Isolation and Antimicrobial Susceptibility Patterns of Campylobacter Species among Diarrheic Children at Jimma, Ethiopia

Prevalence and Antimicrobial Resistance of Campylobacter Species and Associated Factors Among Under-Five Children with Diarrhea at Randomly Selected Public Health Facilities in Mekelle, Tigray, Ethiopia

Background

Campylobacter species are the most predominant bacterial agents to cause diarrhea in under-five children. It poses a serious challenge to public health worldwide with ongoing acquisition of resistance to different antimicrobials with multiple patterns. Thus, this study aimed to determine the prevalence, and antimicrobial resistance of Campylobacter species, and associated factors among under-five children with diarrhea in selected public health facilities.

Methods

A cross-sectional study was conducted among under-five children with diarrhea using convenient sampling. Health facilities were selected using a simple random sampling method. The stool samples collected from 214 study participants were transported and processed following standard microbiological protocols. Campylobacter isolates were identified using Gram staining, biochemical test, serological test, and aerobic growth at 25°C. Antimicrobial susceptibility profiles of isolates were performed using the Kirby-Bauer method. Data were analyzed using SPSS ver. 25.0. Association between variables was assessed using Chi-square test and Logistic regression, with P ≤ 0.05.

Results

The subject's mean age was 31.3 (±3.9) months. Of the 214 samples cultured, 14 (6.5%) of them were positive for Campylobacter species with 95% CI (3.3-10.3). Out of the isolated species, 12 (85.7%) were Campylobacter jejuni /Campylobacter coli and 2 (14.3%) were other Campylobacter species. Bottle feeding and history of direct contact to domestic animals were associated with Campylobacter species (AOR=5.13, CI=1.21-21.6, p=0.026 and AOR=4.93, CI=1.33-18.17, P=0.016), respectively. Campylobacter isolates were highly resistant to ciprofloxacin 5 (35.7%), and tetracycline 3 (21.4%).

Conclusion

A higher incidence of Campylobacter species was obtained in children who were bottle-fed and who had a history of direct contact with domestic animals. The isolates were highly resistant to ciprofloxacin and tetracycline. These findings indicate that special attention is needed for better management of Campylobacter drug resistance in under-five children. To enhance and support our current findings, further research using molecular techniques is needed to identify the resistant and virulent genes of the bacterial isolates.

Occurrence of Diarrheagenic Pathogens and Their Coinfection Profiles in Diarrheic Under Five Children and Tracked Human Contacts in Urban and Rural Settings of Eastern Ethiopia

Diarrheagenic Escherichia coli, Campylobacter, Nontyphoidal Salmonella, and Shigella are common cause of childhood diarrhea in countries like Ethiopia, but data on their sources and coinfection profiles is limited. A cross sectional study was conducted from November 2021 to January 2023 to determine the prevalence, coinfection, and monthly occurrence rates of major diarrheagenic bacteria in diarrheic under five children and asymptomatic contacts at urban and rural settings in Ethiopia. A total of 345 stool samples were collected from; 262 diarrheic children visiting Hiwot Fana Hospital, Kersa, and Adelle Health Centers; and 83 caretakers and siblings through case based contact tracing. Samples were analyzed using standard laboratory procedures and the overall prevalence of enteric pathogens was 26.96%, with the highest isolation rate during the winter and peaks of 73.91% in February. The occurrence of the pathogens in children and tracked contacts was 27.86 and 24.09%, respectively. In our study, 8.53% coinfection and 23.66% single pathogen infection was recorded in diarrheic children. The study also showed 4.51 and 3.88% of diarrhea in children from urban and rural had attributed to bacterial coinfection, respectively. The most prevalent pathogen in diarrheic children was Diarrheagenic E. coli (10.31%), and followed by Campylobacter. On the other hand, Diarrheagenic E. coli was the second dominant bacteria following Shigella in the traced contacts, with prevalence of 8.43% and 9.64%, respectively. Based on the study site, the prevalence of Diarrheagenic E. coli and Nontyphoidal Salmonella was higher in children from urban than those from rural. However, the occurrence of each pathogen had no significant differences (P > .05) between settings. The high pathogens occurrence rate in the current study indicates the need for strong control strategies and better child carrying and treatment of diarrheal diseases at both urban and rural settings. Further studies on possible sources and factors attributing to the occurrence of enteric pathogens in children are also recommended.

