ANTIBIOTIC SUSCEPTIBILITY AND PREVALENCE OF CAMPYLOBACTER jejuni, ESCHERICHIA coli, SALMONELLA AND SHIGELLA IN DIARRHOIC CHILDREN AT KAPSABET COUNTY REFERRAL HOSPITAL.
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ThesisDiarrhoea causes significant morbidity and mortality among children in Kenya, but it is also a devious problem in children less than 5 years of age in most developing countries with substantial illness among rural sub-Saharan Africans. This cross sectional study was set out to determine the antibiotic susceptibility patterns and prevalence of Campylobacter jejuni, Non-typhoid Salmonella (NTS) and Shigella among diarrhoeic children admitted to the paediatric ward at Kapsabet County Hospital. Stool samples collected in a period of six months were cultured in selective media and biochemical tests done on suspect colonies for proper identification. The Kirby-Bauer disk diffusion method was used for susceptibility testing on eleven commonly used antibiotic agents. One hundred and thirty-nine (97%) specimens were investigated, which yielded a total of 72 bacterial isolates, with 12.9% of C. jejuni, Salmonella species-(NTS) 9.4% and Shigella (20.5%). Further evaluation of samples yielded enterogenic E. coli (9.4%) and on differential diagnosis, Giardia lamblia (2.9%) and Entamoeba histolytica (0.7%) were identified. C. jejuni and Salmonella (NTS) and Shigella spp. were found to be highly susceptible to ciprofloxacin at (70.4%), (100%) and (73.3%) respectively. Salmonella was the single most highly susceptible isolate to Nalidixic acid at 13(86.7%; p=.016) while E.coli was highly susceptible to ciprofloxacin 11(100.0%) and minocyclin 8(88.9%). Among the 28 isolates of Shigella spp. 82.1%, were resistant to ampicillin. The least potent drugs were erythromycin, doxycyclin, cotrimoxazole and ampicillin. All the 72 isolates were resistant to at least four antibiotic agents (p= .047) indicating that their use would not have reduced the illness. Low resistance to ciprofloxacin, norfloxacin, ceftriaxone and Cefuroxime indicates that these drugs may be more effective. Chi-square (χ2) value 252.4, p=0.0001 indicated significant difference in drug resistance patterns among the pathogens isolated. Nearly one-half of the patients who presented to the paediatric ward with diarrhoea had a definite or plausible pathogen in their stool specimens, with the overall prevalence of cases of diarrhoea in Kapsabet with a known aetiology of 52% during the period under study. This not only calls for a better health education, improved and sustainable food hygiene and provision of more functional water services but also a judicious use of antibiotics.
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