Antibiotic utilization and resistance in diarrheagenic Escherichia coli isolated from children under 5 Years in Nakuru County: a case-control study

Abstract

Background: Children under the age of 5 years continue to suffer the ravaging effects of microbial resistance. Majority of the infections associated with this age are of bacterial and viral nature. Highest mortalities in this age group are those associated with enteric and diarrheal diseases. Diarrheagenic Escherichia coli (DEC) is among the leading causes of these diseases due to their ubiquitous nature. Methods: The study adopted a case-control design and aimed at investigating antibiotic utilization and resistance in DEC strains isolated from children under 5 years in Nakuru County. A total sample size of 384 children were considered. Stool samples from anal swabs were obtained and cultured on Eosin Methylene Blue (EMB). Antimicrobial susceptibility testing was done using the Kirby-Bauer disk diffusion method to segregate the resistant DEC isolates against amoxicillin, ampicillin, erythromycin, cefoxitin and nalidixic acid. Results: All the DEC (n=192, 100%) strains were resistant to amoxicillin, n=168, 87.5% were resistant to ampicillin, n=156, 81.3% to erythromycin n=72, 37.5% to cefoxitin and only n=64, 33.3% to nalidixic acid. Based on demographic factors, it was that observed self-medication leads among factors contributing to the observed trend in antimicrobial resistance (AMR). Other factors such the length of antibiotic use did not show any level of significance (p<0.05). Conclusions: Thus, we conclude that a conglomerate of several factors is associated with the rising cases of AMR among the DEC strains. Notably, the use of first-line antibiotics especially the β-lactams poses a critical health concern being the most resisted class of antibiotics. Therefore, the current study unravels the need to remediate the effects of AMR among the DEC strains through proper formulation and implementation of guidelines on antibiotic usage.