Open Access Highly Accessed Research article

Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India

Pragya Shakya1, Peter Barrett2, Vishal Diwan23*, Yogyata Marothi1, Harshada Shah1, Neeraj Chhari4, Ashok J Tamhankar25, Ashish Pathak267 and Cecilia Stålsby Lundborg2

Author Affiliations

1 Department of Microbiology, R.D. Gardi Medical College, Ujjain, India

2 Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

3 Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India

4 Department of Community Medicine, R.D. Gardi Medical College, Ujjain, India

5 Department of Environmental Medicine, R.D. Gardi Medical College, Indian Initiative for Management of Antibiotic Resistance, Ujjain, India

6 Department of Paediatrics, R.D. Gardi Medical College, Ujjain, India

7 Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden

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BMC Infectious Diseases 2013, 13:477  doi:10.1186/1471-2334-13-477

Published: 14 October 2013



Antibiotic resistance is a major global public health concern, particularly in settings where few treatment options are available. Limited research has been done on antibiotic resistance in Escherichia coli of Indian children at community level. Therefore we studied antibiotic resistance patterns in E. coli isolates from stool samples of children aged 3-14 years from Ujjain, Central India, to investigate associations of resistance with demographic variables.


Children, 3-14 years of age, were included from 30 randomly selected villages of Palwa demographic surveillance site, Ujjain, India. Parents were interviewed using a questionnaire, and stool samples were collected from participating children. E. coli were isolated from stool samples (n = 529), and susceptibility testing to 18 different antibiotics was done using standard methods.


The proportions of isolates resistant to various antibiotics were, nalidixic acid, (45%), tetracycline (37%), ampicillin (37%), sulfamethoxazole/trimethoprim (29%) and amoxicillin/clavulanic acid (29%). No isolates were resistant to imipenem. Overall, 72% of isolates were resistant to at least one antibiotic and 33% were multi-drug resistant. High rates of cross-resistance were seen for 15 (83%) of the antibiotics studied. E. coli isolates from children with literate mothers were more resistant to penicillins and fluoroquinolones. ESBL-producers comprised 9% of the isolates.


Antibiotic resistance and cross-resistance were common in E. coli from stools of children. Resistance rates were associated with maternal literacy.

E. coli; Faecal; Children; Commensal; Antibiotic resistance; Asia