ro13-9904 and Dysentery--Bacillary

Outbreaks of sexually transmitted. We systematically searched 4 bibliographical databases (EMBASE, medline, EMCARE and CINAHL) from January 2011 to November 2021. We used a 2-stage process to assess eligibility: the primary author conducted an initial screen and then 3 authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts in English which included men who have sex with men with sexually transmitted shigella where data on antimicrobial resistance was available.. Thirty-nine manuscripts met the inclusion criteria. A majority of the manuscripts (. There is little role for macrolides, quinolones or third generation cephalosporins in the management of sexually transmitted shigella in men who have sex with men. More research is needed to develop novel strategies for shigella control in men who have sex with men, as antimicrobial options are diminishing.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Drug Resistance, Bacterial; Dysentery, Bacillary; Homosexuality, Male; Humans; Macrolides; Male; Microbial Sensitivity Tests; Quinolones; Sexual and Gender Minorities; Shigella

Shigellosis remains one of the global causes of morbidity and mortality. However, the global emergence of antibiotic resistance has become the leading cause of treatment failure in shigellosis. This review aimed to provide an updated picture of the antimicrobial resistance rates in. A comprehensive systematic search was performed on PubMed, Scopus, Embase, and Web of Science until 28 July 2021. The meta-analysis was performed by computing the pooled using a random-effects model with Stata/SE software, v.17.1. The discrepancy within articles was surveyed by the forest plot in addition to the I. Totally, of 28 eligible studies published between 2008 and 2021. The pooled prevalence rate of multidrug-resistant (MDR) was 63% (95% CI 50-76). Regarding suggested antimicrobial agents for. Our findings revealed that ciprofloxacin is an effective drug for shigellosis in Iranian children. The substantially high prevalence estimation proposes that the first- and second-line treatments for shigellosis are the major threat to public health and active antibiotic treatment policies are essential.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Ciprofloxacin; Drug Resistance, Bacterial; Dysentery, Bacillary; Humans; Iran; Microbial Sensitivity Tests; Shigella

Ciprofloxacin, ceftriaxone and pivmecillinam are the antibiotics currently recommended by the World Health Organization (WHO) for the treatment of dysentery in children; yet there have been no reviews of the clinical effectiveness of these antibiotics in recent years.. We reviewed all literature reporting the effect of ciprofloxacin, ceftriaxone and pivmecillinam for the treatment of dysentery in children in the developing countries. We used a standardized abstraction and grading format and performed meta-analyses to determine the effect of treatment with these antibiotics on rates of treatment failure, bacteriological failure and bacteriological relapse. The CHERG Standard Rules were applied to determine the final effect of treatment with these antibiotics on diarrhoea mortality.. Eight papers were selected for abstraction. Treatment with ciprofloxacin, ceftriaxone or pivmecillinam resulted in a cure rate of >99% while assessing clinical failure, bacteriological failure and bacteriological relapse.. The antibiotics recommended by the WHO--ciprofloxacin, ceftriaxone and pivmecillinam--are effective in reducing the clinical and bacteriological signs and symptoms of dysentery and thus can be expected to decrease diarrhoea mortality attributable to dysentery.

Topics: Amdinocillin Pivoxil; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Ciprofloxacin; Dysentery; Dysentery, Bacillary; Female; Humans; Infant; Male; Randomized Controlled Trials as Topic; Salmonella Infections; Shigella dysenteriae; Treatment Outcome

