European Journal of Epidemiology

, Volume 18, Issue 1, pp 85–90 | Cite as

A 5-year study of the bacterial pathogens associated with acute diarrhea on the island of Crete, Greece, and their resistance to antibiotics

  • S. Maraki
  • A. Georgiladakis
  • Y. Tselentis
  • G. Samonis
Article

Abstract

During a 5-year period (1995–1999) a total of 7090 stool samples obtained from patients with acute diarrhoea, mostly community-acquired, were examined for bacterial pathogens, in the Greek island of Crete. One or more enteric pathogens were isolated from 987 patients (14%). Salmonella enterica were the most commonly isolated bacteria (6%), followed by Campylobacter spp. (4.2%), and enteropathogenic Escherichia coli (EPEC) (1.8%). Yersinia enterocolitica (0.6%), Shigella spp. (0.3%), and Aeromonas hydrophila (0.04%), were less frequently isolated. Clostridium difficile was isolated from 65 out of 451 diarrhoeal specimens examined (14.4%). Toxin B was detected in all cases. No verotoxigenic E. coli strains were identified. Resistance to ampicillin was observed in 31.5% of the Salmonella, 58.3% of the Shigella and 31.5% of the EPEC isolates. Resistance to trimethoprim-sulfamethoxazole was observed in 4.4% of the Salmonella, 30.5% of the Shigella, and 18.5% of the EPEC isolates. High percentages of resistance to quinolones (44.5% to norfloxacin, and 40.5% to ciprofloxacin), were found among Campylobacter isolates, while resistance to erythromycin was observed in 14.9% of them. With the present study we continue the surveillance of bacterial pathogens associated with diarrhoeal disease on the island of Crete.

