Diarrhoeagenic Escherichia coli in childhood diarrhoea in Osun state, Nigeria

Abstract

Introduction: Diarrhoea is a major public health concern in developing countries, usually exacerbated by poor water, sanitation and hygiene but it’s aetiology is under-studied, particularly away from capital cities. We identified diarrheagenic Escherichia coli (DEC) from stools collected in Ile-Ife and Ilesa, Osun state, Nigeria and determined their antibiotic resistance profiles. Methods: Stool samples from 167 children with diarrhoea and 334 controls under the age of 5 years were cultured for E. coli and Salmonella. Bacterial isolates were identified biochemically and DEC were identified by PCR. Antimicrobial susceptibility testing was by modified Kirby-Bauer disc diffusion method in accordance with the CLSI guidelines. Data were analyzed using Chi-square and Fisher’s exact tests. Result: Risk factors associated with diarrhoea included age under 12 months (p = 0.002), caregivers without at least primary school education (p = 0.006), breastfeeding for under 6 months (p˂0.001), and care-givers who were siblings (p = 0.004). DEC was detected in 69(41.3%) cases but only 86(25.7%) controls (p < 0.001) and more commonly recovered during wet season (p < 0.001). Enterotoxigenic E. coli (p = 0.031), enteropathogenic E. coli (p = 0.031) and Shiga-toxin producing E. coli (p = 0.044) were recovered more commonly from cases than controls. DEC from patients with diarrhoea were commonly resistant to sulphonamides (91.3%), trimethoprim (82.6%), and ampicillin (78.3%) but were largely susceptible to quinolones (%) and carbapenems (%). Conclusion: Enteropathogenic, enterotoxigenic and Shiga toxin-producing E. coli are associated with diarrhoea in our setting, and show considerable resistance to first line antimicrobials. Risk factors for DEC diarrhoea include infancy, inadequate breast feeding and caregivers with education below primary school.