Antimicrobial Resistance Patterns of Bacterial Fecal E. Coli Isolated From Patients Presenting With Bacterial Diarrhea in Nakivale Refugee Settlement, Southwestern Uganda

Background: Antimicrobial resistance (AMR) in bacterial diarrheal organisms is threatening the world population's health, thus posing a global public health crisis. Antimicrobial resistance patterns threaten effective prevention and treatment options of bacterial diarrheal diseases in the refugee population. Therefore, this study aimed at determining antimicrobial resistance patterns in the most isolated bacterial diarrheal pathogens. Method: The study was carried out in Nakivale Refugee settlement camp in Isingiro district Southwestern Uganda. All stool samples collected were transported in Cary Blair subsequently cultured on MacConkey, Xylose Lysine Deoxycholate (XLD), and Thiosulfate Citrate Bile Salts Sucrose agar(TCBS) culture media. Significant organisms were identified using conventional biochemical identification. Further identification of presumptive bacterial organisms using Bruker MALDI Biotyper was performed. Subsequent isolation on Sorbitol MacConkey and Latex agglutination was performed to identify potential bacterial pathogenic microorganisms to the species level. Polymerase Chain Reaction was used for genotyping extended beta Lactamase genes in E. coli isolates. Findings: Out of 197 samples collected, 39% (n=77) showed significant presumptive pathogenic enteropathogens growth. Further analysis showed that E. coli was the most isolated causative agent of bacterial diarrhea at 53.2%(n=41). Organisms showed the highest resistance to Trimethoprim, Tetracycline, and Ampicillin at 92.68%, 90.24%, 82.93%, respectively. In contrast, organisms showed the least resistance to Cefuroxime (30ug), Levofloxacin (15 mcg), and Ceftazidime (30ug) at 73.17%,65.85%,92.68%, respectively among the isolated E. coli. Molecular detection of Extended Spectrum Beta-Lactamase genes in E. coli isolates showed that blaTEM., bla CTX-M, bla SHV were detected at 96.96%(32/33), 87.87%(29/33) 45.45%(15/33), respectively. Conclusion: E. coli is among the leading enteropathogens that cause bacterial diarrhea among the refugee population. E. coli pathogens are resistant to some commonly used antibiotics, which risks developing antimicrobial resistance in the beta-lactam class.