Pii: s0924-8579(02)00208-x

International Journal of Antimicrobial Agents 20 (2002) 387 Á/389 Epidemiology of bacterial resistance in gastro-intestinal pathogens in Giovanni Bonfiglio a, Jacques Simpore` b, Salvatore Pignatelli b, Salvatore Musumeci c,d,, a Dipartimento di Scienze Microbiologiche, University of Catania, Catania, Italy b Centre Medical St. Camille, Ouagadougou, Burkina Faso c Department of Pediatrics, Cattedra di Pediatria Sociale e Puericultura, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy d Institute of Population Genetics, Italian National Research Council, Alghero, SS, Italy Received 14 February 2002; accepted 10 May 2002 During 1999 Á/2000 a total of 4131 faecal specimens were collected and analysed at the medical centre St. Camille at Ouagadougou. Eight hundred and twenty-six (8.0%) grew significant bacteria. Escherichia coli (35%), Salmonella spp. (15%) andShigella spp. (10%) were most frequently isolated. A large number of E. coli strains were resistant to aminopenicillins ( /90%) andcotrimoxazole (80%); for Yersinia spp the resistance was 80 and 25%, respectively. Norfloxacin was the most active antibiotic butwas rarely used. The study showed that it is necessary to create antibiotic-resistance surveillance centres in developing countries sothat therapy may be appropriate and the spread of antibiotic resistance to other developed countries via increased emigration maybe reduced.
# 2002 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.
Keywords: Escherichia coli ; Salmonella ; Yersinia responsible are usually unknown and in many cases areresponsible of the death of these patients because of Burkina Faso is a western African nation of 274 000 km2 and with 12 000 000 citizen of whom 10% live in the The aim of this study was to look at bacteria capital Ouagadougou. Burkina Faso is one of the responsible for episodes of diarrhoeal disease in patients poorest African nations and the economy is based on at the medical centre of St. Camille at Ouagadougou agriculture. The health system comprises two national during 1999 Á/2000. The antibiotic susceptibility of the and nine regional hospitals. There is no national means isolated microorganisms was also studied.
of monitoring antibiotic resistance.
One of the most important problems of this nation is the high level of starvation, in particular in the children, due principally to poor diet and dietary taboos espe-cially in those groups belonging to strict religions. In addition, the children have frequent intestinal infectionsincluding parasitic infestations and bacterial diarrhoea During 1999 Á/2000, a total of 4131 faecal specimens that carry a very high mortality . Bacterial diar- were collected from different patients. Microscopic rhoea diseases are frequent and the microorganisms examination was performed on every specimen todetermine the presence of leukocytes, erythrocytes andmucous.
* Corresponding author. Tel.: '/39-360-285505; fax: '/39-095- Faecal material was cultured on Hektoen enteric, Salmonella Shigella and MacConkey agar and incu- 0924-8579/02/$ - see front matter # 2002 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.
PII: S 0 9 2 4 - 8 5 7 9 ( 0 2 ) 0 0 2 0 8 - X G. Bonfiglio et al. / International Journal of Antimicrobial Agents 20 (2002) 387 Á/389 bated for at least 48 h at 37 8C; plates were examined daily. MacConkey sorbitol agar was used for entero- Percentage of different microorganisms isolated during the study novobiocin (CIN) agar for Yersinia spp isolation, and Campy BAP incubated in a CO2 atmosphere forCampylobacter isolation.
Bacterial identification was carried out on the basis of morphological characteristics and colony observation and was confirmed using the API 20 system (BioMer- All isolated strains were tested for their susceptibility to different antibiotics using an agar diffusion method on Mueller Hinton agar according to the methodology Antibiotic susceptibility of the most common bacteria recommended by the National Committee for ClinicalLaboratory Standards (NCCLS) The antibiotics tested were ampicillin, amoxycillin, amoxycillin/clavulanic acid, cotrimoxazole, tetracycline,colistin, chloramphenicol and norfloxacin. Antibiotic breakpoints defined by NCCLS were used.
Inoculated plates containing discs were incubated at 35 8C for 18 Á/24 h after which the inhibition zones around the antibiotic discs were measured using a cotrimoxazole; colistin and norfloxacin were mostactive.
