title: Antimicrobial-resistant bacterial diarrhea in rural western Kenya.
abstract: Bacterial diarrheal diseases cause substantial morbidity and mortality in sub-Saharan Africa, but data on the epidemiology and antimicrobial susceptibility patterns of enteric bacterial pathogens are limited. Between May 1997 and April 1998, a clinic-based surveillance for diarrheal disease was conducted in Asembo, a rural area in western Kenya. In total, 729 diarrheal specimens were collected, and 244 (33%) yielded >or=1 bacterial pathogen, as determined by standard culture techniques; 107 (44%) Shigella isolates, 73 (30%) Campylobacter isolates, 45 (18%) Vibrio cholerae O1 isolates, and 33 (14%) Salmonella isolates were identified. Shigella dysenteriae type 1 accounted for 22 (21%) of the Shigella isolates. Among 112 patients empirically treated with an antimicrobial agent and whose stool specimens yielded isolates on which resistance testing was done, 57 (51%) had isolates that were not susceptible to their antimicrobial treatment. Empiric treatment strategies for diarrheal disease in western Kenya need to be reevaluated, to improve clinical care.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. rshapiro@hsphx.harvard.edu
authors.forename: R L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: L
authors.initials: L
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Phillips-Howard
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
authors.forename: P
authors.initials: P
authors.lastname: Adcock
authors.forename: J
authors.initials: J
authors.lastname: Brooks
authors.forename: M L
authors.initials: ML
authors.lastname: Ackers
authors.forename: J B
authors.initials: JB
authors.lastname: Ochieng
authors.forename: E
authors.initials: E
authors.lastname: Mintz
authors.forename: S
authors.initials: S
authors.lastname: Wahlquist
authors.forename: P
authors.initials: P
authors.lastname: Waiyaki
authors.forename: L
authors.initials: L
authors.lastname: Slutsker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002167:Campylobacter / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012424:Rural Population; D012475:Salmonella / Q000187:drug effects; D012760:Shigella / Q000187:drug effects; D014734:Vibrio cholerae / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents