Prevalence and antibiotic resistance pattern of enteropathogens isolated from patients presenting with acute diarrhea in Karachi, Pakistan

Background: Diarrheal infection is one of the most common infectious diseases globally. Objectives: To determine the frequency of Enteropathogens and their antibiotic resistance profile among patients with acute diarrhea. Methods: A total of 951 stool samples were collected from patients with complaint of diarrhea. Samples were streaked for growth on different bacterial culture media. For strain identification, specific antisera were used. Finally, the isolated strain was processed for antibiotics susceptibility testing on Muller Hinton agar by Kirby Bauer disk diffusion method following CLSI guidelines 2021. Results: Among 951 enrolled cases, bacterial infection was found in 103 (10.8%). A high prevalence 35(33.59%) of bacterial infection was found in the age group from 2 to 5 years. The frequency of diarrheal cases was higher in July. Among bacteria, Vibrio cholerae was found predominant with 50(48.5%) followed by Enteropathogenic Escherichia coli 25(24.3 %), Salmonella sp. 10(9.7 %), Campylobacter species 9(8.7 %), Shigella species 6(5.8 %), and Aeromonas hydrophilia 3(2.9%). Vibrio species were mostly resistant to co-cotrimoxazole, (58%), and Tetracycline (58%) followed by Ampicillin (8%), & Ciprofloxacin (6%). Enteropathogenic Escherichia coli was extended-spectrum beta-lactamase positive which exhibited high resistance against Ampicillin (72%), followed by Ciprofloxacin (56%), Co-trimoxazole (48%), Amoxi-clavulanic acid, Aztreonam, Ceftriaxone, Cefepime (40%), Amikacin, Gentamicin (24%), Sulbactam/Cefoperazone, Piperacillin/tazobactam, Meropenem (16%) respectively. The majority of Salmonella species were multi-drug resistant showing 100 % resistance to Ciprofloxacin and 80 % resistance to Ampicillin, Cefepime, Ceftriaxone, and Co-trimoxazole. Shigella species also showed a high level of resistance to Ampicillin and Co-trimoxazole (83.3%). Conclusion: The prevalence of bacterial diarrhea was found 10%. The high incident was reported in June and July in the age group under 5 years and above 65 years. Predominant bacterial pathogen was Vibrio cholerae while the least common was Aeromonas. The resistance pattern was reported highest against the penicillin group followed by quinolones. The current study will help in managing empirical therapy for diarrheal infections.