Etiological agents of diarrhea in hospitalized pediatric patients with special emphasis on diarrheagenic Escherichia coli in North India

Abstract

INTRODUCTION: Infectious diarrhea is leading infectious cause of childhood morbidity, hospitalizations, and mortality particularly in children living in developing countries like India. The etiological agents differ depending on geographical area, and recent data suggest increase in drug resistance to various enteropathogens. AIMS AND OBJECTIVES: The aim of the study was to investigate emerging diarrheal agents and antimicrobial resistance profile of bacterial pathogens from children (<12 years of age) hospitalized with acute diarrhea. MATERIALS AND METHODS: A cross-sectional, hospital-based observational study was conducted over 1 year in which 100 children <12 years who were hospitalized due to diarrhea were recruited. Diarrhea was defined as the passage of three or more liquid stools in a 24-h period using the World Health Organization guidelines. Samples were processed for detection of various bacterial, viral, and parasitic agents by standard microbiological, serological, and molecular tests. Antimicrobial resistance testing was performed with the Kirby–Bauer disk diffusion method. ELISA was performed for Rotavirus and Escherichia coli O157. Multiplex polymerase chain reaction test was performed to detect diarrheagenic E. coli (DEC). RESULTS: Pathogenic diarrheal agents were found in 63% patients. Rotavirus was identified in 52.5%, DEC in 29%, Vibrio cholerae in 4%, Shigella flexneri in 3%, Aeromonas sp. in 1%, Giardia lamblia in 4%, and Entamoeba histolytica in 1% cases. Enteropathogenic E. coli (EPEC) in 19 (65.5%) cases was the most common agent followed by Enteroaggregative E. coli (EAEC) in 5 (17.2%), Enterotoxigenic E. coli (ETEC) in 2 (6%), and Enteroinvasive E. coli (EIEC) in 3 (10.3%) cases. Resistance rates of DEC to first-line therapeutic drugs were high, 97.3% to ampicillin and 95.95% to co-trimoxazole. DEC was susceptible to chloramphenicol in 58.11%, gentamicin in 48.19%, and amikacin in 58.11% cases. Shigella sp. and V. cholerae isolates were 100% sensitive to gentamicin and ofloxacin. CONCLUSION: EPEC is the most common DEC pathotype and EAEC, ETEC, and EIEC are also emerging as dominant diarrheal agents. Rotavirus was the most common causative agents of diarrhea especially in children <5 years. Most of the bacterial isolates showed high level of drug resistance to first-line empirical drugs and were multidrug resistant making them unsuitable for empiric treatment. Laboratory monitoring of drug susceptibility of stool isolates appears necessary to formulate antibiotic policy for treating diarrheal illness at the local level. There is an urgent need to strengthen diarrheal surveillance to monitor susceptibility to commonly prescribed antibiotics.

Detection of Diarrheagenic E. Coli Among Children Under ‎‏5‏‎ Year’s Age in Tikrit City of Iraq by Using Single Multiplex PCR ‎technique

“…In this study, ETEC account 11 (24%) isolates came second after EPEC among DEC pathotypes , the detection of ETEC is in consonance with previous local findings by Al-Marzoqi et al (2019) and concur with global study by Abbasi et al (2020) in Iran. Our study differ from other reports by Verma et al (2019), Thakur et al (2018) in India which suggested low prevalence of ETEC 6%, 5.7%. While in Huber et al (2019), ETEC was recognized ETEC as major pathotype among children less than 5 years, and in the study by Hasan et al (2020) in Dohuk /Iraq, the isolation rate of ETEC was the highest.…”

“…Among all the DEC pathotypes, EPEC were found to be the most common pathotypes for children with (45.7%), our result compatible with local study by Abdul-hussein et al (2018) who showed EPEC as most than other pathotypes (45.3%), and in contrast with Khalil (2015) and Al-Dulaimi (2015) where they show it came second after EAEC. Our finding was, however, similar to globally studies with Verma et al (2019), Zhou et al (2018), Thakur et al (2018) that also reported a high frequency of EPEC pathotypes associated with diarrhea. Whereas in Saka.…”

“…There was a high resistance of DEC to Azitromycin and this disagree with the result of Abbasi et al (2020) that found low resistance to Azitromycin (25%), and this is nearly similar to the study found the prevalence of resistance to Verma et al, (2019) reach to 74.32%.…”

Molecular Prevalence and Epidemiological Characteristics of Diarrheagenic <i>E. coli</i> in Children under 5 Years Old in the City of Koula-Moutou, East-Central Gabon

“…In addition, the practice of exclusive breastfeeding during the first 6 months or up to the 11th month of birth is an effective preventive means against child mortality related to diarrheal diseases [37]. This prevalence was higher than the one reported among children in Malawi (10.6%) [38], in a rural area of Egypt (18.9%) [39], in Kenya (7.2%) [32], in Northern India (6%) [40] and Perou (4%) [41].…”

New Insights into the Antimicrobial Action of Cinnamaldehyde towards Escherichia coli and Its Effects on Intestinal Colonization of Mice

“…Escherichia coli is an important pathogen responsible for numerous cases of diarrhea worldwide, representing a serious problem for immunocompromised individuals, and especially children [ 1 , 2 , 3 , 4 ]. Several reports have associated diarrhea with significant delays in childhood development [ 1 , 3 , 5 ].…”