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LETTER TO EDITOR  
Year : 2014  |  Volume : 6  |  Issue : 4  |  Page : 194-195
Fecal carriage of Escherichia coli from pediatric patients with diarrhea and asymptomatic healthy individuals


Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, India

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Date of Web Publication21-Nov-2014
 

How to cite this article:
Saha R, Das S, De K, Singh T, Kumari A. Fecal carriage of Escherichia coli from pediatric patients with diarrhea and asymptomatic healthy individuals . J Global Infect Dis 2014;6:194-5

How to cite this URL:
Saha R, Das S, De K, Singh T, Kumari A. Fecal carriage of Escherichia coli from pediatric patients with diarrhea and asymptomatic healthy individuals . J Global Infect Dis [serial online] 2014 [cited 2019 Dec 10];6:194-5. Available from: http://www.jgid.org/text.asp?2014/6/4/194/145256


Sir,

The emergence of drug resistance among diarrheagenic Escherichia coli in the pediatric population is an important cause of morbidity and mortality in developing countries. The widespread reports [1] of different mechanisms of drug resistance in E. coli not only complicates treatment of different infections caused by it, but also enhances the risks of transmission of these traits into bacteria of the same or other genus. This potential threat of spreading of drug resistance through transferrable genetic elements is complemented by the ability of E. coli to remain as intestinal commensal bacteria. The increasing importance of fecal carriage of E. coli as a source of drug resistant strain associated outbreaks has been widely reported. [1] Proper knowledge of the current status of enteric carriage of resistant strains of E. coli and the antimicrobial susceptibility pattern of diarrhea causing strains in a given geographic location is a basic requirement toward adequate preventive measures. Unfortunately, indigenous data regarding both the drug resistance in diarrheagenic E. coli strains and also the incidence of gastrointestinal carriage of resistant strains is very limited. Such data is of immense importance in formulating the treatment protocol and hospital antimicrobial policy as well as outbreak control. Considering these facts, this study was initiated to establish the role of drug resistant E. coli existing either as normal flora or as a pathogen under different conditions responsible for further dissemination of antimicrobial resistance amongst different organisms.

Fecal samples were collected from patients presenting to pediatric outpatients department (community group) with diarrhea and compared with hospitalized pediatric patients with more than 72 h of hospital stay and concurrent intravenous antimicrobial therapy (hospitalized group) and control group of asymptomatic siblings of admitted pediatric patients of our tertiary care hospital between February 2013 and November 2013. 50 E. coli strain from each of the three study groups were isolated by standard protocol and were subjected to antimicrobial susceptibility testing as per the CLSI guidelines. [2] ESBL producing strains of E. coli were screened by using ceftazidime and cefotaxime and phenotypically confirmed by double disk synergy test. [3] E. coli strain ATTC 25922 was used as negative control and Klebsiella pneumonia strain ATCC 700603 as positive control.

All three groups showed a significant resistance to ampicillin, ceftazidime, piperacillin - tazobactam, aztreonam and meropenem. Hospitalized patients outnumbered (100%) the community patients (86%) or the asymptomatic healthy children (90%) in their carriage of ESBLs, suggesting excessive use of antibiotics in the hospital settings. A significant higher hospital acquisition of ESBL producing E. coli has been reported in pediatric population from Madagascar and other developing countries. [4] A hospital-based study on neonatal sepsis in Delhi a few years earlier showed that 50% of the causative gram negatives were ESBL producing E. coli. [5]

Dissemination of ESBL producing clones resulting from movement of patients between community to hospital and intra- and inter-hospital not only promotes epidemic spread without any borders but also limits availability of treatments options for infections caused by such organism. Thus, there is an urgent need to promote a rational use of antibiotics, both in hospital and in the community, the development of new generic drugs, strict personal hygiene to prevent the selection and the spread of these strains and increase awareness among the population of the hazards of taking antibiotics without medical consultation.


   Acknowledgments Top


We acknowledge the support provided by our departmental chair Dr. Iqbal R Kaur in allowing us to conduct the study. We also acknowledge the help of Dr. Dheeraj Shah, Associate Professor, Dept. of Pediatrics, of our Institute for helping us with the collection of samples.

 
   References Top

1.
Valverde A, Coque TM, Sánchez-Moreno MP, Rollán A, Baquero F, Cantón R. Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during nonoutbreak situations in Spain. J Clin Microbiol 2004;42:4769-75.  Back to cited text no. 1
    
2.
Clinical and Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing: Approved Standard M100-S18. Wayne, PA, USA: CLSI; 2010.  Back to cited text no. 2
    
3.
Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867-78.  Back to cited text no. 3
    
4.
Andriatahina T, Randrianirina F, Hariniana ER, Talarmin A, Raobijaona H, Buisson Y, et al. High prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar. BMC Infect Dis 2010;10:204.  Back to cited text no. 4
    
5.
Sehgal R, Gaind R, Chellani H, Agarwal P. Extended-spectrum beta lactamase-producing gram-negative bacteria: Clinical profile and outcome in a neonatal intensive care unit. Ann Trop Paediatr 2007;27:45-54.  Back to cited text no. 5
    

Top
Correspondence Address:
Rumpa Saha
Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.145256

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008