Bacterial pathogens Crete Diarrhoea Resistance 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Guerrant RL, Hughes JM, Lima NL, Crane J. Diarrhea in developed and developing countries: magnitude, special settings, and etiologies. Rev Infect Dis 1990; 12(Suppl 1): 41–50.Google Scholar
  2. 2.
    Albert MJ, Faruque AS, Faruque SM, Sack RB, Mahalanabis D. Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol 1999; 37: 3458–3464.Google Scholar
  3. 3.
    Guerrant RL, Steiner TS. Principles and syndromes of enteric infection. In: Mandell GL, Bennett JE, Dolin R (eds), Principles and Practice of Infectious Diseases. New York: Churchill Livingstone, 2000: 1076–1093.Google Scholar
  4. 4.
    Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001; 32: 331–350.Google Scholar
  5. 5.
    Samonis G, Elting L, Skoulika E, Maraki S, Tselentis Y. An outbreak of diarrhoeal disease attributed to Shigella sonnei. Epidemiol Infect 1994; 112: 235–245.Google Scholar
  6. 6.
    Samonis G, Maraki S, Christidou A, Georgiladakis A, Tselentis Y. Bacterial pathogens associated with diarrhoea on the island of Crete. Eur J Epidemiol 1997; 13: 831–836.Google Scholar
  7. 7.
    Bopp CA, Brenner FW, Wells JG, Strockbine NA. Escherichia, Shigella, and Salmonella. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (eds), Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 1999: 459–474.Google Scholar
  8. 8.
    Nachamkin I. Campylobacter and Arcobacter. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (eds), Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 1999: 716–726.Google Scholar
  9. 9.
    National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing; Eleventh informational supplement. NCCLS document M100-S11. National Committee for Clinical Laboratory Standards, Villanova, PA, 2001.Google Scholar
  10. 10.
    Essers B, Burnens AP, Lanfranchini FM, et al. Acute community-acquired diarrhea requiring hospital admission in Swiss children. Clin Infect Dis 2000; 31: 192–196.Google Scholar
  11. 11.
    Caprioli A, Pezzella C, Morelli R, et al. Enteropathogens associated with childhood diarrhea in Italy. Pediatr Infect Dis J 1996; 15: 876–883.Google Scholar
  12. 12.
    Kafetzis DA, Maltezou HC, Zafeiropoulou A, Attilakos A, Stavrinadis C, Foustoukou M. Epidemiology, clinical course and impact on hospitalization costs of acute diarrhea among hospitalized children in Athens, Greece. Scand J Infect Dis 2001; 33: 681–685.Google Scholar
  13. 13.
    Rodrigue DC, Tauxe RV, Rowe B. International increase in Salmonella enteritidis: A pandemic? Epidemiol Infect 1990; 105: 21–27.Google Scholar
  14. 14.
    Scuderi G, Fantasia M, Niglio T. Results of the threeyear surveillance by the Italian System: Human isolates of Salmonella serotypes. Eur J Epidemiol 2000; 16: 377–383.Google Scholar
  15. 15.
    Banatvala N, Cramp A, Jones IR, Feldman RA. Salmonellosis in North Thames (East), UK. Epidemiol Infect 1999; 122: 201–207.Google Scholar
  16. 16.
    Tavechio AT, Fernandes SA, Neves BC, Dias AM, Irino K. Changing patterns of Salmonella serovars: Increase of Salmonella enteritidis in Sao Paulo, Brasil. Rev Inst Med Trop Sao Paulo 1996; 38: 315–322.Google Scholar
  17. 17.
    Papadakis J. Presented at WHO meeting for salmonellosis, Talavera, Spain, 1992.Google Scholar
  18. 18.
    Vatopoulos AC, Mainas E, Balis E, et al. Molecular epidemiology of ampicillin-resistant clinical isolates of Salmonella enteritidis. J Clin Microbiol 1994; 32: 1322–1325.Google Scholar
  19. 19.
    Tassios PT, Markogiannakis A, Vatopoulos A, et al. Molecular epidemiology of antibiotic resistance in Salmonella enteritidis during a 7-year period in Greece. J Clin Microbiol 1997; 35: 1316–1321.Google Scholar
  20. 20.
    Levine MM, Edelman R. Enteropathogenic Escherichia coli of classic serotypes associated with infant diarrhea: Epidemiology and pathogenesis. Epidemiol Rev 1984; 6: 31–51.Google Scholar
  21. 21.
    Nataro JP, Kaper JB. Diarrheagenic Escherichia coli. Clin Microbiol Rev 1998; 11: 142–201.Google Scholar
  22. 22.
    Svenungsson B, Lagergren Å, Ekwall E, et al. Enteropathogens in adult patients with diarrhea and healthy control subjects: A 1-year prospective study in a Swedish clinic for infectious diseases. Clin Infect Dis 2000; 30: 770–778.Google Scholar
  23. 23.
    Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002; 34: 346–353.Google Scholar
  24. 24.
