Antimicrobial-resistant bacterial diarrhea in rural western Kenya

Bacterial diarrheal diseases cause substantial morbidity and mortality in s ub-Saharan Africa, but data on the epidemiology and antimicrobial susceptib ility patterns of enteric bacterial pathogens are limited. Between May 1997 and April 1998, a clinic-based surveillance for diarrheal disease was cond ucted in Asembo, a rural area in western Kenya. In total, 729 diarrheal spe cimens were collected, and 244 (33%) yielded greater than or equal to1 bact erial pathogen, as determined by standard culture techniques; 107 (44%) Shi gella isolates, 73 (30%) Campylobacter isolates, 45 (18%) Vibrio cholerae O 1 isolates, and 33 (14%) Salmonella isolates were identified. Shigella dyse nteriae type 1 accounted for 22 (21%) of the Shigella isolates. Among 112 p atients empirically treated with an antimicrobial agent and whose stool spe cimens yielded isolates on which resistance testing was done, 57 (51%) had isolates that were not susceptible to their antimicrobial treatment. Empiri c treatment strategies for diarrheal disease in western Kenya need to be re evaluated, to improve clinical care.