Foodborne disease hazards and burden in Ethiopia: A systematic literature review, 1990–2019

Background

Foodborne disease (FBD) affects millions of people each year, posing a health burden similar to malaria, tuberculosis or HIV. A recent World Bank study estimated the productivity losses alone attributed to unsafe food within Africa at $20 billion in 2016, and the cost of treating these illnesses at an additional $3.5 billion. Ethiopia faces multiple food safety challenges due to lack of infrastructure and basic pre-requisites for food safety such as clean water and environment, washing facilities, compounded by limited implementation of food safety regulations, and a lack of incentives for producers to improve food safety. A consolidation of our understanding and evidence of the source, nature and scale of FBD in Ethiopia is needed to inform policy and future research. We performed a Systematic Literature Review (SLR) of publications on FBD occurrence in Ethiopia including hazard presence and impact.

Method

The SLR followed Cochrane and PRISMA guidelines. We searched PubMed and CAB-Direct for relevant publications between 1990 and 2019 (inclusive). Observational studies and reviews were included. Two reviewers screened titles and abstracts, and retained publications were reviewed in full for quality and data extraction.

Result

In total 128 articles met the inclusion criteria. Most articles focused on the identification of biological hazards in food. High levels of microbial contamination in different food value chains were often found in the small, ad hoc, observational studies that dominated the literature. Raw milk (22/128, 17.0%) and raw beef (21/128, 16.4%) were the most studied food products. Foodborne (FB) parasites were often found at higher rates in food than bacterial and viral pathogens, possibly due to differences in ease of identification. High levels of bacterial contamination on the hands of food handlers were widely reported. There were no reports on the incidence of human FBDs or resulting health and economic impacts.

Conclusion

Our findings reflect existing concerns around food safety in Ethiopia. A lack of substantial, coordinated studies with robust methodologies means fundamental gaps remain in our knowledge of FBD in Ethiopia, particularly regarding FBD burden and impact. Greater investment in food safety is needed, with enhanced and coordinated research and interventions.

Campylobacter Gastroenteritis Among Under-Five Children in Southwest Ethiopia

Background

Under-five children are at an increased risk for foodborne illnesses because of the ingenuousness of their immune system. Although Campylobacter species are one of the bacterial etiologies of gastroenteritis, Campylobacter gastroenteritis among under-five children is not well considered in Ethiopia. Therefore, this study aimed at exploring the prevalence, associated risk factors, and antibiotic susceptibility patterns of Campylobacter species among under-five children with diarrhea.

Methods

The institution-based cross-sectional study was conducted among under-five children with diarrhea at Jimma Medical Center, southwestern Ethiopia from January 5 to April 21, 2020. Stool samples were collected and inoculated into Campylobacter agar medium. Isolation and identification were done using standard bacteriological techniques. Antibiotic susceptibility testing was conducted on Mueller-Hinton agar supplemented with 10% sheep blood using disk diffusion techniques. Bivariate and multivariate logistic regressions were used to assess the associated risk factors.

Results

A total of 214 under-five children were enrolled. The prevalence of Campylobacter infection was 8.9%. Absence of caretakers' handwashing before preparation of food [AOR = 3.7, 95% CI: (1.2-10.8)], direct contact with domestic animals [AOR = 3.6, 95% CI: (1.0-12.7)], and consumption of raw dairy products [AOR = 4.5, 95% CI: (1.4-13.9)] are the factors associated with Campylobacter infection. Some Campylobacter species were found to be resistant to most available antibiotics.

Conclusion

The magnitude of Campylobacter gastroenteritis indicates the need for routine isolation and identification of Campylobacter species from all under-five children clinically diagnosed with diarrhea. Species that are resistant to the drug of choice for Campylobacteriosis are also emerging. Health education on the importance of pasteurization of milk and caretakers' handwashing can mitigate the transmission. Mechanism of handling of domestic animals should be considered to reduce transmission of zoonotic diseases like Campylobacteriosis.

Prevalence, determinants, and antimicrobial susceptibility patterns of Campylobacter infection among under-five children with diarrhea at Governmental Hospitals in Hawassa city, Sidama, Ethiopia. A cross-sectional study

Background

Campylobacteriosis, is a zoonotic bacterial disease observed with a rising worldwide. It is becoming the most commonly recognized cause of bacterial gastroenteritis in under-five mortality in recent years. This study was done to determine the prevalence and determinants of Campylobacter infection among under-fives with acute watery diarrhea.

Methods

This institutional-based cross-sectional study was conducted at governmental and private health institutions in Hawassa city. All outpatient under-five children who met the inclusion criteria from April 2021 to August 2021 were enrolled in this study. Demographic and clinical data were obtained using a standardized data collection tool. Stool samples were collected from each participant with a sterile container and inoculated on a campylobacter agar media. The isolates were identified by using biochemical tests and a disc diffusion technique was performed to determine the antimicrobial sensitivity patterns of the isolates. Data were entered and analyzed using SPSS version 21. Descriptive and Logistic regression analysis was applied to determine the determinants of Campylobacter infection. P-value < 0.05 was considered statistically significant.