During the 2-year study a total of 4131 faecal speci- Similarly, resistance of Yersinia spp. was high to the mens were examined. Three hundred and thirty (8%) aminopenicillins but low to norfloxacin and colistin.
were positive for protozoa, principally Giardia spp., Norfloxacin was by far the most active antibiotic against Entamoeba histolytica and Trichomonas hominis . In a few specimens Blastocystis hominis , Balantidium coli Shigella spp were also highly resistant to aminopeni- and helminth eggs were found. Candida spp. was seen in cillins and highly susceptibility to norfloxacin and almost half of the specimens. In 2975 specimens (72.0%),microscopical examination was negative for protozoa, clindamicin; 25% of strains were sensitive to amoxycil- worms, leucocytes and erythrocytes and a viral aetiology was suspected. Bacterial isolation was attempted for 826 Over the 2 years of study (1999 Á/2000) Salmonella specimens (20.0%) in which the microscopic examina- spp. became more resistant to the aminopenicillins and tion showed the presence of leucocytes and blood.
resistance to amoxycillin/clavulanate increased in both Of the 826 positive specimens, 8.0% grew the organ- isms shown in The most common isolate was E.
The decreased use of cotrimoxazole was paralleled by coli (35%) followed by Salmonella spp. (15%) and an increase in susceptibility to this antibiotic. No significant change of susceptibility of E. coli was shows the percentage antibiotic susceptibility observed during the 2 years of the study.
of the most commonly isolated microrganisms. Only 4% We also analysed the antibiotic susceptibility of of E. coli strains were susceptible to ampicillin and microorganisms isolated from other patients living 100 amoxycillin and 50% to amoxycillin/clavulate. Resis- km from the capital (Koupela and Nanoro`). The tance to cotrimoxazole was 80% but relatively few percentage of protozoa was very similar (9%) and both strains were resistant to colistin and norfloxacin.
the percentage of pathological microrganisms isolated Twenty-two (22.0%) of Salmonella paratyphi strains and their antibiotic resistance was similar to those were susceptible to amoxycillin and almost 75% to isolated in the capital Ouagadougou.
G. Bonfiglio et al. / International Journal of Antimicrobial Agents 20 (2002) 387 Á/389 Only if these suggestions are adopted shall we be able to prevent the spread of antibiotic resistance.
Every year more than 3 000 000 children die of diarrhoeal diseases Rotavirus infections are morefrequent in children, whereas bacterial infections aremore frequent in adults or the young . The most common microorganisms responsible for intestinal dis-ease are E. coli , Shigella spp., Salmonella spp., Yersinia The authors thank Professor Giovanni Russo, De- spp. and very rarely Vibrio cholerae existing in well partment of Microbiological Science, University of defined areas In Burkina Faso, laboratory support is Catania (Italy) for his valuable suggestions in the available in only a few hospitals and many patients are preparation of manuscript. The authors also thank all cured empirically by the use of minerals and rehydration those who helped and collaborated for the success of distributed by the WHO; often oral antibiotics are used, especially cotrimoxazole The incorrect use of anti-biotics has resulted in a very high incidence of resistance.
Infection with Salmonella spp. is responsible for more than 700 000 deaths per year This has been treatedwith chloramphenicol, ampicillin or cotrimoxazole, but [1] Murray CJL, Lopes AD. Mortality by cause for eight regions of recently several multiresistant Salmonella spp. strains the world: global burden of disease study. Lancet 1997;349:1269 Á/ have been isolated Aminopenicillins, cotrimoxazole and nalidixic acid are widely used to treat infections [2] Stephen J. Pathogenesis of infectious diarrhea. Can J Gastro- with Shigella spp and this has lead to resistance [3] Hart CA, Kariuki S. Antibiotic resistance in developing countries.
development. The high susceptibility to expensive anti- biotics rarely used in this country such as norfloxacin is [4] National Committee for Clinical Laboratory Standards. Perfor- further confirmation of the selective pressure resulting mance Standards for antimicrobial disk susceptibility tests, sixth from the incorrect use of antibiotics. Such antibiotics ed. Approved Standards, M2-A6, NCCLS, Wayne, PA, 1997.
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S. typhi resistant to ciprofloxacin are now common .
[6] Hart CA, Cunliffe NA. Viral gastroenteritis. Curr Opin Infect Dis The similarities in resistance between Ouagadougou and the two distant villages further confirms general [7] Hossain MA, Rahaman M, Ahmed QS, Malek MA, Sack RB, Albert MJ. Increasing frequency of mecillinam-resistant shigella isolates in urban Dhaka and rural Matlab, Bangladesh: a 6 year The faecal flora is recognised as a reservoir of observation. J Antimicrob Chemother 1998;42:99 Á/102.
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fight and control infectious diseases.
[11] Murdoch DA, Banatvala N, Bone A, Shoismatulloev B, Ward General strategies for the development of a controlled LR, Threlfall EJ. Epidemic ciprofloxacin-resistant Salmonellatyphi in Tajikistan. Lancet 1998;351:339.
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possible a rotation of therapy could be used by stopping Decrease in nosocomial Clostridium difficile -associated diarrhea the use of an antibiotic when its resistance increases.
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