Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhea in Beijing, China (2010-2014).
BACKGROUND
Diarrhea is one of the main causes of morbidity and mortality among children less than 5 years of age worldwide, and its causes vary by region. This study aimed to determine the etiologic spectrum, prevalent characteristics and antimicrobial resistance patterns of common enteropathogenic bacteria from diarrheagenic children in Beijing, the capital of China.


METHODS
Stool samples were collected from 2524 outpatients who were aged 0-5 years in Beijing, China during 2010-2014. Microbiological methods, real-time PCR and antimicrobial susceptibility test were used to identify the bacterial causes and antimicrobial resistance patterns in the isolates.


RESULTS
Of the 2524 patients screened, we identified the causes of 269 cases (10.7 %) as follows: diarrheagenic Escherichia coli (4.6 %), Salmonella (4.3 %), Shigella (1.4 %) and Vibrio parahaemolyticus (0.4 %). Atypical EPEC, Salmonella enteritidis, Shigella sonnei and serotype O3:K6 were the most common serogroups or serotypes of the four etiological bacteria. The prevalence of pathogens was correlated with age, season and clinical symptoms. The highest proportion of all causative bacteria was found in children aged 3-5 years and in summer. The clinical symptoms associated with specific bacterial infection, such as fever; abdominal pain; vomiting; and watery, mucus, and bloody stool, were observed frequently in diarrheal patients. Salmonella showed moderate rates of resistance (40-60 %) to ampicillin, nalidixic acid, streptomycin and sulfisoxazole. Resistance to at least three antimicrobials was found in 50 % of isolates. Of the top three serotypes in Salmonella, high-level antimicrobial resistance to single and multiple antibiotics was more common among Salmonella typhimurium and Salmonella 1, 4, [5], 12:i:- than among S. enteritidis. More than 90 % of Shigella isolates showed more alarming resistance to most antibiotics, with a widened spectrum compared to Salmonella.


CONCLUSIONS
Constant antibiotic surveillance is warranted because the bacteria were highly resistant to various antimicrobials. Our study contributes to the strengthening of the existing surveillance system and provides aid for effective prevention and control strategies for childhood diarrhea.
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Mei
M
Qu
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Bing
B
Lv
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Xin
X
Zhang
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Hanqiu
H
Yan
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Ying
Y
Huang
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Haikun
H
Qian
State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, 102206 People's Republic of China.
Bo
B
Pang
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Lei
L
Jia
State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, 102206 People's Republic of China.
Biao
B
Kan
Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China.
Quanyi
Q
Wang
Antimicrobial resistance; Children; Diarrhea surveillance; Diarrheagenic bacteria