Results

A total of 235 under-five children were enrolled in this study with a 100% response rate. Of these 130 (55.3%) and 105(44.7%) were males and females respectively with the age range of 2 months to 60 months with the mean age of 25 months. The majority of the 150 (63.2%) were rural residents. Of 235 under-fives with acute watery diarrhea, 16 (6.8%) patients were found to have Campylobacter infection with (95% CI, 3.8–10.2%). Consumption of pasteurized milk (AOR: 0.12; 95% CI 0.02–0.75, P<0.05), presence of domestic animals like cats, hens, and cows (AOR: 0.09: 95% CI 0.01–0.67, P<0.05), absence of handwashing practice before food preparation (AOR: 3.63, 95% CI 1.15–11.46, P<0.05) showed significant association with campylobacter infection.

The antimicrobial susceptibility patterns of the isolated bacteria were 100% sensitivity to Azithromycin, Chloramphenicol, and Gentamicin, however; it was 100% resistant to Cephalothin. The associations of socio-demographic, environmental, and behavioral factors were compared and consumption of unpasteurized milk, the presence of domestic animal like the cat was significantly associated.

Conclusion

Campylobacter infection showed a comparatively low prevalence in under-fives with acute watery diarrhea. In this study contact with cats, consumption of unpasteurized milk were associated with Campylobacter infection. The treatment approach of Campylobacter infection must consider the sensitivity profile of antibiotics as indicated in the study. We, therefore, recommend further studies to determine the species responsible for Campylobacter infection with other co-morbidities and the susceptibility pattern for each species to indicate appropriate antibiotic therapy.

Prevalence and drug resistance patterns of Gram-negative enteric bacterial pathogens from diarrheic patients in Ethiopia: A systematic review and meta-analysis

Background

Diarrhoea is the leading cause of morbidity and mortality in the world particularly in developing countries and among vulnerable groups of the population. Gram-negative enteric bacterial pathogens (GNEBPs) are a group of organisms that reside mainly in the intestine and induce diarrhoea. Antimicrobial agents are usually the part of their treatment regimen. The therapeutic effect of antimicrobials is hindered by the emergence and spread of drug-resistant strains. The information regarding the prevalence and antimicrobial resistance patterns of GNEBPs in Ethiopia is limited and found in a scattered form.

Objectives

This study was designed to determine the pooled prevalence and drug resistance patterns of GNEBPs by meta-analysis of data from diarrhoeic patients in Ethiopia.

Method

A comprehensive literature search was conducted through internet searches using Google Scholar, PubMed, Science Direct, HINARI databases, and reference lists of previous studies. Published articles were included in the study based on priorly set inclusion and exclusion criteria. Results were presented in the forest plot, tables, and figures with a 95% confidence interval (CI). The inconsistency index (I²) test statistics was used to assess heterogeneity across studies. The pooled prevalence estimate of GNEBPs and their drug resistance patterns were computed by a random-effects model. Software for Statistics and Data Science (STATA) version 14 statistical software was used for the analysis.

Result

After removing those articles which did not fulfil the inclusion criteria, 43 studies were included in the analysis. Studies were conducted in 8 regions of the country and most of the published articles were from the Amhara region (30.23%) followed by Oromia (18.60%) and Southern Nations, Nationalities, and Peoples’ region (SNNP) (18.60%). The pooled prevalence of GNEBPs was 15.81% (CI = 13.33–18.29). The funnel plot indicated the presence of publication bias. The pooled prevalence of GNEBPs in Addis Ababa, Amhara, SNNP, and Oromia regions were 20.08, 16.67, 12.12, and 11.61%, respectively. The pooled prevalence was 14.91, 18.03, and 13.46% among studies conducted from 2006–2010, 2011–2015, and 2016–2021, respectively and it was the highest (20.35%) in children having age less than or equal to 15 years. The pooled prevalence of Escherichia coli, Campylobacter spp., Shigella spp., and Salmonella enterica were 19.79, 10.76, 6.24, and 5.06%, respectively. Large proportions (60–90%) of the isolates were resistant to ampicillin, amoxicillin, tetracycline, and trimethoprim-sulphamethoxazole. The pooled prevalence of multidrug resistance (MDR) was 70.56% (CI = 64.56–76.77%) and MDR in Campylobacter spp., Shigella spp., E. coli, and S. enterica. were 80.78, 79.08, 78.20, and 59.46%, respectively.

