title: Surveillance of bacterial pathogens associated with acute diarrhea in Lima, Peru.
abstract: OBJECTIVE
  A study was conducted in Lima, Peru, from January to April 1995, to determine the bacterial pathogens associated with acute diarrhea in adults, their susceptibility to common antimicrobials, the risk factors involved in cholera transmission, and the best clinical predictors of cholera.
  
  
  METHODS
  A random sample of adult patients with acute diarrhea was studied. Epidemiologic and clinical data and risk factors to acquire diarrheal diseases were evaluated. Identification of bacteria and susceptibility to antimicrobials were determined.
  
  
  RESULTS
  The study included 336 patients. Vibrio cholerae O1 (52.7%), Shigella spp. (4. 8%), and Salmonella spp (2.7%) were the pathogens most commonly isolated. No resistance to antimicrobials was observed. Patients with cholera had less access to municipal water (P = 0.0018) and were less likely to have homes connected to a sewage system (P = 0. 0003) or to have indoor toilet facilities (P = 0.0001) than those without cholera. Liquid stools (odds ratio [OR] = 16.51; confidence interval [CI] = 13.71-19.02; P = 0.003), severe dehydration (OR = 2. 48; CI = 1.57-3.38; P = 0.0083), generalized cramps (OR = 4.63; CI = 3.10-6.17, P < 0.0001), and washerwoman's hands (OR = 2.45; CI = 1. 55-3.34; P = 0.017) were the best clinical predictors of cholera in this setting.
  
  
  CONCLUSIONS
  Cholera is still prevalent in Lima, and people living in environments with low sanitary conditions are especially at risk. Clinical signs of severe dehydration and liquid stools were the best predictors of cholera.
authors.affiliation: Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia; Departamento de Enfermedades Transmisibles y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru. cseas@upch.edu.pe
authors.forename: C
authors.initials: C
authors.lastname: Seas
authors.forename: M
authors.initials: M
authors.lastname: Alarcon
authors.forename: J C
authors.initials: JC
authors.lastname: Aragon
authors.forename: S
authors.initials: S
authors.lastname: Beneit
authors.forename: M
authors.initials: M
authors.lastname: Quiñonez
authors.forename: H
authors.initials: H
authors.lastname: Guerra
authors.forename: E
authors.initials: E
authors.lastname: Gotuzzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D002771:Cholera / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D012475:Salmonella / Q000187:drug effects / Q000302:isolation & purification; D012480:Salmonella Infections / Q000453:epidemiology / Q000382:microbiology; D012760:Shigella / Q000187:drug effects / Q000302:isolation & purification; D014734:Vibrio cholerae / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents