| dc.description.abstract | Relatively few studies have been carried out in Kenya to detect and classify diarmOeageniC bacterial agents. This was a prospective cross-sectional study whose objective was to characterize bacterial etiological agents of diarrhoea using multiplex polymeraSe chain reaction (PCR) in children aged 5 years and below. In addition the study aimed at producing data on bacterial diarmoea prevalence and antimicrobial susceptibility patterns in low Income
urban settings. Rectal swabs were collected from three hundred children and transported in Amle's transport media to University of Nairobi and NUITM- Kenya Medical Research Institute laboratories for processing and expertise management. The rectal swabs were inoculated on selective agars for direct bacterial Isolation, Identification and antimi crobi al susceptibility testing.
Standard methods of identification of bacterial agents were used for initial diagnosis. Multiplex PCR with several loci was then applied for detection of the bacterial virulence genes: ipaH (for identification of Shigella), invA(for Identification of Salmonella); cadF (genus-specific virulence gene), hipO (hippuricase gene for C. jejum) and asp (aspartokinase gene for C. coli); eaeA (for identification of EPEC), aspU/ aggR (for identification of EAEC) , Est/elt (for identification of ETEC), vt/eae (for Identification of EHEC) and invE/ipaH (for identification of EIEC). The prevalence of bacterial diarrhoea was found to be 19.7% with 20.5% of Isolates having the virulence gene. DiarrhoeageniC E.coli (DEC) was responsible for 82.3%, Shigella for 9.7% and Salmonella contributed to 8.1 % of all bacterial diarrhoea.
In the 62 pathogenic isolates EAEC accounted. for 37.1 %, mC distribution was 24.2%, EPEC had 21%, Shigella had 9.7% and Salmonella contributed to 8.1 %. campylobacter spp.. Vibrio sop.. EHEC and EIEC strains were not isolated.. aggR and aat genes of EAEC had highest prevalence with other DEC, Salmonella spp- and Shigella spp. demonstrating multidrug (MDR) resistanCe patterns. DEC, Shigella and Salmonella were resistant to Amoxicillin (MIC: 0.016- 256U9/ml), Ampicillin (MIC: 0.016-256U9/ml), and Trimethoprim-Sulfurmethoxazole (MIC: 0.002- 32ug/ml). In addition was found to be resistant to Ceftriazone (MIC: 0.002- 32ug/ml) in which DEC were susceptible within O.047-0.064ug/ml and within O.023-0.032ug/ml (MIC).
The odds ratio of having the detected gene in who drank treated water was 20% less and 25% higher in those who not treat drinking water. In conclusion, and are still a major cause of diarrhoea in children aged five years and below in Kenya. and genes are the major cause of diarrhoea among the group. EAEC strain of DEC was a major cause of diarrhoea at Use of molecular technique increased sensitivity for detection of DEC. Antimicrobial susceptibility tests results demonstrated MDR resistance pattern especially where multiple virulence genes caused diarrhoea in the patient attending The multidrug resistance and the relationship with
the virulence genes need further investigations. Larger surveillance studies to monitor changes in diarrhoeal causative agents and trends in MICs over longer periods of time is required. In addition larger to test for ESBL in resistant bacteria strains and species should be carried out. | en_US |