Conclusion

The pooled estimate showed a high burden of GNEBPs infections and a high proportion of drug resistance characters to commonly used antimicrobial agents in Ethiopia. Therefore, performing drug susceptibility tests, establishing an antimicrobial surveillance system and confirmation by molecular techniques are needed.

Identification and Characterization of Campylobacter Species in Livestock, Humans, and Water in Livestock Owning Households of Peri-urban Addis Ababa, Ethiopia: A One Health Approach

Campylobacter is the most common cause of bacterial infectious diarrhea and acute gastroenteritis globally, and is recognized as a significant zoonotic pathogen. Antimicrobial resistance amongst Campylobacter isolates is a significant global concern. A cross-sectional study was conducted to identify and characterize Campylobacter species in humans, animals and water sources in livestock owning households of peri-urban Addis Ababa, Ethiopia; and to characterize antimicrobial resistance. A total of 519 fecal samples from humans (n = 99), livestock (n = 179), poultry (n = 69), and water (n = 172) were collected. Samples were cultured for viable Campylobacter spp. and multiplex PCR utilized for the identification and confirmation. Antimicrobial susceptibility of the isolates was assessed using the Kirby-Bauer disc diffusion method. Campylobacter spp. was detected in 67/519 (13.0%) of the total tested samples, and the household level prevalence of Campylobacter was 42.4%. The prevalence of Campylobacter spp. was: humans (10.1%), cattle (18.5%), poultry (13.0%), sheep (13.3%), goats (7.1%), and water (10.5%). Campylobacter jejuni and C. fetus were the most frequently isolated species, followed by C. coli. The majority of isolates obtained from human samples had co-occurrence with isolates from cattle, poultry or water samples from the same household. The use of stored water, the practice of indoor and outdoor manure collecting, and animal species Campylobacter positivity were significantly associated with greater odds of human Campylobacter spp. positivity. All Campylobacter isolates from humans, poultry, sheep, goats and water, and 96.0% of isolates from cattle were resistant to at least one or more of the tested antimicrobials, with 95.5% of isolates resistant to three or more classes of antimicrobials. A One Health approach is recommended to further investigate Campylobacter species infections, and other zoonotic infectious diseases, in the livestock owning populations in Ethiopia, where there is close interaction between humans, animals and the environment.

Isolation, identification, and antimicrobial susceptibility pattern of Campylobacter jejuni and Campylobacter coli from cattle, goat, and chicken meats in Mekelle, Ethiopia

Campylobacter jejuni and Campylobacter coli are globally recognized as a major cause of bacterial foodborne gastroenteritis. A cross-sectional study was conducted from October 2015 to May 2016 in Mekelle city to isolate, identify, and estimate the prevalence of C. jejuni and C. coli in raw meat samples and to determine their antibiotic susceptibility pattern. A total of 384 raw meat samples were randomly collected from bovine (n = 210), goat (n = 108), and chicken (n = 66), and isolation and identification of Campylobacter spp. were performed using standard bacteriological techniques and PCR. Antibiotic susceptibility test was performed using disc diffusion method. Of the total 384 raw meat samples, 64 (16.67%) were found positive for Campylobacter spp. The highest prevalence of Campylobacter spp. was found in chicken meat (43.93%) followed by bovine meat (11.90%) and goat meat (9.25%). The most prevalent Campylobacter spp. isolated from meat samples was C. jejuni (81.25%). The overall prevalence of Campylobacter in restaurants, butcher shops, and abattoir was 43.93%, 18.30%, and 9.30%, respectively. 96.8%, 81.25%, 75%, and 71% of the Campylobacter spp. isolates were sensitive to norfloxacin, erythromycin, chloramphenicol, and sulphamethoxazole-trimethoprim, respectively. However, 96.9%, 85.9%, and 50% of the isolates were resistant to ampicillin, amoxicillin, and streptomycin, respectively. Strains that developed multi-drug resistant were 68.7%. The result of this study revealed the occurrence of Campylobacter in bovine, goat, and chicken meats. Hence, there is a chance of acquiring infection via consumption of raw or undercooked meat. Thus, implementation of hygienic practices from a slaughterhouse to the retailers, proper handling and cooking of foods of meat are very important in preventing Campylobacter infection.

A systematic review and meta-analysis reveal that Campylobacter spp. and antibiotic resistance are widespread in humans in sub-Saharan Africa

INTRODUCTION

Campylobacter spp. are zoonotic bacteria that cause gastroenteritis in humans worldwide, whose main symptom is diarrhea. In certain cases, extra intestinal manifestations may occur, such as Guillain Barré syndrome. The bacteria cause severe diarrhea mostly in children and in immunocompromised individuals. This review aims to address the prevalence of Campylobacter spp. in humans in sub-Saharan Africa. It also aims to understand the impact of HIV in the prevalence, as well as to report data on antibiotic resistance and propose research priorities.

