Diarrheic Escherichia coli: A Predominant Etiological Agent of Gastroenteritis, a Case Study in Douala, Cameroon

Abstract

Context: Gastroenteritis remains an infectious disease with high morbidity and mortality particularly in low incomes countries, where the capacity to search all etiological agents, especially pathogenic Escherichia coli, is very limited. We investigated the contribution of pathogenic Escherichia coli and their antibiotic resistance profiles in cases of gastroenteritis. Methods: A cross-sectional study was carried out on human stool samples from October 2021 to June 2022 at Laquintinie Hospital. Samples were received from patients of all age groups and screened for bacteriological and parasitological identification by microscopy, bacterial culture, biochemical identification, and antimicrobial susceptibility tests. Results: A total of 296 patients with gastroenteritis complaints, were enrolled in the study with ages ranging from 5 months to 90 years old (Median = 35.5; SD = 20.8). Among the samples analyzed, 1.7% (n = 5/296) were positive for parasites and 27% (n = 80/296) were positive for bacterial pathogens. Parasites were found in mono parasitism, mainly Entamoeba histolytica (60%; n = 3/5), followed by Trichomonas intestinalis (20%; n = 1/5), and Giardia intestinalis (20%; n = 1/5). Three species of bacterial pathogens were identified with no co-infection: diarrheic Escherichia coli (DEC), Salmonella sp, and Shigella sp with respective proportions of 90% (n = 72/80), 6.3% (n = 5/80), and 3.7% (n = 3/80). For antibiotic resistance profiles (ARPs) of the 72 isolates of DEC, high levels of resistance were observed globally with amoxicillin (93.1%; n = 67/72), followed by ciprofloxacin (75%; n = 54/72), and to trimethoprim + sulfamethazole (73.6%; n = 53/72). In contrast, DEC showed low resistance rates with nitrofurans (6.9%; n = 5/72) and imipenem (2.8%; n = 2/72). The strains had 56 distinct ARPs, of which 88.9% (n = 64/72) were MDR. Salmonella sp and Shigella sp showed high levels of resistance to amoxicillin and trimethoprim + sulfamethazole. Conclusion: These results emphasize the need to consider DEC as the main cause of consultation in cases of gastroenteritis and reiterate the urgent need to rationalize antibiotic use in Cameroon.