Antimicrobial resistance in shigellosis: A surveillance study among urban and rural children over 20 years in Bangladesh

Abstract

Antimicrobial resistance against shigellosis is increasingly alarming. However, evidence-based knowledge gaps regarding the changing trends of shigellosis in Bangladesh exist due to the scarcity of longitudinal data on antimicrobial resistance. Our study evaluated the last 20 years antimicrobial resistance patterns against shigellosis among under-5 children in the urban and rural sites of Bangladesh. Data were extracted from the Diarrheal Disease Surveillance System (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between January 2001 and December 2020. We studied culture-confirmed shigellosis cases from urban Dhaka Hospital (n = 883) and rural Matlab Hospital (n = 1263). Since 2001, a declining percentage of shigellosis in children observed in urban and rural sites. Moreover, higher isolation rates of Shigella were found in the rural site [1263/15684 (8.1%)] compared to the urban site [883/26804 (3.3%)] in the last 20 years. In both areas, S. flexneri was the predominant species. The upward trend of S. sonnei in both the study sites was statistically significant after adjusting for age and sex. WHO-recommended 1st line antibiotic ciprofloxacin resistance gradually reached more than 70% in both the urban and rural site by 2020. In multiple logistic regression after adjusting for age and sex, ciprofloxacin, azithromycin, mecillinam, ceftriaxone, and multidrug resistance (resistance to any two of these four drugs) among under-5 children were found to be increasing significantly (p<0.01) in the last 20 years in both sites. The study results underscore the importance of therapeutic interventions for shigellosis by appropriate drugs based on their current antibiogram for under-5 children. These observations may help policymakers in formulating better case management strategies for shigellosis.

Multidrug-resistant conjugative plasmid carrying mphA confers increased antimicrobial resistance in Shigella

“…After being the most preferred treatment option, CIP is seldom prescribed to treat Shigellosis in countries like Bangladesh currently because of its resistance mediated inefficiency 14 , 42 . In recent years, the prevalence of CIP resistance has been about 70% in patients of all ages, especially in Bangladesh 43 , 44 . In our study, we also found more than 70% CIP-resistance in 2016.…”

Optimizing Vaccine Trials for Enteric Diseases: The Enterics for Global Health (EFGH) Shigella Surveillance Study

“…In Bangladesh, surveillance of children under 5 years of age presenting with diarrhea to 2 hospitals during 2001–2020 showed resistance to ciprofloxacin increasing from essentially 0% of S. flexneri and S. sonnei clinical isolates in 2001–2005 to >70% resistant in 2016–2020. Resistance was worse for S. sonnei, with >90% of isolates resistant to ciprofloxacin [ 20 ]. Similar trends have been observed for azithromycin and ceftriaxone, though to different degrees.…”

Pathogenicity and virulence of Shigella sonnei : A highly drug-resistant pathogen of increasing prevalence

“…In Vietnam, throughout a period of 14 years (1995–2008) S. sonnei cases increased from 29% to the 78% of Shigella isolations [ 23 ]. In Bangladesh, S. sonnei increased from around 10% of all Shigella cases in 2001 to nearly 50% in rural areas and over 50% in urban settings by 2020 [ 24 ]. More countries experiencing this phenomenon include Brazil [ 25 ], India [ 26 ], and Iran [ 27 ], among others.…”

“…Shigella infections are one of the major life-threatening hazards to which children from low- and middle- income countries, particularly in sub-Saharan Africa and South Asia, are exposed [ 3 , 23 , 24 , 82 , 85 ]. Shigella is the most prevalent cause of diarrhoeal illness among children between the ages of two and five, and the second most common cause in children below two years of age [ 86 ].…”