METHODS

We followed PRISMA guidelines to find studies on the occurrence of Campylobacter spp. in humans in all countries from sub-Saharan Africa. Studies published between 2000 and 2020 were searched in PubMed, Cochrane Library, CINAHL, African Index Medicus, African Journals Online, Google Scholar and Science Direct. We have conducted a random-effect meta-analysis and calculated the proportion of resistant isolates to different antibiotics.

RESULTS AND DISCUSSION

We found 77 studies that described such occurrence in humans in 20 out of 53 sub-Saharan African countries. Campylobacter jejuni was the most prevalent species. Pooled prevalence was 9.9% (CI: 8.4%-11.6%). No major variations within the different sub-regions were found. Most studies reported Campylobacter spp. as the cause of diarrhea, mainly in children. Some studies reported the bacteria as a possible etiologic agent of acute flaccid paralysis and urinary tract infection. Campylobacter spp. presented a higher pooled prevalence in HIV infected patients, although not statistically significant. High proportions of resistant strains were reported for many antibiotics, including erythromycin and tetracycline.

CONCLUSION

Campylobacter spp. occur in sub-Saharan Africa, although information is scarce or inexistent for many countries. Research priorities should include investigation of the understudied species; extra intestinal manifestations; the impact of HIV infection and associated risk factors. Control strategies should be reinforced to contain the spread of this pathogen and drug resistance.

Multiple drug resistance of Campylobacter jejuni and Shigella isolated from diarrhoeic children at Kapsabet County referral hospital, Kenya

Background

Diarrhoea is a common cause of mortality and morbidity in children under five years old. In Kenya, it has a 21% case fatality with Enteropathogenic E. coli, Campylobacter jejuni, Shigella spp. and Salmonella spp. accounting for 50–60% of the cases. Sulphonamides, tetracycline, ampicillin and trimethoprim/sulfamethoxazole are typically used in the treatment of diarrhoeal diseases but have become ineffective in the face of emerging antimicrobial resistance. The objective of this study was to evaluate the prevalence and antimicrobial susceptibility of Campylobacter jejuni and Shigella species in children under five years of age presenting with diarrhoea at Kapsabet County Referral Hospital in Kenya.

Methods

Faecal samples were collected from 139 children admitted with diarrhoea. Each sample was examined macroscopically for colour, texture, and presence of extraneous material. The samples were then cultured for bacterial growth. Observed bacterial growth was isolated and identified by a series of biochemical tests. Resistance patterns were also evaluated using the Kirby – Bauer Disk diffusion method. The chi – square test and Pearson Correlation Coefficient were used to establish statistical significance.

Results

Approximately 33.1% of the total faecal samples tested were positive for enteric pathogens. Shigella spp. demonstrated resistance to erythromycin (91.7%), doxycyclin (83.3%), ampicillin (82.1%), cotrimoxazole (73.1%), minocycline (66.7%) and cefuroxime (54.2%). Campylobacter jejuni also exhibited resistance to erythromycin (87.5%), doxycyclin (75%), ampicillin (73.7%), cotrimoxazole (73.3%) and minocycline (68.8%).

Conclusions

The resistance patterns of Shigella spp. and Campylobacter jejuni reported in this study necessitates the need for a comprehensive multiregional investigation to evaluate the geographical prevalence and antimicrobial resistance distributions of these microorganisms. These findings also support the need for the discovery and development of effective therapeutic alternatives.

Trial registration

Retrospectively registered. Certificate No. 00762

Prevalence and associated factor of Campylobacter species among less than 5-year-old children in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Despite the significant reductions in under-five mortality, campylobacteriosis has emerged as one of the most common causative agents of bacterial foodborne gastroenteritis in humans. We performed this systematic review and meta-analysis to estimate the pooled prevalence of Campylobacter species and associated risk factors among children less than 5 years of age in Ethiopia.

METHODS

A systematic search was conducted on PubMed, Web of Science, EMBASE, Google Scholar and the Cochrane Library. All identified observational studies reporting the prevalence and determinants of diarrhea among children under 5 years of age in Ethiopia were included. Two authors independently extracted data and analyzed them using STATA Version 13 statistical software. A random-effects model was computed to estimate the pooled prevalence and the associations between determinant factors and campylobacteriosis.

