Bacterial enteropathogens in adult acute diarrhoea: a retrospective survey at the Kenyatta National Hospital

Abstract

Study Type: Retrospective cross - sectional study that involved the review of laboratory reports on stool culture of adults at KNH microbiology laboratory from ~ﾷI;t January 2005 to 31 st December 2009 Objectives: To determine the rate of isolation of bacterial pathogens and their antibiotic sensitivity patterns Methodology: A sampling frame constituting 3044 reports was used to obtaip a sample of 338 reports. The sampled reports were reviewed for demographic data, culture outcomes, pathogens isolated and their antibiotic sensitivity characteristics Results: From the 338 reports reviewed, there was no growth in 100 (29.6%) of the stool cultures. There was growth in 238(70%) cultures Salmonella spp isolates were identified in 11(3.3%) stool cultures. Shigella spp isolates were identified in 7(2.1 %) cultures, non lactose fermenters other than Salmonella spp and Shigella spp were found in 102(34.9%) of the stool cultures. The Salmonella spp and Shigella spp isolated were relatively sensitive to ceftriaxone,(1 00%) ceftazidime (100%) and (75%) and ciprofloxacin (83.3%-100%). For the three antibiotics Salmonella spp were more sensitive compared to those of Shigella spp. For both Salmonella and Shigella there were isolates resistant to more than two antibiotics ( multidrug resistant isolates). Salmonella isolates resistant to augmentin (22%), ciprofloxacin (16.7%), minocycline (25%), pipercillin (50%). Shigella isolates resistant to augmentin (60%), Gentamicin (100%),piperacillin (100%) and ceftazidine (25%). Conclusion/ Recommendations: Bacterial enteropathogens other than Salmonella spp and Shigella spp are important causative agents of adult acute diarrhea in the catchment patient population of Kenyatta National Hospital. Multidrug resistant Salmonella spp, Shigella spp and by extrapolation multidrug resistant enterobacteriaceae exist among the patient population of Kenyatta National Hospital. Screening for other bacterial enteropathogens other than Salmonella spp, Shigella spp in KNH microbiology laboratory should be facilitated. Ciprofloxacin, cefuroxime and ceftriaxone can be used for empirical treatment of adult acute diarrhea. Surveillance for multi drug resistant enterobacteriaceae should be instituted.