Prasad Abhijit Kumar, Lyngdoh Wihiwot Valarie, Devi Thigujam Surbala, Durairaj Elantamilan
Department of Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
Manipur Health Department, Community Health Centre, Imphal, Manipur, India.
J Lab Physicians. 2022 Feb 9;14(3):278-283. doi: 10.1055/s-0042-1742421. eCollection 2022 Sep.
Diarrheal illness such as diarrheagenic (DEC), apart from rotavirus, is a common etiological agent known to cause moderate-to-severe diarrhea in low-income countries where unregulated use of antibiotics is rampant, giving rise to multidrug resistant (MDR) strains. This study is an earnest effort in reflecting the resistance pattern in such isolates. It is a hospital-based cross-sectional study conducted over a period of 1 year (January to December, 2015). Children aged less than 18 years presenting with ( = 170) and without ( = 47) diarrhea were included as cases and controls, respectively. Fresh stool sample from eligible participants was collected and inoculated on MacConkey agar. Based on the colony morphology and biochemical identification followed by polymerase chain reaction (PCR), different pathotypes of DEC were identified. All such isolates were subjected to antimicrobial susceptibility testing employing VITEK 2 identification system. The result of the tested antibiotics was evaluated as per Clinical and Laboratory Standards Institute 2015 guidelines. DEC with specific virulence genes were detected by multiplex real-time PCR in 39 and 3 children with or without diarrhea, respectively. Most common DEC pathotypes found were enteroaggregative (38%) followed by enteropathogenic (28.5%). MDR isolates comprised 35 of 42 DEC pathotypes (83.3%). Resistance among DEC pathotypes to ampicillin, amoxicillin-clavulanate, ciprofloxacin, cephalosporin, nalidixic acid, imipenem, and cotrimoxazole was found to be statistically significant in comparison to non-DEC isolates. This study has highlighted the increased prevalence of MDR strains among DEC pathotypes. Looking for these isolates will help detect dreadful DEC pathotypes like where early administration of a sensitive antibiotic will go a long way in preventing complication like hemorrhagic colitis and hemolytic uremic syndrome.
除轮状病毒外，腹泻性疾病（如致泻性大肠埃希菌，DEC）是一种常见的病原体，在抗生素使用不受监管且泛滥的低收入国家，它会导致中度至重度腹泻，进而产生多重耐药（MDR）菌株。本研究旨在切实反映此类分离株的耐药模式。
这是一项基于医院的横断面研究，为期1年（2015年1月至12月）。分别将出现腹泻（n = 170）和未出现腹泻（n = 47）的18岁以下儿童作为病例组和对照组纳入研究。收集符合条件参与者的新鲜粪便样本，并接种在麦康凯琼脂培养基上。根据菌落形态和生化鉴定，随后进行聚合酶链反应（PCR），确定DEC的不同致病型。所有此类分离株均采用VITEK 2鉴定系统进行药敏试验。根据临床和实验室标准协会2015年指南评估受试抗生素的结果。
分别在39例和3例腹泻或未腹泻儿童中通过多重实时PCR检测到具有特定毒力基因的DEC。发现最常见的DEC致病型是集聚性（38%），其次是致病性（28.5%）。42种DEC致病型中有35种（83.3%）为多重耐药分离株。与非DEC分离株相比，DEC致病型对氨苄西林、阿莫西林 - 克拉维酸、环丙沙星、头孢菌素、萘啶酸、亚胺培南和复方新诺明的耐药性具有统计学意义。
本研究强调了DEC致病型中多重耐药菌株的患病率增加。寻找这些分离株将有助于检测出可怕的DEC致病型，如[此处原文缺失具体致病型名称]，早期使用敏感抗生素将在很大程度上预防诸如出血性结肠炎和溶血尿毒综合征等并发症。