RESULTS

Out of 166 papers reviewed, 8 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of Campylobacter species among children under 5 years of age in Ethiopia was 10% (95% CI: 7, 13). Contact with domestic animals (OR: 3.2, 95% CI: 2.0, 5.1), illiterate mothers (OR: 2.1, 95% CI: 1.1, 3.8), consumption of animal products (OR: 1.7, 95% CI: 0.7, 4.5), and status of mothers' personal hygiene (OR: 1.1, 95% CI: 0.7, 1.8) were significantly associated with the prevalence of Campylobacter species.

CONCLUSION

In our study, Campylobacter species among children under 5 years of age in Ethiopia were significantly high. Contact with domestic animals, illiterate mothers and consumption of animal products were significantly associated with prevalence of Campylobacter species.

Prevalence of Campylobacter species in human, animal and food of animal origin and their antimicrobial susceptibility in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Campylobacter jejuni and Campylobacter coli accounts for most cases of human gastrointestinal infections. The infection occurs through ingestion of contaminated food or water, and direct contact with feces of infected animal or human. Regardless of few local reports of Campylobacter and its antimicrobial susceptibility profile, there is no comprehensive data that show the burden of Campylobacter infection at national level in Ethiopia. This systemic review and meta-analysis aimed to determine the pooled prevalence of Campylobacter and its resistance patterns in Ethiopia from different sources.

METHOD

A comprehensive literature search of PubMed, Google scholar, Science direct and Google engine search was conducted for studies published from 2000 to July 30, 2020 on prevalence and antimicrobial susceptibility of Campylobacter in human, animal and food. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Checklist. Data from articles was extracted using a standardized data extraction format. The quality of the studies was assessed based on the Newcastle-Ottawa scale. The Q test and I2 test statistic were used to test heterogeneity across studies. The Pooled estimate of prevalence of Campylobacter species and its antimicrobial susceptibility profile was computed by a random effects model using STATA 16.0 software. Results were presented in forest plot, tables, funnel plot and figures with 95% confidence interval.

RESULTS

A total of 291 articles were retrieved initially. The pooled prevalence of Campylobacter species from different sources was 10.2% (95% CI 3.79, 16.51). In this meta-analysis, the lowest prevalence was 6.0% whereas the highest prevalence was 72.7%. In the sub-group analysis, the pooled prevalence was similar in Amhara and Oromia region, higher in Gambella and lower in Sidama. Prevalence of Campylobacter was higher in animals (14.6%) compared to humans (9%). The pooled antimicrobial resistance rates of Campylobacter species to different antimicrobials ranged from 2.9-100%. Overall, higher rate of resistance was to cephalothin (67.2%), gentamicin (67.2%), and trimethoprim-sulfamethoxazole (33.3%) in Campylobacter isolates from all sources. In isolates from human, resistance to cephalothin was 83% followed by amoxicillin (80%), amoxicillin-clavulnate (36%), trimethoprim-sulfamethpxazole (32%), clindamycin (31%) and ceftriaxone (28%). On the other hand, higher rate of resistance to penicillin (100%), cephalothin (60%), ciprofloxacin (71.2%), and trimethoprim-sulfamethoxazole (39%) was recorded in isolates from animals.

CONCLUSION

The present study highlights the burden of Campylobacter species in the country and higher rate of resistance among investigated isolates. Designing appropriate prevention strategies and further local in-depth studies are recommended to establish actual epidemiological burden of the bacteria in the country.

Risk factors and transmission pathways associated with infant Campylobacter spp. prevalence and malnutrition: A formative study in rural Ethiopia

Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships between infant Campylobacter prevalence, malnutrition and associated risk factors, including domestic animal husbandry practices, in rural Ethiopia. Thirty-five households were visited in Sidama zone, Southern Nations, Nationalities and Peoples' region. Infant and poultry faeces and domestic floor surfaces (total = 102) were analysed for presumptive Campylobacter spp. using selective culture. Infant anthropometry and diarrhoeal prevalence, WASH facilities and animal husbandry data were collected. Of the infants, 14.3% were wasted, 31.4% stunted and 31.4% had recent diarrhoea. Presumptive Campylobacter spp. was isolated from 48.6% of infant, 68.6% of poultry and 65.6% of floor surface samples. Compared to non-wasted infants, wasted infants had an increased odds ratio (OR) of 1.41 for a Campylobacter-positive stool and 1.81 for diarrhoea. Positive infant stools showed a significant relationship with wasting (p = 0.026) but not stunting. Significant risk factors for a positive stool included keeping animals inside (p = 0.027, OR 3.5), owning cattle (p = 0.018, OR 6.5) and positive poultry faeces (p<0.001, OR 1.34). Positive floor samples showed a significant correlation with positive infant (p = 0.023), and positive poultry (p = 0.013, OR 2.68) stools. Ownership of improved WASH facilities was not correlated with lower odds of positive stools. This formative study shows a high prevalence of infants positive for Campylobacter in households with free-range animals. Findings reaffirm contaminated floors as an important pathway to infant pathogen ingestion and suggest that simply upgrading household WASH facilities will not reduce infection without addressing the burden of contamination from animals, alongside adequate separation in the home.

