Bacterial aetiology and anti-microbial resistance of childhood diarrhoea in Yemen

In a 12-month period, 561 stool cultures from Yemeni children aged 1-60 months and presenting with diarrhoea, were analysed to identify the bacterial aetiology and their anti-microbial resistance to the commonly used antibiotics. A total of 190 (33.9 per cent) were positive for bacterial culture. Most of the positive cultures (58 per cent) were from children aged 1-12 months. The majority of the positive cultures were enteropathogenic Escherichia coli (58.4 per cent) Salmonella spp., and Shigella spp. (20 per cent each). Campylobacter were found to be an extremely uncommon agent of childhood diarrhoea making only 1.6 per cent of the positive cultures. The majority of the Salmonella were group C (60.5 per cent) and group B (29 per cent). Of the Shigella isolates, 13 (34 per cent) were S. flexneri, and seven (18 per cent) S. dysentrea. More than two-thirds of the Salmonella isolates were resistant to nalidixic acid, chloramphenicol, co-trimoxazole, gentamicin, and amoxycillin, while 42 per cent were resistant to cefotaxime. Most of the Shigella isolates were susceptible to nalidixic acid and cefotaxime, and resistant to the other antibiotics. All the tested enteropathogenic E. coli isolates were resistant to amoxycillin, 83 per cent were resistant to co-trimoxazole, 62 per cent to chloramphenicol, and 54 per cent to gentamicin, while only 16 and 6 per cent were resistant to nalidixic acid and cefotaxime, respectively. This study, the first in Yemen, draws attention to the urgent need of a national surveillance system, essential for the containment of anti-microbial resistance.