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Am. J. Trop. Med. Hyg., 81(2), 2009, pp. 296-301
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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High Frequency of Antimicrobial Drug Resistance of Diarrheagenic Escherichia coli in Infants in Peru

Theresa J. Ochoa*, Joaquím Ruiz, Margarita Molina, Luis J. Del Valle, Martha Vargas, Ana I. Gil, Lucie Ecker, Francesca Barletta, Eric Hall, Thomas G. Cleary, AND Claudio F. Lanata
Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas; Centre de Recerca en Salut Internacional de Barcelona, Hospital Clinic/Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Instituto de Investigación Nutricional, Lima, Peru; Departament d’Enginyeria Agroalimentària i Biotecnologia, Escola Superior d’Agricultura de Barcelona, Universitat Politécnica de Catalunya, Castelldefels, Spain; U.S. Naval Medical Research Center, Lima, Peru; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru

In a prospective passive diarrhea surveillance cohort study of 1,034 infants of low socioeconomic communities in Lima, Peru, we determined the prevalence and antimicrobial drug susceptibility of the diarrheagenic Escherichia coli . The prevalence of diarrheagenic E. coli was 29% (161 of 557) in children with gastroenteritis and 30% (58 of 195) in the control group without diarrhea. The most common E. coli pathogens in diarrhea were enteroaggregative E. coli (EAEC) (14%), enteropathogenic E. coli (EPEC) (7%), diffusely adherent E. coli (DAEC) (4%), and enterotoxigenic E. coli (ETEC) (4%). Diarrheagenic E. coli as a group exhibited high levels of antimicrobial drug resistance in diarrheal cases to ampicillin (85%), cotrimoxazole (79%), tetracycline (65%), and nalidixic acid (28%). Among individual E. coli groups in patients with diarrhea, DAEC and EAEC exhibited significant higher frequencies of resistance to ampicillin, cotrimoxazole, tetracycline and nalidixic acid than EPEC and ETEC. Antimicrobial drug resistance to ampicillin and cotrimoxazole were more frequent in E. coli isolated from diarrheal samples than controls, which reflected greater antibiotic exposure in patients with gastroenteritis.

Received September 19, 2008. Accepted for publication May 12, 2009.

Financial support: This study was partially supported by the Agencia Española de Cooperación Internacional (grant A/4892/06), the Agència CatalanadeCooperacióalDesenvolupament,GeneralitatdeCatalunya (grant U2006), and the Centre de Cooperació per al Desenvolupament, Universitat Politècnica de Catalunya (grant to Luis J. Del Valle LJdV). Theresa J. Ochoa is supported by grant PHS-FIC 1K01TW007405 from the National Institutes of Health, Joaquím Ruiz is supported by grant FIS CP05/0130 from the Fondo de Investigaciones Sanitarias, Spain, Thomas G. Cleary is supported by grant PHS-NICHD R01-HD051716 from the National Institutes of Health.

Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, the U.S. Government, or the National Institutes of Health and other funding institutions.

* Address correspondence to Theresa J. Ochoa, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, San Martin de Porras, Lima 31, Peru. E-mail: theresa.j.ochoa{at}uth.tmc.edu

Authors’ addresses: Theresa J. Ochoa and Francesca Barletta, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, San Martin de Porras, Lima 31, Peru, E-mails: theresa.j.ochoa{at}uth.tmc.edu and francescabarletta{at}yahoo.es . Joaquím Ruiz, Centre de Recerca en Salut Internacional de Barcelona, C/Rosselló 132, 4. 08036, Barcelona, Spain, E-mail: joruiz{at}clinic.ub.es . Margarita Molina, Ana I. Gil, Lucie Ecker, and Claudio F. Lanata, Instituto de Investigación Nutricional, Avenida La Molina 1885, La Molina, Lima 12, Peru, E-mails: micro{at}iin.sld.pe , agil{at}iin.sld.pe , lecker{at}iin.sld.pe , and clanata{at}iin.sld.pe . Luis J. del Valle, Departament d’Enginyeria Agroalimentària i Biotecnologia, Escola Superior d’Agricultura de Barcelona, Universitat Politècnica de Catalunya, Avenida Canal Olímpic 15, 08860 Castelldefels, Barcelona, Spain, E-mail: luis.javier.del.valle{at}upc.edu . Martha Vargas, Hospital Clinic de Barcelona Villarroel 179, 08036 Barcelona, Spain, E-mail: mvargas{at}clinic.ub.es . Eric Hall, Director for Administration, Public Affairs Officer, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, E-mail: eric.hall{at}med.navy.mil . Thomas G. Cleary, Center for Infectious Diseases, University of Texas School of Public Health, PO Box 20186, Houston, TX 77225, E-mail: thomas.g.cleary{at}uth.tmc.edu .






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