Antimicrobial Susceptibility Patterns Of Common Circulating Enteric Bacteria Pathogens in HIV Positive And Negative Children in Dandora Kenya

Abstract

There is an increasing trend in antibiotic resistance among enteric bacterial pathogens, particularly in developing countries, where bacterial diarrhoea is one of the main causes of morbidity and mortality, especially in children. It is documented that bacterial pathogens in HIV patients may manifest differently from infections in immune-competent hosts. Most studies on enteric bacterial pathogens and HIV co-infection have focused on children under five years of age. This study aimed at evaluating the distribution of common circulating enteric bacterial pathogens; Escherichia coli (E. coli), Shigella, Salmonella, and resistance patterns of these isolates among HIV positive and negative children aged between five and twelve years living in Dandora. This was analytic cross sectional study of HIV positive children enrolled at Nyumbani Lea Toto HIV/AIDS outreach program in Dandora, while HIV negative children were from the same area (preferably sibling). After obtaining informed consent and assent forms, stool samples were collected and sent to the Microbiology laboratory in Kenya Medical Research Institute for processing. The samples were cultured using differential media for enteric bacteria. Suspected isolates were further identified using conventional biochemical methods and serotyping. Multiplex PCR was done on E. coli isolates to detect virulence factors responsible for different E. coli pathotypes. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. The overall prevalence of pathogenic E. coli, Shigella and Salmonella were 44 (28%), 31 (19.7%) and 0 (0.0%), respectively. Enteroaggregative E. coli (43.2%) was the main E. coli pathotypes observed. The distribution of pathogenic E. coli from HIV positive and negative children was 12.7% and 15.3%, respectively, while that of Shigella was 6.4% and 13.4%. Antimicrobial Susceptibility testing was done against commonly prescribed antibiotics in the clinic that provide medical services for HIV positive children. The levels of resistance vary with each drug and HIV status as follows; STX (95%HIV +ve Vs 96%HIV -ve), Amp (70 % HIV +ve Vs 75% HIV -ve) and Nal (55% HIV +ve Vs 50% HIV -ve) in E. coli isolates. Among Shigella isolates the levels of resistance were as follows, STX (100% Vs 81%), Amp (60% Vs 62%) and Nal (30% Vs 48%). The results portrayed in this study are striking in that the prevalence of pathogenic E. coli and Shigella was high among HIV negative children as compared to HIV positive children. The antimicrobial susceptibility test showed a slight difference in resistance patterns. However, resistance to Gentamicin and Ciprofloxacin was higher in HIV positive compared to HIV negative children, which indicates emerging resistance