Surveillance for bacterial diarrhea and antimicrobial resistance in rural western Kenya, 1997-2003.
BACKGROUND
Diarrhea is a major cause of preventable illness in sub-Saharan Africa. Although most cases of bacterial gastroenteritis do not require antimicrobial treatment, antimicrobial use is widespread. We examined the bacterial causes of diarrhea and monitored antimicrobial susceptibilities of isolates through clinic-based surveillance in a rural Kenyan community.


METHODS
From May 1997 through April 2003, diarrheal stool samples from persons presenting to 4 sentinel health centers were cultured by standard techniques for routine bacterial enteric pathogens, for which antimicrobial susceptibilities were determined. A random subset of specimens was also evaluated for diarrheagenic Escherichia coli.


RESULTS
Among stool specimens from 3445 persons, 1092 (32%) yielded at least 1 bacterial pathogen. Shigella species was most commonly isolated (responsible for 16% of all illnesses; 54% of isolates were Shigella flexneri). Campylobacter species and diarrheagenic E. coli predominated among children aged <5 years and were progressively replaced by Shigella species with increasing age. With the exception of Campylobacter species, susceptibility to the antimicrobials used most widely in the community was low: <40% for all isolates tested and <25% for Shigella species. Most persons were treated with an antimicrobial to which their isolate was resistant. Susceptibility to specific antimicrobials was inversely proportional to the frequency with which they were prescribed.


CONCLUSIONS
The utility of available antimicrobials for treating bacterial diarrhea in rural western Kenya is substantially limited by reduced susceptibility. More judicious use of appropriate antimicrobials is warranted. Efforts to prevent illness through provision of clean water, improved hygiene, and vaccine development should be strengthened.
Brooks
John T
JT
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Ochieng
John Benjamin
JB
Kumar
Lata
L
Okoth
George
G
Shapiro
Roger L
RL
Wells
Joy G
JG
Bird
Michele
M
Bopp
Cheryl
C
Chege
Wairimu
W
Beatty
Mark E
ME
Chiller
Tom
T
Vulule
John M
JM
Mintz
Eric
E
Slutsker
Laurence
L
D024901:Drug Resistance, Multiple, Bacterial; D004403:Dysentery / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D015980:Public Health Practice; D012424:Rural Population