    Naqvi SH, Swierkosz EM, Gerard J, Mills JR. Presentation of Yersinia enterocolitica enteritis in children. Pediatr Infect Dis J 1993; 12: 386–389.Google Scholar
  25. 25.
    Cover TL, Aber RC. Yersinia enterocolitica. N Engl J Med 1989; 21: 16–24.Google Scholar
  26. 26.
    Gikas A, Pediaditis J, Giti Z, Papadakis J, Tselentis Y. Shigellosis on an Italian cruise ship. Lancet 1996; 348: 1593–1594.Google Scholar
  27. 27.
    Threlfall EJ, Ward LR, Skinner JA, Rowe B. Increase in multiple antibiotic resistance in nontyphoidal salmonellas from human in England and Wales: A comparison of data for 1994 and 1996. Microb Drug Resist 1997; 3: 263–266.Google Scholar
  28. 28.
    Sramova H, Karpiskova R, Dedicova D, Sisak F, Rychlik I. Properties of Salmonella isolates in the Czech Republic. Epidemiol Mikrobiol Immunol 1999; 48: 111–116.Google Scholar
  29. 29.
    Nastasi A, Mammina C, Cannova L. Antimicrobial resistance in Salmonella enteritidis, Southern Italy, 1990-1998. Emerg Infect Dis 2000; 6: 401–403.Google Scholar
  30. 30.
    Wilcox MH, Spencer RC. Quinolones and Salmonella gastroenteritis. J Antimicrob Chemother 1992; 30: 221–228.Google Scholar
  31. 31.
    Ling JM, Koo IC, Kam KM, Cheng AF. Antimicrobial susceptibilities and molecular epidemiology of Salmonella enterica serotype enteritidis strains isolated in Hong Kong from 1986 to 1996. J Clin Microbiol 1998; 36: 1693–1699.Google Scholar
  32. 32.
    Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis 1998; 26: 341–345.Google Scholar
  33. 33.
    Prats G, Mirelis B, Llovet T, Munoz C, Miro E, Navarro F. Antibiotic resistance trends in enteropathogenic bacteria isolated in 1985-1987 and 1995-1998 in Barcelona. Antimicrob Agents Chemother 2000; 44: 1140–1145.Google Scholar
  34. 34.
    Thwaites RT, Frost JA. Drug resistance in Campylobacter jejuni, C. coli, and C. lari isolated from humans in north west England and Wales. J Clin Pathol 1999; 52: 812–814.Google Scholar
  35. 35.
    Gaudreau C, Gilbert H. Antimicrobial resistance in clinical strains of Campylobacter jejuni subsp. Jejuni isolated from 1985 to 1997 in Quebec, Canada. Antimicrob Agents Chemother 1998; 42: 2106–2108.Google Scholar
  36. 36.
    Smith K, Besser J, Hedberg C, et al. Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992-1998. N Engl J Med 1999; 340: 1525–1532.Google Scholar
  37. 37.
    Piddock LJ. Quinolone resistance and Campylobacter spp. J Antimicrob Chemother 1995; 36: 891–898.Google Scholar
  38. 38.
    Gomes TA, Rassi V, MacDonald KL, et al. Enteropathogens associated with acute diarrheal disease in urban infants in Sao Paulo, Brasil. J Infect Dis 1991; 164: 331–337.Google Scholar
  39. 39.
    Stock I, Wiedemann B. An in-vitro study of the antimicrobial susceptibilities of Yersinia enterocolitica and the definition of a database. J Antimicrob Chemother 1999; 43: 37–45.Google Scholar
  40. 40.
    Pham JN, Bell S, Lanzarone JYM. A study of the β-lactamases of 100 clinical isolates of Yersinia enterocolitica. J Antimicrob Chemother 1991; 28: 19–24.Google Scholar
  41. 41.
    Alzugaray R, Gonzalez Hevia MA, Landeras E, Mendoza ML. Yersinia enterocolitica O:3. Antimicrobial resistance patterns, virulence profiles and plasmids. New Microbiol 1995; 18: 215–222.Google Scholar
  42. 42.
    Maraki S, Georgiladakis A, Christidou A, Scoulica E, Tselentis Y. Antimicrobial susceptibilities and β-lactamase production of Shigella isolates in Crete, Greece during the period 1991-1995. APMIS 1998; 106: 879–883.Google Scholar
  43. 43.
    Aysev AD, Guriz H. Drug resistance of Shigella strains isolated in Ankara, Turkey, 1993-1996. Scand J Infect Dis 1998; 30: 351–353.Google Scholar
  44. 44.
    Mates A, Eyny D, Philo S. Antimicrobial resistance trends in Shigella serogroups isolated in Israel, 1990-1995. Eur J Clin Microbiol Infect Dis 2000; 19: 108–111.Google Scholar
  45. 45.
    San Joaquin VH, Scribner RK, Pickett DA, Welch DF. Antimicrobial susceptibility of Aeromonas species isolated from patients with diarrhea. Antimicrob Agents Chemother 1986; 30: 794–795.Google Scholar
  46. 46.
    Juan HJ, Tang RB, Wu TC, Yu KW. Isolation of Aeromonas hydrophila in children with diarrhea. J Microbiol Immunol Infect 2000; 33: 115–117.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • S. Maraki
    • 1
  • A. Georgiladakis
    • 1
  • Y. Tselentis
    • 1
  • G. Samonis
    • 1
  1. 1.Department of Clinical Bacteriology–Parasitology–Zoonoses and Geographical MedicineUniversity Hospital of HeraklionCreteGreece

Personalised recommendations