Bacterial etiologies of Diarrhea in Children Under 5 Years from Mukuru informal settlement and their Antimicrobial Sensitivity Profiles

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Abstract Background In Kenya, diarrhoeal disease is the third leading cause of child mortality after Malaria and Pneumonia, accounting for nearly 100 deaths daily. We conducted a cross-sectional study in Mukuru informal settlements to determine the diarrhoea-causing bacteria and their ASTs to provide data essential for implementing appropriate intervention measures. Methods Diarrheagenic children (≤ 5 years) were recruited from outpatient clinics of Municipal City Council, Mukuru kwa Reuben, Mary Mother Mission, and Mama Lucy Kibaki Hospital, Nairobi. A total of 219 stool samples were collected from the children between May 2021 and August 2021. Stool culture was done on MacConkey and Salmonella Shigella Agar, while the recovered bacteria were identified using VITEK®2GNID and PCR, and Antibiotic Susceptibility Testing (AST) was done using VITEK®2AST-GN83. Results At least one bacterial organism was recovered from each of the 213 (97%) participants, with 115( 56%) participants having only one bacterial type isolated, 90( 43%) with two types of bacteria, and 2(1%) with three types of bacteria recovered. The most dominant bacteria recovered included; Escherichia coli (35.5%), Enterobacter spp (27.8%), Klebsiella spp (11%), and Citrobacter spp (4.7%). Potentially pathogenic isolates such as Salmonella 7 (2%), Proteus mirabilis 16 (6%), Providencia alcalifaciens 1 (0.3 %), and Shigella16 (4.7%) were also detected. Isolates such as Pantoea spp 0.67%( 2), Raoultella planticola 0.33%( 1), and Kluyvera 2%( 6) rarely reported but implicated with diarrhoeal disease were also recovered. Ampicillin, cefazolin, and sulfamethoxazole-trimethoprim were the least effective antimicrobials at 64%, 57%, and 55% resistance, respectively, while meropenem(99%), amikacin (99%), tazobactam piperacillin (96%), and cefepime (95%) were the most effective. Overall 33( 21%) of all enterics recovered were multidrug-resistant ( MDR). Conclusion Infection with diarrhoeagenic bacteria is prevalent in children in the Mukuru settlement. The strains were resistant to the commonly used antibiotics, thus narrowing the treatment options for diarrheal disease.

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