Epidemiology of Antimicrobial Resistance among Escherichia coli Strains in Trans-Nzoia County, Kenya

Abstract

Objective: This study aimed to determine prevalence, antimicrobial susceptibility profile and the genetic basis to antimicrobial resistance, targeting blaTEM gene expression of diarrheagenic Escherichia coli among patients suffering from gastroenteritis in Kitale County Referral Hospital. Methods: A cross-sectional study design was adopted. A total of 103 fecal specimens were collected from participants ranging in age from two weeks to 82 years. E. coli was isolated and identified based on phenotypic and biochemical properties. Antimicrobial susceptibility was determined by Kirby-Bauer disk diffusion method. Polymerase chain reaction was used to detect the presence of blaTEM gene. Results: The prevalence of E. coli was 90.2% and age of the patient explained 53% of variation in prevalence. Isolates of diarrheagenic E. coli showed varied degree of susceptibility with sulfamethoxazole at 97%, co-trimoxazole 96%, ampicillin 84%, chloramphenicol 27%, tetracycline 16%, kanamycin 10% and streptomycin 9%. However, E. coli was highly sensitive to gentamicin at 96.8%. Approximately 42.2% of E. coli isolates were multidrug resistant to sulfamethoxazole, co-trimoxazole, ampicillin, chloramphenicol, tetracycline, kanamycin and streptomycin. All isolates that were resistant to ampicillin harbored blaTEM gene suggesting genetic mediation. Conclusion: The observed pattern of resistance to antibiotics points to the need to regulate their use and arrest buildup of resistant genes within the population. J Microbiol Infect Dis 2016;6(3): 107-112  Antimicrobial resistance, antimicrobial susceptibility, blaTEM gene, Escherichia coli

Keywords

• Antimicrobial resistance,antimicrobial susceptibility,blaTEM gene,Escherichia coli

Kaynakça

1. 1. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. The child health epidemiology reference group. WHO Estimates of the Causes of Death in Children? Lancet 2005; 365:1147-1152.
2. 2. Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379:2151-2161.
3. 3. Kurokawa M, Ono K, Nukina M, Itoh M, Thapa U, Rai SK. Detection of diarrheagenic viruses from diarrheal fecal samples collected from children in Kathmandu, Nepal. Nepal Med Coll J 2004; 6:17-23.
4. 4. Hashmey R, Genta MR, White Jr. AC. Parasites and diarrhea I: Protozoans and diarrhea. J Travel Med 1996; 4:17-31.
5. 5. Guentzel MN. 1996 Escherichia, Klebsiella, Enterobacter, Serratia, Citrobacter, and Proteus. In: Baron S, editor. Medical Microbiology, 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; Chapter 26. Available at http:// www.ncbi.nlm.nih.gov/books/NBK8035/ Retrieved 18/10/ 2015.
6. 6. Lanata CF, Mendoza W, Black RE. Improving diarrhoea estimates WHO 2007. Available athttp://www.who.int/entity/ child_adolescent_health/documents/pdfs/improving_diarrhoea_estimates.pdf; Retrieved 28/8/2014.
7. 7. Nataro JP, Kaper JB. Patterns of adherence of diarrhaegenic Escherichia coli to HEp-2 cells. Pediatr Infec Dis J 1987; 6:829-831.
8. 8. Bhan MK, Raj P, Levine MM. Enteroaggregative Escherichia coli association with persistent diarrhea in a cohort of rural children in India. J Infect Dis 1989; 159:1061-1064.

