Travel Destinations and Sexual Behavior as Indicators of Antibiotic ResistantShigellaStrains—Victoria, Australia

Abstract

Clinicians should consider travel destination as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group.

Culture‐positive shigellosis cases are epidemiologically different to culture‐negative/PCR‐positive cases

“…This finding may be partially related to health seeking behaviour of gay men and increased awareness of sexual transmission of shigellosis in Australia. 33 In the past decade, there have been several outbreaks of shigellosis among the gay community in Australia, 34,35 prompting © 2018 Sydney Local Health District media campaigns in NSW encouraging symptomatic people to present to health services for testing, 36 and therefore this may lead to higher shigellosis detection rates in this risk group. In addition, the finding that culture-negative cases were more likely to be acquired overseas and were clinically less severe may relate to detection of EIEC in the culture-negative/PCR-positive group, in line with published evidence suggesting that E.coli versus Shigella was the cause of travellers' diarrhoea for residents of southern hemisphere countries for 35% vs. 5% of specimens tested globally.…”

Elevated Risk for Antimicrobial Drug–ResistantShigellaInfection among Men Who Have Sex with Men, United States, 2011–2015

“…Although our sample was small, the estimated prevalence of resistance to preferred antimicrobial drugs for MSM-associated shigellosis clusters was 3–77 times the prevalence for clusters with nonsexual transmission routes. Although shigellosis with these antimicrobial drug resistance phenotypes has been documented among MSM internationally, the reasons for this association are unknown ( 7 , 8 , 12 – 14 , 16 , 17 ). Additional studies are needed to elucidate these findings; identify specific risk factors; understand clinical outcomes for patients infected with these resistant strains and in the setting of HIV infection; and develop effective interventions to prevent infection of MSM with shigellae, particularly drug-resistant shigellae.…”

“…High rates of resistance to ampicillin and trimethoprim/sulfamethoxazole have made ciprofloxacin, ceftriaxone, and azithromycin the preferred antimicrobial agents for adults and children with shigellosis; ceftriaxone is also the preferred treatment for invasive shigellosis ( 4 – 6 ). However, shigellae resistant to these drugs have emerged in the United States and abroad ( 7 – 17 ). Although shigellosis rates are highest for young children, most reports document ciprofloxacin- or azithromycin-resistant shigellosis largely among men who have sex with men (MSM) ( 7 , 8 , 10 , 12 – 17 ).…”

“…However, shigellae resistant to these drugs have emerged in the United States and abroad ( 7 – 17 ). Although shigellosis rates are highest for young children, most reports document ciprofloxacin- or azithromycin-resistant shigellosis largely among men who have sex with men (MSM) ( 7 , 8 , 10 , 12 – 17 ). Estimates of risk for antimicrobial drug–resistant shigellae among different populations or by transmission route have not been reported.…”

A review of the public health management of shigellosis in Australia in the era of culture‐independent diagnostic testing

“…As laboratories increase the utilisation of culture independent diagnostic testing, health authorities need to be concerned about the potential loss of data on antimicrobial susceptibility, both from a clinical and public health perspective 11 . Antimicrobial resistance among notified cases in Victoria is common 12 . Culture, typing and antimicrobial susceptibility testing must continue in order to track Shigella species and serotypes and to monitor antimicrobial resistance to ensure that high risk cases are treated appropriately.…”