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Volume 30, Supplement—October 2024
SUPPLEMENT ISSUE
Articles

Azithromycin Resistance Patterns in Escherichia coli and Shigella before and after COVID-19, Kenya

Elizabeth A. Odundo, Erick C. Kipkirui, Margaret C. Koech, Mary C. Kirui, Ronald K. Kirera, Nancy C. Kipkemoi, Janet N. Ndonye, Alex Ragalo, Collins K. Kigen, James W. Muturi, Vanessa N. Onyonyi, Gathii Kimita, Erick K. Muthanje, Marissa K. Hetrich, Evelyn W. Mahugu, Kirti K. Tiwari, and Hunter J. SmithComments to Author 
Author affiliation: Kenya Medical Research Institute, Kericho and Kisumu, Kenya (E.A. Odundo, E.C. Kipkirui, M.C. Koech, M.C. Kirui, R.K. Kirera, N.C. Kipkemoi, J.N. Ndonye, A. Ragalo, C.K. Kigen, J.W. Muturi, V.N. Onyonyi, G. Kimita, E.K. Muthanje); Walter Reed Army Institute of Research–Africa, Kericho and Kisumu (E.A. Odundo, E.C. Kipkirui, M.C. Koech, M.C. Kirui, R.K. Kirera, N.C. Kipkemoi, J.N. Ndonye, A. Ragalo, C.K. Kigen, J.W. Muturi, V.N. Onyonyi, G. Kimita, E.K. Muthanje, K.K. Tiwari); Cherokee Nation Strategic Programs, Silver Spring, Maryland, USA (M.K. Hetrich); Armed Forces Health Surveillance Division, Silver Spring (M.K. Hetrich, E.W. Mahugu, H.J. Smith); General Dynamics, Silver Spring (E.W. Mahugu)

Main Article

Table 1

Characteristics of Escherichia coli and Shigella cases in Kenya before (2017–2019) and after (2022–2023) COVID-19*

Characteristic E. coli, n = 116 Shigella, n = 109 p value†
Median age, y (interquartile range)
 7 (3–25)
 18 (4–28)
 0.02
Age group 0.01
Children <18 y 75 (64.7) 52 (47.7)
Adults >18 y
 41 (35.3)
 57 (52.3)
Study period 0.17
Pre–COVID-19, 2017–2019 63 (54.3) 69 (63.3)
Post–COVID-19, 2022–2023
 53 (45.7)
 40 (36.7)
County site 0.96
Busia County Referral Hospital 18 (15.5) 15 (13.8)
Kericho County Referral Hospital 40 (34.5) 38 (34.9)
Kombewa County Hospital 10 (8.6) 7 (6.4)
Kisii Teaching and Referral Hospital 30 (25.9) 31 (28.4)
Uasin Gishu 17 (14.7) 18 (16.5)
Lamu
 1 (0.9)
 0
Diarrhea severity 0.75
No acute diarrhea 3 (2.6) 1 (0.9)
Acute diarrhea‡ 53 (46.5) 50 (45.9)
Severe acute diarrhea§
 58 (50.9)
 58 (53.2)
Water source§
Municipal 54 (47.0) 56 (51.4) 0.51
Rain 22 (19.1) 30 (27.5) 0.14
Borehole 22 (19.1) 18 (16.5) 0.61
Spring 9 (7.8) 18 (16.5) 0.046
Well 7 (6.1) 11 (10.1) 0.27
Bottle 3 (2.6) 4 (3.7) 0.72
Tap 1 (0.9) 0 >0.99
Stream 1 (0.9) 0 >0.99
Other
 0
 1 (0.9)
 0.49
Water treatment¶
No treatment 81 (70.4) 74 (67.9) 0.68
Boil 20 (17.4) 22 (20.2) 0.59
Distillation 0 1 (0.9) 0.49
Chemical 1 (0.9) 1 (0.9) >0.99
Chlorine 0 1 (0.9) 0.49
Water guard
 14 (12.2)
 10 (9.2)
 0.47
Ciprofloxacin susceptibility (15) 0.25
Susceptible 110 (97.3) 108 (100)
Intermediate 0 0
Resistant
 3 (2.7)
 0
Levofloxacin susceptibility (15) 0.25
Susceptible 110 (97.3) 108 (100)
Intermediate 0 0
Resistant
 3 (2.7)
 0
Azithromycin susceptibility (15) <0.001
Susceptible 89 (76.7) 105 (96.3)
Intermediate 1 (0.9) 0 (0)
Resistant 26 (22.4) 4 (3.7)

*Values are no. (%) except as indicated. One adult E. coli case was missing data and removed from denominators for the following variables: diarrhea severity, water source, and water treatment. Four cases (3 E. coli and 1 Shigella) had inconclusive ciprofloxacin and levofloxacin susceptibility results and were excluded from susceptibility profiles. Any missing data were excluded from analysis. †We obtained p values by using the Wilcoxon rank sum test, Fisher exact test, or Pearson χ2 test, as appropriate. ‡Defined as 3–5 loose stools over a 24-h period. §Defined as >6 loose stools over a 24-h period. ¶Participants could select multiple water sources or treatments.

Main Article

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Page created: October 16, 2024
Page updated: November 11, 2024
Page reviewed: November 11, 2024
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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