9. 9. Sang WK, Oundo V, Schnabel D. Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhea in four provinces of Kenya. J Infect Dev Ctries 2012;6:572-578.
10. 10. Anderson AD, McClellan J, Rossiter S, Angulo JF. Public health consequences of use of antimicrobial agents in agriculture. In: Institute of Medicine (US) Forum on Emerging Infections; Knobler SL, Lemon SM, Najafi M, et al., editors. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. Washington (DC): National Academies Press (US). Appendix A. 2003:147-153. Available at http://www.ncbi.nlm.nih.gov/books/NBK97132/ Retrieved 16/6/2015.
11. 11. Beceiro A, Tomas M, Bou G. Antimicrobial resistance and virulence: a successful or deleterious association in the bacterial world. Clin Microbiol 2013; 26:185-230.
12. 12. O’Brien TF, Ross DG, Guzman MA, Medeiros AA, Hedges RW, Botstein D. Dissemination of an antibiotic resistance plasmid in hospital patient flora. Antimicrob Agents Chemother 1980; 17:537-543.
13. 13. Hughes VM, Datta N. Conjugative plasmids in bacteria of the ‘pre-antibiotic’ era. Nature 1983; 302:725-726.
14. 14. Perfeito L, Fernandes L, Mota C, Gordo I. Adaptive mutations in bacteria: high rate and small effect. Sci 2007; 317:813- 815.
15. 15. Perez F, Endimiani A, Hujer KM, Bonomo RA. The continuing challenge of ESBLs. Current Opinion in Pharmacology 2007;7:459-469.
16. 16. Tenover FC, Raney PM, Williams PP, et al. Evaluation of the NCCLS extended-spectrum β-lactamase confirmation methods for Escherichia coli with isolates collected during Project ICARE. Clin Microbiol 2003;41:3142-3146.
17. 17. King-Ting L, Yasin R, Chew-Chieng Y, Puthucheary S, KwaiLin T. Characterization of Multidrug Resistant ESBL-Producing Escherichia coli Isolates from Hospitals in Malaysia. J Biomed Biotech 2009: 1-10.
18. 18. Livermore DM. β-lactamases in laboratory and clinical resistance, Clin Microbiol 1995; 8:557-584.
19. 19. Bauer AW, Kirby WM, Sherri’s JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. J Clin Pathol 1966;45:493-496.
20. 20. Clinical and Laboratory Standard Institute (2012) Performance Standards for Antimicrobial Susceptibility Testing: Twenty- Second Informational Supplement. CLSI document M100-S22.
21. 21. Borsoi A, Santin E, Santos LR, Salle CTP, Moraes HLS, NascimentoVP. Inoculation of newly hatched broiler chicks with two Brazilian isolates of Salmonella Heidelberg strains with different virulence gene profile, antimicrobial resistance and pulsed field gel electrophoresis pattern to intestinal changes evalution. Poult Sci 2009;88:750-758.
22. 22. Aarestrup FM, Lertworapreecha M, Evans MC, Bangtrakulnonth A, Chalermchaikit T, Hendriksen RS, Wegener HC. Antimicrobial susceptibility and occurrence of resistance genes among Salmonella enteric serovar Weltevreden from different countries. J Antimicrob Chemother 2003;52:715-718.
23. 23. Brooks JT, Ochieng JB, Kumar L, et al. Surveillance for bacterial diarrhea and antimicrobial resistance in rural western Kenya, 1997-2003. Clin Infect Dis 2006; 43:393-401.
24. 24. Abba K, Sinfield R, Hart CA, Garner P. Pathogens associated with persistent diarrhea in children in low and middle income countries: systemic review. Inf Dis 2009; 9:88.
25. 25. Sang WK, Kariuki SM, Schnabel D, Boga HI, Waiyaki PG, Wamae CN. Antibiotic susceptibility of enteric pathogens from the Maasai community, Narok and Kajiado Districts, Kenya. Afr J Health Sci 2011;19:74-79.
26. 26. Ibrahim ME, Bilal NE, Hamid ME. Increased multi-drug resistant Escherichia coli from hospitals in Khartoum state, Sudan. Afri Health Sci 2012;12:368-375.
27. 27. Natarajan V, Singaram SS. Prevalence of blaTEM gene in uropathogenic Escherichia coli isolated from Tertiary care hospitals in Coimbatore, South India. Int J Pharm Pharm Sci 2013:194-197.