Surveillance for bacterial diarrhea and antimicrobial resistance in rural western Kenya, 1997-2003

Diarrhea is a major cause of preventable illness in sub-Saharan Africa. Although most cases of bacterial gastroenteritis do not require antimicrobial treatment antimicrobial use is widespread. We examined the bacterial causes of diarrhea and monitored antimicrobial susceptibilities of isolates through clinic-based surveillance in a rural Kenyan community. From May 1997 through April 2003 diarrheal stool samples from persons presenting to 4 sentinel health centers were cultured by standard techniques for routine bacterial enteric pathogens for which antimicrobial susceptibilities were determined. A random subset of specimens was also evaluated for diarrheagenic Escherichia coli. Among stool specimens from 3445 persons 1092 (32%) yielded at least 1 bacterial pathogen. Shigella species was most commonly isolated (responsible for 16% of all illnesses; 54% of isolates were Shigella flexneri). Campylobacter species and diarrheagenic E. coli predominated among children aged < 5 years and were progressively replaced by Shigella species with increasing age. With the exception of Campylobacter species susceptibility to the antimicrobials used most widely in the community was low: < 40% for all isolates tested and < 25% for Shigella species. Most persons were treated with an antimicrobial to which their isolate was resistant. Susceptibility to specific antimicrobials was inversely proportional to the frequency with which they were prescribed. The utility of available antimicrobials for treating bacterial diarrhea in rural western Kenya is substantially limited by reduced susceptibility. More judicious use of appropriate antimicrobials is warranted. Efforts to prevent illness through provision of clean water improved hygiene and vaccine development should be strengthened. (authors)