ANTIBIOTIC SUSCEPTIBILITY AND PREVALENCE OF CAMPYLOBACTER jejuni, ESCHERICHIA coli, SALMONELLA AND SHIGELLA IN DIARRHOIC CHILDREN AT KAPSABET COUNTY REFERRAL HOSPITAL.

Abstract

Diarrhoea causes significant morbidity and mortality among children in Kenya, but it is also a devious problem in children less than 5 years of age in most developing countries with substantial illness among rural sub-Saharan Africans. This cross sectional study was set out to determine the antibiotic susceptibility patterns and prevalence of Campylobacter jejuni, Non-typhoid Salmonella (NTS) and Shigella among diarrhoeic children admitted to the paediatric ward at Kapsabet County Hospital. Stool samples collected in a period of six months were cultured in selective media and biochemical tests done on suspect colonies for proper identification. The Kirby-Bauer disk diffusion method was used for susceptibility testing on eleven commonly used antibiotic agents. One hundred and thirty-nine (97%) specimens were investigated, which yielded a total of 72 bacterial isolates, with 12.9% of C. jejuni, Salmonella species-(NTS) 9.4% and Shigella (20.5%). Further evaluation of samples yielded enterogenic E. coli (9.4%) and on differential diagnosis, Giardia lamblia (2.9%) and Entamoeba histolytica (0.7%) were identified. C. jejuni and Salmonella (NTS) and Shigella spp. were found to be highly susceptible to ciprofloxacin at (70.4%), (100%) and (73.3%) respectively. Salmonella was the single most highly susceptible isolate to Nalidixic acid at 13(86.7%; p=.016) while E.coli was highly susceptible to ciprofloxacin 11(100.0%) and minocyclin 8(88.9%). Among the 28 isolates of Shigella spp. 82.1%, were resistant to ampicillin. The least potent drugs were erythromycin, doxycyclin, cotrimoxazole and ampicillin. All the 72 isolates were resistant to at least four antibiotic agents (p= .047) indicating that their use would not have reduced the illness. Low resistance to ciprofloxacin, norfloxacin, ceftriaxone and Cefuroxime indicates that these drugs may be more effective. Chi-square (χ2) value 252.4, p=0.0001 indicated significant difference in drug resistance patterns among the pathogens isolated. Nearly one-half of the patients who presented to the paediatric ward with diarrhoea had a definite or plausible pathogen in their stool specimens, with the overall prevalence of cases of diarrhoea in Kapsabet with a known aetiology of 52% during the period under study. This not only calls for a better health education, improved and sustainable food hygiene and provision of more functional water services but also a judicious use of antibiotics.