Increasing Antibiotic Resistance inShigellaspp. from Infected New York City Residents, New York, USA

Murray, Kenya; Reddy, Vasudha; Kornblum, John; Waechter, HaeNa; Chicaiza, Ludwin F.; Rubinstein, Inessa; Balter, Sharon; Greene, Sharon K.; Braunstein, Sarah L.; Rakeman, Jennifer L.; Dentinger, Catherine

doi:10.3201/eid2302.161203

Cited by 43 publications

(32 citation statements)

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“…Among men with shigellosis, 37% overall and 76% of those with DSA-Shigella were either PLWH or had a recent STD. These findings are consistent with other shigellosis outbreak reports among MSM but present more robust estimates of recent STD prevalence among shigellosis patients (20,22,27). Co-infection with STDs is of particular concern because azithromycin is recommended as a treatment for chlamydia, as well as for gonorrhea in conjunction with ceftriaxone (30).…”

Section: Discussionsupporting

confidence: 89%

“…However, resistance profiles differed across groups at risk for shigellosis; 42 of the 43 domestically acquired DSA-Shigella cases in Minnesota occurred among men, 60% of whom were also infected with HIV. This trend has been observed in other jurisdictions and has implications for clinical testing, public health surveillance, case management, and prevention efforts (27)(28)(29).…”

Section: Discussionmentioning

confidence: 63%

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Decreased Susceptibility to Azithromycin in ClinicalShigellaIsolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015

Eikmeier¹,

Talley²,

Bowen³

et al. 2020

Emerg. Infect. Dis.

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S higella is an enteric bacterial pathogen that causes diarrhea (sometimes bloody), fever, and cramps (1). An estimated 500,000 Shigella infections occur annually in the United States (2). Shigella transmission is fecal-oral; it is easily spread person-to-person because of a low infectious dose. Outbreaks are most frequently documented in childcare settings but have also been reported among men who have sex with men (MSM) (3-7). Shigella infections are typically selflimiting, but treatment is recommended for patients with severe illness or underlying immunocompromising conditions (1,8). Antimicrobial drug treatment might shorten illness duration and is often used in childcare-associated outbreaks to prevent secondary transmission (1,8). When Shigella antimicrobial drug susceptibilities are unknown (e.g., when empiric therapy is started before culture and sensitivity results are available) or if the isolate is resistant to ampicillin and trimethoprim/sulfamethoxazole, oral treatment options include ciprofloxacin or azithromycin (1). However, fluoroquinolones, including ciprofloxacin, are generally avoided for treatment in children because of the risk for musculoskeletal damage (9). The emergence of Shigella with decreased susceptibility to azithromycin (DSA) has been reported in Asia, Europe, North America, and Oceania (10-17). Local outbreaks and intercontinental sexual transmission of DSA-Shigella have been observed among MSM (10,15,18-20). Co-infection with other enteric pathogens and sexually transmitted diseases (STDs) have also been reported among MSM (20-24). In 2016, the Clinical and Laboratory Standards Institute (CLSI) defined epidemiologic cutoff values for azithromycin resistance in S. sonnei or S. flexneri for the first time (25). Previously, the National Antimicrobial Resistance Monitoring System (NARMS) had documented DSA (azithromycin MIC >16 µg/ mL) among Shigella isolates; during 2011-2015, DSA prevalence increased from 0.9% to 6.1% among S. sonnei isolates and from 12.1% to 32.9% among S. flexneri

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 63%

Decreased Susceptibility to Azithromycin in ClinicalShigellaIsolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015

Eikmeier¹,

Talley²,

Bowen³

et al. 2020

Emerg. Infect. Dis.

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“…28 To reduce the emergence of resistance, antibiotics should be avoided for treating Shigella infections, except in patients with severe shigellosis or cases at risk for systemic infection. 29 In our study, nine (6.3%) S. sonnei were nonsusceptible to all of the tested antibiotics. Our analysis also showed that the multidrug resistance was more frequent among S. sonnei as compared to S. flexneri.…”

Section: Discussionmentioning

confidence: 46%

High Rates of Antimicrobial Resistance and Virulence Gene Distribution Among Shigella spp. Isolated from Pediatric Patients in Tehran, Iran

