OP3 - Characteristics of common bacterial pathogens and contributory factors causing acute gastroenteritis in children admitted to a tertiary care hospital, Sri Lankan children admitted to a tertiary care hospital, Sri Lanka.

Dias KMGHH¹, Piyasiri DLB¹, Pathirage S²¹National Hospital, Galle, ²Medical Research Institute

Abstract

Introduction

Acute gastroenteritis (AGE) remains a leading cause of paediatric morbidity and mortality globally, with approximately 1.7 billion annual cases of childhood diarrhoea. In Sri Lanka, there is a lack of recently published evidence on the bacterial aetiology of AGE. This study aims to fill that gap by determining the prevalence, antibiotic sensitivity patterns (ABST), and hygienic and dietary factors associated with bacterial AGE.

Objectives

The primary objective was to determine characteristics of common bacterial pathogens and identify contributory factors for AGE in hospitalised children. Specific goals included determining the percentage of bacterial pathogens, identifying the specific pathogens, assessing their ABST patterns, and analysing the contributory factors.

Design, setting, and methods

A descriptive cross-sectional study was conducted from November 2023 to March 2024 at the National Hospital, Galle. Stool samples from 141 paediatric patients under 14 years, diagnosed with AGE, were collected and processed using selective media named Salmonella Shigella, Xylose Lysine Deoxycholate, CHROMagar Shiga toxin-producing E. coli (STEC), and Campylobacter selective agar. ABST was performed according to CLSI M100, 33rd edition. Data on contributory factors were gathered via interviewer-based questionnaires. Data were analysed using SPSS v25.

Results

Bacterial pathogens were isolated in 15.6% (n=22) of patients. The most common isolates were STEC (8.51%), followed by non-typhoidal Salmonella spp. (3.54%), Campylobacter spp. (2.83%, n=4), and Shigella sonnei (0.70%). Notably, 41.6% of STEC isolates were extended-spectrum beta-lactamase (ESBL) producers. While Salmonella isolates showed high sensitivity to most antibiotics, all Campylobacter isolates were resistant to ciprofloxacin and nalidixic acid. Significant contributory factors for culture positivity included raw milk consumption (p=0.01) and inadequate handwashing before meals (p=0.046).

Conclusion

Bacterial pathogens, particularly STEC, significantly contribute to the burden of paediatric AGE in Galle district, Sri Lanka. The identification of ESBL-producing organisms and high fluoroquinolone resistance in Campylobacter highlights an emerging challenge with antimicrobial resistance. These findings emphasise the need for rational antibiotic use in the community and improved public health strategies focusing on food hygiene and handwashing.