ETIOLOGY OF BLOODY DIARRHEA IN BOLIVIAN CHILDREN - IMPLICATIONS FOR EMPIRIC THERAPY

In Bolivia, few data are available to guide empiric therapy for bloody diarrhea, A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Re ctal swabs from children < 5 years old with bloody diarrhea were exami ned for Salmonella, Shigella, and Campylobacter organisms; fecal speci mens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms we re found in 39 specimens (29%); 37 isolates (95%) were resistant to am picillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to c hloramphenicol, but all were susceptible to nalidixic acid, Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-r esistant Shigella species are a frequent cause of bloody diarrhea in B olivian children; E. histolytica is uncommon, Clinical predictors desc ribed in this study may help identify patients most likely to have Shi gella infection, Laboratory surveillance is essential to monitor antim icrobial resistance and guide empiric treatment.