Etiological diversity of diarrhoeal disease in Bangladesh.

Background: This study compared the diversity of common diarrhoeal pathogens and antimicrobial susceptibility in four hospitals in Bangladesh.

Methodology: A total of 13,959 diarrhoea patients, comprising rural Mirzapur (2,820), rural Matlab (2,865), urban Dhaka (5,287) and urban Mirpur (2,987) were included under the diarrhoeal disease surveillance system of icddr,b during 2010-2011; stool specimens were tested for Shigella spp., Vibrio cholerae, enterotoxigenic Escherichia coli and rotavirus.

Results: Rotavirus was highest in Mirzapur (28%) followed by Dhaka (24%), Matlab (19%) and Mirpur (18%). Overall, Shigella was significantly more prevalent in rural sites (Mirzapur 13% and Matlab 7%), than in urban sites (Dhaka 3% and Mirpur 3%). Vibrio cholerae was more common in the urban sites of Dhaka (14%) and Mirpur (12%). 72% of Shigella isolates were susceptible to ciprofloxacin in Mirzapur, and 88% to mecillinam. In Dhaka, the figures for Shigella were 65% and 50%, in Matlab 65% and 85%, and in Mirpur 59% and 92% respectively. Susceptibility of Shigella to azithromycin and ceftriaxone in Dhaka was 74% and 95%, and in Mirpur 88% and 92% respectively.  Vibrio cholerae showed the highest resistance to trimethoprim-sulfamethoxazole (100% in Mirpur) and lowest resistance to ciprofloxacin (0% in Dhaka, Matlab and Mirpur) and azithromycin (30% in Dhaka to 7% in Mirzapur). Multidrug resistance (≥3 antibiotics) for Shigella were: Mirzapur (50%); Dhaka (36%); Matlab (23%) and Mirpur (37%); and for V. cholerae it was 26%, 37%, 49% and 23% respectively.

Conclusion: The isolation rates and antimicrobial susceptibility of Shigella spp. and V. cholerae along with rotavirus differed significantly in certain geographical sites.