High rates of quinolone-resistant strains of Shigella sonnei in HIV-infected MSM

Abstract

The high rates of S. sonnei isolates resistant to quinolones and other traditional antibiotics are of concern. Innovative prevention efforts are urgently needed. The empirical use of quinolones in HIV-infected patients presenting with S. sonnei infection is no longer recommended.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…Reduced sensitivity to antimicrobial agents, particularly to fluoroquinolones and macrolides (259)(260)(261)(262) is a significant problem for some enteric pathogens and for STIs such as NG (263)(264)(265)and MG (145,266,267). Appropriate selection of antibiotics (antibiotic stewardship) is therefore required, based wherever possible on antibiotic susceptibility profiles.…”

Shigellosis in Subjects with Traveler's Diarrhea Versus Domestically Acquired Diarrhea: Implications for Antimicrobial Therapy and Human Immunodeficiency Virus Surveillance

“…In addition, behavioral factors in MSM can contribute to outbreaks and spreading of resistant strains. 11,20,21 Therefore, increased monitoring and counseling for shigellosis would be recommendable, notably in HIV-positive MSM with diarrhea.…”

“…However, it is noteworthy that Hoffman and others have found a 66% of resistance to this antimicrobial agent among HIV-positive MSM in Germany. 21 Possible alternative treatments for shigellosis are the use of other antibiotics such as AZT. Although no clinical breakpoints are available for AZT, a MIC ≤ 16 mg/L is comparable to the MIC distribution in wild-type Shigella isolates and, therefore, expected to respond to treatment.…”

Enteropatógenos y antibióticos

“…UU., el 4,5% de las cepas aisladas en 2012 fueron resistentes al ácido nalidíxico y el 2% a ciprofloxacino, con un incremento estadísticamente significativo de la resistencia al ácido nalidíxico desde 2003 18 . En Alemania se han detectado cifras más elevadas de resistencia a ciprofloxacino (54%) en cepas de hombres que mantienen relaciones sexuales con hombres; la resistencia fue aún mayor en aquellos coinfectados con el VIH (66 vs. 24%) 62 . En la India las tasas de resistencia al ácido nalidíxico superan el 90% y son del 70-85% a fluoroquinolonas 59,60 .…”