Multidrug-Resistant Shigellosis among Children Aged below Five Years with Diarrhea at Banadir Hospital in Mogadishu, Somalia

Abstract

Globally, shigellosis remains the second leading cause of diarrhea-associated deaths among children under five years of age, and the infections are disproportionately higher in resource-limited settings due to overcrowding, poor sanitation, and inadequate safe drinking water. The emergence and global spread of multidrug-resistant (MDR) Shigella are exacerbating the shigellosis burden. We adopted a cross-sectional study design to determine the distribution and antimicrobial susceptibility (AST) patterns of Shigella serogroups among children aged below five years presenting with diarrhea at Banadir Hospital in Mogadishu, Somalia, from August to October 2019. Stool and rectal swab samples were collected from 180 children consecutively enrolled using a convenient sampling technique and processed following standard bacteriological methods. AST was determined using the Kirby–Bauer disc diffusion method and interpreted as per the Clinical Laboratory Standard Institute (2018) guidelines. Shigellosis prevalence was 20.6% (37/180), and S. flexneri (26/37 (70.3%)) was the predominant serogroup. All the serogroups were 100% resistant to ampicillin (AMP), trimethoprim-sulfamethoxazole (SXT), and tetracycline (TE). Ceftriaxone (CRO) resistance was the highest among S. sonnei (66.7%) isolates. 19.2% of S. flexneri and S. sonnei (50%) serogroups were resistant to ciprofloxacin (CIP), but all S. dysenteriae type 1 isolates remained (100%) susceptible. Forty percent of CIP-susceptible S. dysenteriae type 1 were resistant to CRO. Seven MDR Shigella phenotypes were identified, dominated by those involving resistance to AMP, SXT, and TE (100%). Our findings showed a high prevalence of shigellosis with S. flexneri as the most predominant serogroup among children under five years of age in Banadir Hospital, Somalia. AMP and SXT are no longer appropriate treatments for shigellosis in children under five years in Banadir Hospital. MDR Shigella strains, including those resistant to CIP and CRO, have emerged in Somalia, posing a public health challenge. Therefore, there is an urgent need for AMR surveillance and continuous monitoring to mitigate the further spread of the MDR Shigella strains in Banadir Hospital and beyond.

Prevalence and Antimicrobial-Resistant Features of Shigella Species in East Africa from 2015–2022: A Systematic Review and Meta-Analysis

“…Another study conducted in -Treatments need to be based on species identifcation [26] Table 1: Continued. -Among the serogroups, most of the MDR phenotypes were found in S. fexneri (65.9%) Tere is an urgent need for AMR surveillance and continuous monitoring [32] Note: "-" means not done or did not get the information. Somalia [32] showed the highest resistance to ceftriaxone occurred among S. sonnei (66.7%) serogroup, followed by S. dysenteriae type 1 (40%) and S. fexneri (38.5%).…”

“…-Among the serogroups, most of the MDR phenotypes were found in S. fexneri (65.9%) Tere is an urgent need for AMR surveillance and continuous monitoring [32] Note: "-" means not done or did not get the information. Somalia [32] showed the highest resistance to ceftriaxone occurred among S. sonnei (66.7%) serogroup, followed by S. dysenteriae type 1 (40%) and S. fexneri (38.5%). In this review, included studies primarily used stool culture for Shigella identifcation.…”

Evaluation of the physicochemical properties and bacterial loads of selected rivers in Ondo State, Nigeria

“…Shigella causes an infection known as shigellosis. Most infected individuals develop fever, diarrhoea, and stomach cramps, but often recover without chemotherapeutic interventions ( 37 ).…”

The genomic epidemiology of shigellosis in South Africa

“…Further WGSA of the GEMS study isolates showed multiple Phylogroups of S. flexneri in each participating African country, highlighting the diversity of circulating strains [16]. While this provides a useful snapshot into the diversity of Shigella strains circulating regionally, detailed national studies are needed to further unpick the ecology of shigellosis in the region.Non-genomic studies from across sub-Saharan Africa highlight the importance of endemic disease in the region and confirm S. flexneri is typically the dominant serogroup of Shigella [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. There is variation in shigellosis incidence, sub-continentally and nationally, with national attributable disease burden estimates of up to 63.3% of diarrhoeal cases, and intra-national variation as high as 34% [46,47].…”

“…Non-genomic studies from across sub-Saharan Africa highlight the importance of endemic disease in the region and confirm S. flexneri is typically the dominant serogroup of Shigella [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. There is variation in shigellosis incidence, sub-continentally and nationally, with national attributable disease burden estimates of up to 63.3% of diarrhoeal cases, and intra-national variation as high as 34% [46,47].…”