Epidemiological characteristics of diarrhea in children and drug resistance of diarrheagenic Escherichia coli in Shanghai, 2015–2018

ObjectiveTo investigate the epidemiological characteristics and pathogenic spectrum of diarrhea in children in Shanghai, and analyze the drug resistance of diarrheagenic Escherichia coli (DEC).

MethodsThe clinical and epidemiological information of the children who sought medical case in sentinel hospitals due to diarrhea from April 2015 to March 2018 were collected. The stool samples were collected from them for bacterium culture and virus nucleic acid test. The test of drug resistance of the DEC strains was conducted.

ResultsA total of 880 children with diarrhea were surveyed, in whom 92.95% were less than 5 years old. The overall pathogen detection rate was 47.50%. There was no significant difference in pathogen detection rate between boys and girls (χ²＝1.778, P＝0.182). The pathogen detection rate was significantly lower in infants less than 1 year old than in other groups (χ²＝90.929, P＜0.001). The pathogen detection rate was significantly lower in breastfed infants than in non-breastfed infants and mixed feeding infants (χ²＝31.384, 14.746, P＜0.001). The pathogen detection rate was higher in children in child care settings than in children outside child care settings (χ²＝11.158, P＝0.001). The common bacteria causing diarrhea was Salmonella (5.11%), followed by enteropathogenic E. coli (4.55%), Campylobacter jejuni (4.43%) and enteroaggregative E. coli (3.07%). The common viruses detected were Norovirus GⅡ(7.95%) and rotavirus A (4.66%). The bacteria detection rate was highest in children over 5 years old (35.48%). The virus detection rate was highest in children aged 3–4 years (28.30%). The co-infection rate of bacteria and virus was highest in children aged ≥5 years (9.68%). The predominant pathogen was bacterium in summer and virus in winter. The peak of the detection of co-infection of bacterium and virus was in autumn. The drug resistance rates of DEC to second and third generation cephalosporins of cefotaxime, cefuroxime, cefoxitin were 15.44%, 20.59% and 5.88%, respectively. The drug resistance rates of DEC to quinolones of levofloxacin and ciprofloxacin were all 5.15%.

ConclusionClose attention should be paid to children in child care settings since the pathogen detection rate was considerably high. The incidences of bacterial diarrhea and viral diarrhea showed obvious age and seasonal patterns. Although the drug resistance level of DEC to second and third generation cephalosporins was lower than the national level, it is still necessary to use antibiotics rationally.