title: Enteroaggregative Escherichia coli in diarrheic children in Egypt: molecular characterization and antimicrobial susceptibility.
abstract: BACKGROUND
  Little information is available regarding the significance of enteroaggregative Escherichia coli (EAEC) in pediatric diarrhea in Egypt.
  
  
  METHODS
  Escherichia coli was isolated from stool samples of 62 diarrheic and 43 non-diarrheic (control) Egyptian children. Samples were screened for genes specific for enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), Shiga toxin-producing E. coli (STEC), and enteroinvasive E. coli (EIEC) using polymerase chain reaction (PCR). Diarrheagenic E. coli were grouped phylogenetically using PCR and tested for their susceptibility to antibiotics using the disk diffusion method. Isolates designated as EAEC were examined for eight virulence factors (VFs) using PCR.
  
  
  RESULTS
  EAEC was detected in 19 (30.7%) and 4 (9.3%), EPEC in 2 (3.2%) and 1 (2.3%), and ETEC in 2 (3.2%) and 0 (0.0%) diarrheic and control children, respectively; STEC and EIEC were not detected. Only EAEC was significantly isolated from diarrheic children compared with controls (p < 0.01, OR = 4.31).Three or more VFs (multivirulent isolates) were found in 52.6% and 50% of EAEC isolated from diarrheic children and controls, respectively. More than 73% (17/23) of EAEC isolates were identified as belonging to phylogenetic group D. Multiple-antibiotic resistance (resistance to three or more drugs) was observed in more than 91% of EAEC.
  
  
  CONCLUSIONS
  Multivirulent EAEC is a significant causative agent of pediatric diarrhea in Egypt, with the majority of isolated EAEC belong to phylogenetic group D. Multiple-antibiotic resistance among EAEC has the potential to be a serious public health problem for the country.
authors.affiliation: Faculty of Science, Cairo University, Egypt. mustafa_benali@yahoo.co.uk.
authors.forename: Mostafa Mohamed M
authors.initials: MM
authors.lastname: Ali
authors.forename: Salwa Fouad
authors.initials: SF
authors.lastname: Ahmed
authors.forename: John D
authors.initials: JD
authors.lastname: Klena
authors.forename: Zienat Kamel
authors.initials: ZK
authors.lastname: Mohamed
authors.forename: Tarek A A
authors.initials: TA
authors.lastname: Moussa
authors.forename: Khalifa Sifaw
authors.initials: KS
authors.lastname: Ghenghesh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002675:Child, Preschool; D016000:Cluster Analysis; D004534:Egypt / Q000453:epidemiology; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D037521:Virulence Factors / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D037521:Virulence Factors