Karimi-Yazdi¹,

Ghalavand²,

Shabani³

et al. 2020

IDR

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Background: Shigella continues to be important causes of acute pediatric diarrhea worldwide. Shigella produces numerous virulence factors involved in colonization and invasion into epithelial cells which eventually result in the disease. The present study was conducted to evaluate the prevalence of virulence genes and to investigate antibiotic resistance profiles among Shigella isolates obtained from pediatric patients in Iran. Methods: A total of 141 Shigella isolates were collected between March 2017 and September 2018 from stool of children under 14 who were suspected to have shigellosis. Shigella isolates were identified using standard microbiological and serological tests and antimicrobial susceptibility testing was carried out via Kirby-Bauer disk diffusion method. In addition, the presence of seven virulence determinants including ipaH, ipaB, ipaC, ipaD, ipgD, sen, and virA were evaluated using PCR. Results: S. sonnei (78.7%) was the most prevalent shigella spp. among children with shigellosis followed by S. flexneri (19.9%) and S. boydii (1.4%). Antimicrobial susceptibility testing revealed that most of the isolates were considered as multidrug-resistant (MDR) strains. Our findings also showed a high resistance rate against trimethoprimsulfamethoxazole in Shigella isolates. The prevalence of ipaH, ipaC, sen, ipaD, virA, ipaB, and ipgD were 100%, 95.7%, 95.7%, 94.3%, 93.6%, 92.9%, and 80.8%, respectively. Conclusion: The current study revealed that S. sonnei was the predominant species isolated from children with shigellosis in Iran. Our results also indicated a high distribution of type III secretion system effector protein-encoding genes and high multidrug-resistance among shigella spp. in Iran. Therefore, it is suggested that antimicrobial susceptibility testing be performed prior to antibiotic prescription.

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“…Although young children were at highest risk of Shigella related mortality in studies in Bangladesh [ 10 ] and the United States, some data now suggest an association between shigellosis severity and HIV-infection [ 11 , 12 ]. Additional reports have shown disproportionate levels of shigellosis among men who have sex with men (MSM), particularly those with HIV infection [ 13 , 14 ], and high levels of antimicrobial resistance in Shigella isolates from MSM [ 15 , 16 ]. However, it remains unclear whether disparities in shigellosis severity exist among adult populations.…”

Section: Introductionmentioning

confidence: 99%

Disparities in severe shigellosis among adults — Foodborne diseases active surveillance network, 2002–2014

et al. 2018

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BackgroundShigella causes approximately 500,000 illnesses, 6000 hospitalizations, and 40 deaths in the United States annually, but incidence and populations at risk for severe shigellosis among adults are unclear. This study describes severe shigellosis among US adults.MethodsWe analyzed Foodborne Diseases Active Surveillance Network data for infections caused by Shigella among adults ≥18 years old during 2002–2014. Criteria to define severe shigellosis included hospitalization, bacteremia, or death. We estimated annual incidence of shigellosis per 100,000 among adult populations, and conducted multivariable mixed-effects logistic regression to assess associations between severe shigellosis, demographic factors and Shigella species among adults with shigellosis.ResultsAmong 9968 shigellosis cases, 2764 (28%) were severe. Restricting to cases due to S. sonnei and S. flexneri, median annual incidence of severe shigellosis among adults was 0.56 and highest overall incidence was among black males 18–49 years old (1.58). Among adults with shigellosis, odds of severe disease were higher among males than females aged 18–49 years old (OR [95% CI] = 1.32 [1.15–1.52], p < 0.001) and among males than females with S. flexneri infections (OR [95% CI] =1.39 [1.10–1.75], p = 0.005). The odds of severe shigellosis were higher among blacks than whites (OR [95% CI] = 1.36 [1.22–1.52], p < 0.001).ConclusionsAmong adults, men 18–49 years old, particularly blacks, have the highest incidence of severe shigellosis. Among adults with shigellosis, severe shigellosis was associated with being male in age group 18–49 years, with infections caused by S. flexneri, and with black race. Future research should assess associations between severe shigellosis and sexual practices, antimicrobial resistance, comorbidities, and access to care.

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Increasing Antibiotic Resistance inShigellaspp. from Infected New York City Residents, New York, USA

Cited by 43 publications

References 5 publications

Decreased Susceptibility to Azithromycin in ClinicalShigellaIsolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015

Decreased Susceptibility to Azithromycin in ClinicalShigellaIsolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015

<p>High Rates of Antimicrobial Resistance and Virulence Gene Distribution Among<em> Shigella</em> spp. Isolated from Pediatric Patients in Tehran, Iran</p>

Disparities in severe shigellosis among adults — Foodborne diseases active surveillance network, 2002–2014

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