Shigellaspp. with Reduced Azithromycin Susceptibility, Quebec, Canada, 2012–2013

Abstract

During 2012–2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.

Shigellosis in refugees, Austria, July to November 2015

“…Azithromycin is recommended by the American Academy of Paediatrics for treatment of shigellosis in children and by the WHO as a second-line treatment in adults [7]. So far, the intercontinental spread of azithromycin-resistant Shigella mainly affected men who have sex with men [11][12][13]. The acquisition and expression of ESBLs is not unusual for Shigella.…”

Macrolide resistance mechanisms inEnterobacteriaceae: Focus on azithromycin

“…This gene has also frequently been detected in both hospital recovered and commensal E. coli of different geographical origins (Nguyen et al, 2009). It is interesting to note that in microorganisms in which only the mph(A) gene has been identified and no other mechanism of macrolide-resistance has been detected, the levels of resistance varies greatly (Boumghar-Bourtchai et al, 2008;Gaudreau et al, 2014;Lluque et al, 2015;Sj€ olund Karlsson et al, 2013). This may be related to both the presence of specific alleles which might have different inactivation levels, by the concomitant presence of unidentified macrolide-resistance mechanisms or by mph(A) gene expression levels.…”

“…Together with its ability to inactivate azithromycin this finding may have a direct impact on the usefulness of azithromycin against pathogenic Enterobacteriaceae and has been increasingly described in Shigella spp. including some recent azithromycin-resistant Shigella sonnei outbreaks (Boumghar-Bourtchai et al, 2008;Gaudreau et al, 2014;Heiman et al, 2014;Howie et al, 2010;Sj€ olund Karlsson et al, 2013) and intercontinental spreaded Shigella flexneri 3a clone (Baker et al, 2015). The mph(A) gene has also been detected in a few isolates of the highly antibiotic-resistant Salmonella enterica serovar Kentucky, which is currently spreading from North Africa to different European countries (Le Hello et al, 2013).…”

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

“…18 In fact, AZT treatment failure has been reported for patients who received this drug for infection with isolates of MIC > 16 mg/L. 32 In our study, one strain with an MIC > 16 mg/L was found. Unfortunately, the strains tested against AZT were scarce, as this antibiotic has not been used for treatment until quite recently.…”

“…Two recent reports have described Shigella isolates with increased MICs to AZT in HIV-positive patients, most of them with no travel-abroad history. 32,33 In addition, cases of Shigella strains with MICs elevated for this drug have already been documented in Asian countries. 34 These data suggest that AZT may be emerging with reduced susceptibility and MIC for this antimicrobial agent should always be determined in patients with shigellosis.…”