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.
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