Comparative efficacy of two- and five-day courses of ceftriaxone for treatment of severe shigellosis in children

Eidlitz-Marcus, T.; Cohen, Y.; Nussinovitch, Moshe; Elian, I.; Varsano, I

doi:10.1016/s0022-3476(05)80868-6

Cited by 29 publications

(13 citation statements)

References 8 publications

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“…A treatment course of 5 days has been recommended for shigellosis. However, a shorter treatment course has been proposed as well (7,27) and has demonstrated clinical and bacteriological cure rates comparable to those of the longer course. This would limit the environmental pressure for selection and dissemination of resistance genes among bacterial populations.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of Dysentery Associated with Ceftriaxone-Resistant Shigella sonnei : First Report of Plasmid-Mediated CMY-2-Type AmpC β-Lactamase Resistance in S. sonnei

Huang¹,

Chiu

Wang

et al. 2005

J Clin Microbiol

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We document the first report of plasmid-encoded CMY-2-type AmpC ␤-lactamase identified among Shigella sonnei isolates resistant to ceftriaxone and obtained after an outbreak of bacillary dysentery in Taiwan. One hundred eighty-two children in two elementary schools in Yu-Li, Taiwan, where an outbreak occurred after a typhoon hit this area in 2001, were enrolled in this study. Clinical and epidemiologic data on the infected children were collected. Pulsed-field gel electrophoresis (PFGE) was performed on the isolates to determine the genetic relatedness of outbreak strains. Plasmid analysis and PCR were performed to identify ␤-lactamase genes responsible for ceftriaxone resistance. Forty-seven children from the two elementary schools were culture positive for S. sonnei in this outbreak. Twenty-three children were asymptomatic. Of the total isolates 55.3% were resistant to ampicillin. One hundred percent of the isolates obtained from children in school A were initially susceptible to both ampicillin and ceftriaxone. Of isolates obtained from school B 96.2% were nonsusceptible to ceftriaxone. However, two isolates from school A developed resistance to ampicillin during the course of treatment. All 18 available isolates showed closely related PFGE patterns (4, 4a, 4b, and 4c). CMY-2-type AmpC ␤-lactamase was responsible for ceftriaxone resistance in ceftriaxone-nonsusceptible isolates; Southern blot hybridization confirmed that such a resistance gene was located on the plasmid. This is the first report of plasmid-mediated CMY-2-type AmpC ␤-lactamase in S. sonnei. Ampicillin-resistant isolates can develop during the course of antibiotic treatment.Shigellosis is primarily a disease of poor, crowded communities that do not have adequate sanitation or clean water. Among the four Shigella species, S. flexneri is the most commonly isolated species in the developing world. However, in industrialized countries, the predominant species is S. sonnei, which accounts for 90% of the infections caused by Shigella spp. (25). Despite the continual improvement of sanitary conditions and the socioeconomic level of the population in Taiwan, outbreaks of shigellosis still occur after natural disasters such as typhoons or earthquakes.Resistance of Shigella spp. to various antibiotics is increasing (26); however, plasmid-encoded resistance of Shigella spp. to extended-spectrum cephalosporins is still rare. Genetic testing is required to identify the relationship and mechanism of antimicrobial resistance in outbreak situations. Pulsed-field gel electrophoresis (PFGE) is a useful epidemiological tool but provides limited information about the genetic (plasmid) profile of the microorganisms. The purpose of this study was to investigate the epidemiological, clinical, and microbiological features of an outbreak of Shigella dysentery caused by S. sonnei in Yu-Li, Hua-Lien, Taiwan. Of note, this is the first report documenting production of CMY-2-type AmpC ␤-lactamase by S. sonnei. MATERIALS AND METHODSPatients and population. An outbreak of ba...

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Section: Discussionmentioning

confidence: 99%

Outbreak of Dysentery Associated with Ceftriaxone-Resistant Shigella sonnei : First Report of Plasmid-Mediated CMY-2-Type AmpC β-Lactamase Resistance in S. sonnei

Huang¹,

Chiu

Wang

et al. 2005

J Clin Microbiol

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“…At our center, children with clinical dysentery who are less than 1 year old, or those who appear ill, dehydrated (> 5%) or are unable to drink and have multiple bloody stools, severe electrolyte imbalances or clinical complications (e.g. convulsions, encephalopathy) are hospitalized for monitoring, rehydration and antibiotic treatment with a third-generation cephalosporin (usually ceftriaxone) intravenously or intramuscularly [11]. Only children who were hospitalized were included in the study.…”

Section: Methodsmentioning

confidence: 99%

Clinical Dysentery in Hospitalized Children

et al. 2002

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“…Ceftriaxone and ciprofl oxacin have been shown to be highly effective for shigellosis. 5,[29][30][31] Ceftriaxone requires parenteral administration, whereas ciprofl oxacin is avoided in children.…”

Section: 25mentioning

confidence: 99%

Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006

Pourakbari¹,

Mamishi²,

Mashoori³

et al. 2010

Braz J Infect Dis

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We declare no confl ict of interest. ABSTRACTAppropriate antimicrobial treatment of shigellosis depends on identifying its changing resistance pattern over time. We evaluated 15,255 stool culture submitted from July 2001 to June 2006 to the Laboratory of Children Medical Center Hospital. Specimen culture, bacterial identifi cation, and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. From 15,255 stool samples, 682 (4.5%) were positive for Shigella species. The most common species of Shigella were S. fl exneri (48%) and S. sonnei (45%); other results were S. dysenteriae (5%) and S. boydii (2%). The rate of Sensitivity to ceftriaxone (95%), ceftizoxime (94%), and nalidixic acid (84%) were among our isolates. Resistance to co-trimoxazole and ampicillin was 87% and 86%, respectively. S. fl exneri was more multiresistant than other species (47.9%). Our isolates are overall most sensitive to ceftriaxone, ceftazidime, and nalidixic acid (> 84%). They were most resistant to co-trimoxazole and ampicillin (> 86%). Because resistance varies according to specifi c location, continuous local monitoring of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy.

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Comparative efficacy of two- and five-day courses of ceftriaxone for treatment of severe shigellosis in children

Cited by 29 publications

References 8 publications

Outbreak of Dysentery Associated with Ceftriaxone-Resistant Shigella sonnei : First Report of Plasmid-Mediated CMY-2-Type AmpC β-Lactamase Resistance in S. sonnei

Outbreak of Dysentery Associated with Ceftriaxone-Resistant Shigella sonnei : First Report of Plasmid-Mediated CMY-2-Type AmpC β-Lactamase Resistance in S. sonnei

Clinical Dysentery in Hospitalized Children

Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006

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