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

Theresa J. Ochoa 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

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Joaquím Ruiz 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

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Margarita Molina 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

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Luis J. Del Valle 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

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Martha Vargas 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

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Ana I. Gil 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

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Lucie Ecker 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

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Francesca Barletta 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

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Eric Hall 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

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Thomas G. Cleary 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

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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

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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.

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