Bacterial enteropathogens and risk factors associated with childhood diarrhea.

Objective: To investigate the etiology of bacterial enteropathogens causing diarrhea among children; to elucidate the risk factors, sign and symptoms involved in developing of infection; and to identify the antimicrobial susceptibility pattern.

Methods: Stool samples from diarrheal cases with clinical diagnosis of gastroenteritis compared to matched controls, were examined for detection of bacterial enteropathogens by conventional cultural method from February 2006 through January 2007.

Results: Ninety three of diarrheal cases comprising enteropathogen isolates. A recognized bacterial enteric pathogen was identified in 31% of the cases and 8% of the control group. The frequency of isolated enteropathogens from faeces of diarrheal cases was recorded in the following order, Enterohemorrhagic E. coli 8.3%, Shigella spp. 6.7%, Campylobacter jejuni 5%, Salmonella spp. 4%, Yersinia enterocolitica 2.7%, Aeromonas spp. 4.7%, and Plesiomonas spp. 1.3%. E.H.E coli, Shigella and Salmonella had shown a significant statistical association with diarrhea (p<0.05). Compared to matched uninfected control, multivariate analysis revealed that malnutrition status (OR adjusted 8.37; p<0.001) was the only independent factor associated with infection. Antibiotic susceptibility profile indicated that enteropathogens were generally susceptible to meropenem, ceftriaxone, followed by amikacin and ciprofloxacin. Almost all enteropathogens were resistant to ampicillin and amoxicillin.

Conclusions: The results of this study emphasize the importance of bacterial enteropathogens in causing severe diarrhea in children. E.H.E. coli was the most predominant pathogen. Malnutrition was identified as the main independent risk factor associated with developing of infection. Ampicillin and amoxicillin should not be used as empirical treatment in acute diarrhea.