Prevalence, Risk Factors, and Antimicrobial Resistance Profiles of Thermophilic Campylobacter Species in Humans and Animals in Sub-Saharan Africa: A Systematic Review

Thermophilic Campylobacter species are clinically important aetiologies of gastroenteritis in humans throughout the world. The colonization of different animal reservoirs by Campylobacter poses an important risk for humans through shedding of the pathogen in livestock waste and contamination of water sources, environment, and food. A review of published articles was conducted to obtain information on the prevalence and antimicrobial resistance (AMR) profiles of thermophilic Campylobacter species in humans and animals in sub-Saharan Africa (SSA). Electronic databases, namely, PubMed, Google Scholar, Research4life-HINARI Health, and Researchgate.net, were searched using the following search terms “thermophilic Campylobacter,” “Campylobacter jejuni,” “Campylobacter coli,” “diarrhea/diarrhoea,” “antimicrobial resistance,” “antibiotic resistance,” “humans,” “animals,” “Sub-Saharan Africa,” and “a specific country name.” Initially, a total of 614 articles were identified, and the lists of references were screened in which 22 more articles were identified. After screening, 33 articles on humans and 34 on animals and animal products were included in this review. In humans, Nigeria reported the highest prevalence (62.7%), followed by Malawi (21%) and South Africa (20.3%). For Campylobacter infections in under-five children, Kenya reported 16.4%, followed by Rwanda (15.5%) and Ethiopia (14.5%). The country-level mean prevalence in all ages and under-five children was 18.6% and 9.4%, respectively. The prevalence ranged from 1.7%–62.7% in humans and 1.2%–80% in animals. The most reported species were C. jejuni and C. coli. The AMR to commonly used antimicrobials ranged from 0–100% in both humans and animals. Poultry consumption and drinking surface water were the main risk factors for campylobacteriosis. The present review provides evidence of thermophilic Campylobacter occurrence in humans and animals and high levels of AMR in SSA, emphasizing the need for strengthening both national and regional multisectoral antimicrobial resistance standard surveillance protocols to curb both the campylobacteriosis burden and increase of antimicrobial resistance in the region.

Epidemiological patterns and antimicrobial resistance of bacterial diarrhea among children in Nairobi City, Kenya

AIM

Determine the prevalence of enteric bacterial pathogens and their antimicrobial resistance among diarrheic children in Nairobi City, Kenya.

BACKGROUND

Regardless of enteric bacterial pathogens being a major cause of gastroenteritis in children, their occurrence and antimicrobial resistance patterns reveals regional spatial and temporal variation.

METHODS

In a cross-sectional study, a total of 374 children below five years presenting with diarrhea at Mbagathi County Hospital were recruited. Stool microbiology test was used to detect enteric bacterial infection. Antimicrobial resistance was determined using the disk diffusion method.

RESULTS

Diarrheagenic E. coli (36.4%) was the leading species followed by Shigella (3.2%), Salmonella (2.4%), Campylobacter (1.6%), Yersinia (1.3%) and Aeromonas (1.1%) species. Escherichia coli pathotyping revealed that 20.9%, 4.0%, 10.2% and 0.5% of the study participants were infected with enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC) and enteroinvasive E. coli (EIEC) pure isolates while the prevalence of mixed pathotype infections was 0.3% for EAEC/EPEC/ETEC and 0.5% for EAEC/ETEC. Shigella sero-grouping revealed that 0.5%, 0.3%, 1.9%, and 0.5% were infected with Shigella boydii, Shigella dysentriae, Shigella flexneri and Shigella sonnei pure isolates. Shigella species and E. coli co-infection was detected in 2.4% of the children, specifically, 1.1% for EAEC/Shigella boydii, 0.5% for EAEC/Shigella dysentriae and 0.3% in each case of EAEC/Shigella sonnei, EPEC/Shigella flexneri and ETEC/Shigella flexneri co-infections. Most of the isolates were resistant to commonly prescribed antibiotics.

CONCLUSION

There was a high prevalence of enteric bacterial pathogens and co-infection alters epidemiological dynamics of bacterial diarrhea in children. Continuous antibiotic resistance surveillance is justified because the pathogens were highly resistant to commonly prescribed antimicrobials.

