title: Diarrhoeagenic Escherichia coli are not a significant cause of diarrhoea in hospitalised children in Kuwait.
abstract: BACKGROUND
  The importance of diarrhoeagenic Escherichia coli (DEC) infections in the Arabian Gulf including Kuwait is not known. The prevalence of DEC (enterotoxigenic [ETEC], enteropathogenic [EPEC], enteroinvasive [EIEC], enterohemorrhagic [EHEC] and enteroaggregative [EAEC]) was studied in 537 children < or = 5 years old hospitalised with acute diarrhoea and 113 matched controls from two hospitals during 2005-07 by PCR assays using E. coli colony pools.
  
  
  RESULTS
  The prevalence of DEC varied from 0.75% for EHEC to 8.4% for EPEC (mostly atypical variety) in diarrhoeal children with no significant differences compared to that in control children (P values 0.15 to 1.00). Twenty-seven EPEC isolates studied mostly belonged to non-traditional serotypes and possessed beta and theta intimin subtypes. A total of 54 DEC isolates from diarrhoeal children and 4 from controls studied for antimicrobial susceptibility showed resistance for older antimicrobials, ampicillin (0 to 100%), tetracycline (33 to 100%) and trimethoprim (22.2 to 100%); 43.1% of the isolates were multidrug-resistant (resistant to 3 or more agents). Six (10.4%) DEC isolates produced extended spectrum beta-lactamases and possessed genetic elements (blaCTX-M, blaTEM and ISEcp1) associated with them.
  
  
  CONCLUSIONS
  We speculate that the lack of significant association of DEC with diarrhoea in children in Kuwait compared to countries surrounding the Arabian Gulf Region may be attributable to high environmental and food hygiene due to high disposable income in Kuwait.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait. john@hsc.edu.kw
authors.forename: M John
authors.initials: MJ
authors.lastname: Albert
authors.forename: Vincent O
authors.initials: VO
authors.lastname: Rotimi
authors.forename: Rita
authors.initials: R
authors.lastname: Dhar
authors.forename: Susan
authors.initials: S
authors.lastname: Silpikurian
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Pacsa
authors.forename: A Majid
authors.initials: AM
authors.lastname: Molla
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Szucs