Enteric bacterial etiology, antimicrobial resistance profiles, and evaluation of epidemiological risk factors among elderly patients with diarrhea in an urban Kenyan hospital: a cross-sectional study.

Objectives: Diarrheal disease remains a major cause of morbidity and mortality among older adults, yet data on enteric bacterial isolates and antimicrobial resistance in elderly populations in sub-Saharan Africa are limited. This study investigated the bacterial etiology, antimicrobial resistance profiles, and associated risk factors among elderly patients presenting with diarrhea at an urban Kenyan referral hospital. Methods: A hospital-based cross-sectional study was conducted among 271 patients aged ≥60 years presenting with acute diarrhea at Mama Lucy Kibaki Hospital, Nairobi, between February and December 2025. Stool specimens were cultured using selective and differential media, and bacterial isolates were identified by standard biochemical methods. Results: Potential enteric bacterial isolates were recovered from 118 of 271 participants (43.5%); this falls to 84/271 (31.0%) if untyped Conclusion: Elderly patients in urban Kenya carry a substantial burden of enteric bacterial isolates with high rates of MDR among the organisms for which resistance could be validly classified. Because many bacterial diarrheal illnesses are self-limiting and do not require antimicrobial therapy, these findings support selective, culture- and susceptibility-guided prescribing rather than blanket empirical antibiotic use. Strengthened antimicrobial stewardship, expanded diagnostic and pathotyping capacity, and integration of elderly populations into diarrheal disease surveillance programs are needed.