Campylobacter at the Human-Food Interface: The African Perspective

The foodborne pathogen Campylobacter is a major cause of human gastroenteritis, accounting for an estimated annual 96 million cases worldwide. Assessment of the true burden of Campylobacter in the African context is handicapped by the under-reporting of diarrhoeal incidents and ineffective monitoring and surveillance programmes of foodborne illnesses, as well as the minimal attention given to Campylobacter as a causative agent of diarrhoea. The present review of the literature highlights the variability in the reported occurrence of Campylobacter in humans and animal food sources across different countries and regions in Africa. Campylobacter infection is particularly prevalent in the paediatric population and has been isolated from farm animals, particularly poultry, and foods of animal origin. The reported prevalence of Campylobacter in children under the age of five years ranges from 2% in Sudan to 21% in South Africa. In poultry, the prevalence ranges from 14.4% in Ghana to 96% in Algeria. This review also highlights the alarming trend of increased Campylobacter resistance to clinically important antimicrobials, such as ciprofloxacin and erythromycin, in humans and food animals in Africa. This review adds to our understanding of the global epidemiology of Campylobacter at the human–food animal interface, with an emphasis from the African perspective. Interinstitutional and intersectoral collaborations, as well as the adoption of the One Health approach, would be useful in bridging the gaps in the epidemiological knowledge of Campylobacter in Africa.

Paramedical staffs knowledge and attitudes towards antimicrobial resistance in Dire Dawa, Ethiopia: a cross sectional study

Background

The continuing emergence, development and spread of pathogenic organisms that are resistant to antimicrobials are a cause of increasing concern. The control of antimicrobial resistance requires knowledge of factors causing antimicrobial resistance, good attitudes towards the intervention strategies as well as changes in antibiotic prescribing behavior of health workers. Hence, this study was aimed to assess paramedical staffs’ knowledge and attitudes towards antimicrobial resistance and their antibiotics prescription practices in Dire Dawa, Ethiopia.

Methods

A cross-sectional survey was conducted among paramedical staffs working in hospitals and health centers. A total of 218 paramedical staffs were participated and a self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 20. Chi square/Fisher’s exact tests were used for comparison of data and a p value of less than 0.05 was considered statistically significant.

Results

Out of the total, 137 (62.8%) of paramedical staffs had good knowledge on the factors causing antimicrobial resistance. The most common causes of antimicrobial resistance reported were patients’ poor adherence (96.5%), self prescription (95%), and empiric choice of antibiotics (94.5%). In general, more than 80% of the respondents had positive attitudes towards the antimicrobials resistance intervention strategies. Relatively less proportion of participants recognized that antimicrobial resistance as a problem in their local institutions. The most perceived driving forces for unnecessary antibiotics prescriptions were treatment failure (67.7%) and patient push (53.3%). The majority, 76.9% of the prescribers mentioned that standard treatment guidelines were available in their institutions though only 15.7% of them reported referring the guidelines on the daily basis. Among the prescribers, 85.8% never attended formal trainings on antibiotics prescriptions.

Conclusions

As this study generated important information on knowledge and attitudes of paramedical staffs about antimicrobial resistance, it identified areas of misconceptions and specific groups to be targeted for educational interventions regarding antimicrobial resistance. It is, therefore, suggested that a well-planned, organized and structured training programs should be undertaken to improve the appropriate use of antibiotics.

Prevalence and antibiotic resistance profile of thermophilic Campylobacter spp. of slaughtered cattle and sheep in Shiraz, Iran

Although poultry meat is considered as the main source for human Campylobacter infections, there is limited information about non-poultry sources. The present study was aimed to investigate the prevalence and the antibiotic resistance of thermophilic Campylobacter spp. in fecal samples of the cattle and sheep in Shiraz, Iran. A total of 302 fecal samples were obtained from clinically healthy, slaughtered cattle and sheep from Shiraz slaughterhouse. The animals were clinically healthy before being slaughtered. The samples were cultured according to the specific cultivation method under thermophilic conditions. The susceptibility of Campylobacter isolates were determined for 13 antimicrobial agents. All enriched samples and cultured isolates were targeted for polymerase chain reaction (PCR) detection of 16S rRNA and multiplex PCR for determining their species. Among 302 fecal samples, 65 (21.5%) and 205 (67.8%) samples were positive for the presence of Campylobacter species with the cultivation and PCR techniques, respectively. All 65 distinct isolates were susceptible to neomycin and colistin and the isolates showed high resistance to cephalotin (83.0%) and ciprofloxacin (67.7%). After the multiplex PCR, 78.5% of total positive samples showed the simultaneous presence of Campylobacter jejuni and Campylobacter coli. In conclusion, the results emphasized that non-poultry farms are important as a possible source of Campylobacter infections.