Abstract

Background: From a clinical perspective, it is important to know which serogroups, virulence genes and antibiotic resistance patterns are present in Shiga toxin-producing Escherichia coli strains in pediatric patients suffering from diarrheic and non-diarrheic infections. This is the first study in Iran that has comprehensively investigated the Shiga toxin-producing Escherichia coli-related infection characteristics in diarrheic and non-diarrheic pediatric patients of 0-60 months of age. Methods: Two-hundred and twenty four diarrheic and 84 non-diarrheic stool specimens were collected from the Baqiyatallah hospital of Tehran, Iran. The stool samples were cultured immediately and those that were E. coli-positive were analyzed for the presence of antibiotic resistance genes and bacterial virulence factors using PCR. Antimicrobial susceptibility testing was performed using disk diffusion method. Results: One-hundred and fifty four out of 224 (68.75) diarrheic stools and 31 out of 84 (36.90) non-diarrheic stools harbored E. coli. In addition, children in 13-24 month-old age group had the highest incidence of infection with this bacterium (77.63). A significant difference was found between the frequency of Attaching and Effacing Escherichia coli and Enterohaemorrhagic Escherichia coli (P = 0.045). The genes encoding Shiga toxins and intimin were the most commonly detected virulence factors. Among all serogroups studied, O26 (27.04) and O111 (18.85) had the highest incidences in the diarrheic and non-diarrheic patients. The incidence of genes encoding resistance against sulfonamide (sul1), gentamicin (aac(3)-IV), trimethoprim (aadA1), cephalothin (blaSHV) and tetracycline (tetA) were 82.78, 68.03, 60.65, 56.55 and 51.63, respectively. High resistance levels against penicillin (100), tetracycline (86.88), gentamicin (62.29) and streptomycin (54.91) were observed. Marked seasonality in the serogroup distributions was evident, while STEC infections were more common in summer (P = 0.041). Conclusions: Our findings should raise awareness about antibiotic resistance in diarrheic pediatric patients in Iran. Clinicians should exercise caution when prescribing antibiotics, especially during the warmer months of the year.