarrheagenic Escherichia coli pathotypes: Association of virulent genes, serogroups, and antibiotic resistance among moderate‐to‐severe diarrhea patients

“…These toxins result in secretory diarrhea via Cl − secretion through the cystic fibrosis transport receptor (CFTR) and cyclic guanosine monophosphate (cGMP) . Among the ETEC‐positive patients, estA gene was more frequently isolated than eltB alone, or estA and eltB in combination are similar to other studies . For many years, ETEC has been implicated as the major cause of traveler's diarrhea.…”

“…For many years, ETEC has been implicated as the major cause of traveler's diarrhea. In the present study, ETEC showed varying prevalence among all ages, and similar observations were reported from the northern part of the country …”

Epidemiology of Clostridium difficile infection in Asia

“…The study group also detected widespread contamination of surfaces on beds (51%) and hands of hospital workers (62.5%) [69]. Several reports exist of acute diarrhoea in hospitalised children (7-11%) caused by C. difficile [70-72]. The molecular epidemiology of C. difficile strains in India is not currently known.…”

Clonal Spread of Enterotoxigenic <i>Escherichia coli</i> O128:H45 Strain in the Neonate Unit

“…Thus, we reason that an epidemiologically related ETEC clone, that is, ETEC O128:H45-CS21-ST2332 strain, was responsible for nosocomial diarrhea in the neonate unit. Several hospital-acquired outbreaks of diarrhea in infants and children caused by ETEC have been described (7)(8)(9)(10)(11)(12) MLST, multilocus sequence typing; STh, human heat-stable toxin; STp, porcine heat-stable toxin; TET, tetracycline; AMC, amoxicillin-clavulanic acid; AMP, ampicillin; SXT, trimethoprim-sulfamethoxazole; NAL, nalidixic acid; FEP, cefepime; CTX, cefotaxime; TMP, trimethoprim; CAZ, ceftazidime; S3, sulfisoxazol; STR, streptomycin. * represents medium resistance.…”

“…Birth cohort studies of infants in developing countries suggest that children aged > 6 months may be at increased risk owing to not being exclusively breastfed and the introduction of supplemental foods resulting in increased consumption of contaminated water or foods (4)(5)(6). ETEC is also an important causative agent responsible for nosocomial infantile diarrhea in hospital settings (7)(8)(9). Occasional nosocomial outbreaks caused by ETEC among neonates have been documented (10)(11)(12).…”