Magnitude of Pathogenic Enteric Bacteria, Associated Factors, and Antimicrobial Susceptibility Pattern among Pediatric Patient with diarrhea in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

Abstract

Background: Diarrheal disease remains the most predominant public health problem in developing countries, including Ethiopia. However, there is limited information on the extent of pathogenic enteric bacteria among pediatric patients with diarrhea in the eastern part of Ethiopia. Therefore, this study aimed to determine the prevalence of enteric bacterial pathogens, associated factors, and antimicrobial susceptibility patterns among diarrheic pediatric patients at Hiwot Fana Specialized University Hospital, Harar, eastern Ethiopia, from March 15 to May 15, 2021.

Methods: A hospital-based cross-sectional study was conducted among 210 diarrheic pediatric patients. Stool samples were collected, enteropathogenic bacteria were identified by the standard microbiological techniques, and antimicrobial susceptibility testing was done using the disk diffusion method. Data were analyzed using Statistical Package for Social Science version 20. A multivariable logistic regression model was constructed, and a P-value <0.05 was considered a statistically significant association.

Results: The overall prevalence of enteric bacterial pathogens was 15.7% (95% CI (10.8, 20.6)). The most frequently identified isolates were Shigella flexneri/boydii and EHEC O157:H7, with the same rate of 30.30%. All isolated bacteria were 90.9% susceptible to piperacillin, 87.9% to amoxicillin-clavulanate, and 78.8% to ciprofloxacin; besides, 81.8% and 57.6% of isolated enteropathogenic bacteria were resistant to ampicillin and trimethoprim/sulfamethoxazole, respectively. The overall prevalence of multi-drug resistance was 42.4% (95% CI: 24.2, 60.6.). Parents or guardians with an untrimmed fingernail (AOR = 3.8, 95% CI: 1.4, 10.4) and parents or guardians who hadn’t a habit of washing hands before feeding (AOR = 4.8, 95% CI: 1.51, 15.4) were factors associated with isolated bacteria.

Conclusions: The prevalence of pathogenic enteric bacteria was high. Parent/guardians with untrimmed fingernails and who hadn’t a habit of washing hands before feeding were factors associated with isolated bacteria. The overall prevalence of multi-drug resistance was high. Piperacillin, amoxicillin-clavulanate, and ciprofloxacin can be used as part of the empirical list of drugs for enteric bacteria. Therefore, clinicians should also consider stool culture and antimicrobial susceptibility for better management and control of enteric bacterial diarrhea.

Keywords: Enteric bacteria; Diarrhea; pediatric; Antimicrobial susceptibility test; Eastern Ethiopia