In a prospective randomized open study, ceftriaxone, 50 mg/kg per day, was compared with ampicillin, 100 mg/kg per day, both given for a period of 5 days, for the treatment of 40 children whose mean (+/- SD) age was 4.5 +/- 3.2 years and who had severe dysentery caused by Shigella organisms. Twenty patients were treated with ceftriaxone and 20 with ampicillin. Both drugs were initially given intravenously for a period of 1 to 2 days and were continued intramuscularly, in the case of ceftriaxone, or orally, in the patients receiving ampicillin. All Shigella organisms isolated were susceptible to ceftriaxone; 28% were resistant to ampicillin. The diarrhea persisted for a mean (+/- SD) period of 2.5 +/- 1.0 days in the ceftriaxone-treated patients versus 6.8 +/- 6.3 days in the ampicillin-treated patients (p less than 0.005). At the end of the 5 days of therapy, stool cultures for Shigella organisms were negative in 12 (60%) of the 20 patients from the ampicillin group and in all the children (100%) from the ceftriaxone group (p less than 0.001). Bacteriologic relapses were observed in eight (40%) of the patients treated with ampicillin but in none of the children treated with ceftriaxone (p less than 0.001). In instances of clinical or bacteriologic failure in the ampicillin group, retreatment was instituted in most of the cases with ceftriaxone; persistent clearing of the Shigella organisms from the stool was finally achieved after a mean (+/- SD) period of 11.75 +/- 9.4 days after therapy was started, as compared with 1.85 +/- 0.6 days in the ceftriaxone-treated patients (p less than 0.001). We conclude that in children with severe shigellosis, treatment with ceftriaxone for 5 days is effective and better than use of ampicillin for clinical cure and eradication of the Shigella organisms from the stool.

Topics: Adolescent; Ampicillin; Ceftriaxone; Child; Child, Preschool; Dysentery, Bacillary; Feces; Humans; Infant; Prospective Studies; Shigella flexneri; Shigella sonnei

To evaluate ceftriaxone for the treatment of shigellosis, 94 adult males with acute dysentery were randomly assigned to receive ceftriaxone (1 g), ampicillin (4 g), or saline placebo intravenously in single doses in a double-blind design. Stool cultures were positive for Shigella dysenteriae in 52 patients, S. flexneri in 38 patients, and other species in 4 patients. Both ceftriaxone and ampicillin caused reductions in the mean duration of fever and the means of daily stool frequency 2 to 4 days after therapy versus placebo (P less than 0.05). The ability of ceftriaxone to reduce stool frequency during 6 days after treatment was significant in patients with S. flexneri infections (P less than 0.05), whereas S. dysenteriae infections were relatively refractory to improvement by both antibiotics. Neither drug had a significant effect on overall duration of diarrhea, blood in stool, or tenesmus. Ampicillin reduced the mean duration of positive stool cultures after treatment from 2.6 days in the placebo group to 1.1 days (P less than 0.05), whereas ceftriaxone did not affect the duration of Shigella sp. excretion. These results indicate that single intravenous doses of ceftriaxone and ampicillin caused some clinical improvement in acute shigellosis but only ampicillin exerted a bacteriological effect on Shigella sp. excretion.

Topics: Ampicillin; Ceftriaxone; Double-Blind Method; Dysentery, Bacillary; Feces; Humans; Male; Penicillin Resistance; Shigella dysenteriae; Shigella flexneri

We evaluated the burden of Shigella spp from children aged 0-59 months with medically attended moderate-to-severe diarrhea and matched controls at sites in Mali, The Gambia, and Kenya participating in the Vaccine Impact on Diarrhea in Africa (VIDA) study from 2015 to 2018.. Shigella spp were identified using coprocultures and serotyping in addition to quantitative polymerase chain reaction (qPCR). Episode-specific attributable fractions (AFe) for Shigella were calculated using Shigella DNA quantity; cases with AFe ≥0.5 were considered to have shigellosis.. The prevalence of Shigella was determined to be 359 of 4840 (7.4%) cases and 83 of 6213 (1.3%) controls by culture, and 1641 of 4836 (33.9%) cases and 1084 of 4846 (22.4%) controls by qPCR (cycle threshold <35); shigellosis was higher in The Gambia (30.8%) than in Mali (9.3%) and Kenya (18.7%). Bloody diarrhea attributed to Shigella was more common in 24- to 59-month-old children (50.1%) than 0- to 11-month-old infants (39.5%). The Shigella flexneri serogroup predominated among cases (67.6% of isolates), followed by Shigella sonnei (18.2%), Shigella boydii (11.8%), and Shigella dysenteriae (2.3%). The most frequent S. flexneri serotypes were 2a (40.6%), 1b (18.8%), 6 (17.5%), 3a (9.0%), and 4a (5.1%). Drug-specific resistance among 353 (98.3%) Shigella cases with AMR data was as follows: trimethoprim-sulfamethoxazole (94.9%), ampicillin (48.4%), nalidixic acid (1.7%), ceftriaxone (0.3%), azithromycin (0.3%), and ciprofloxacin (0.0%).. A high prevalence of shigellosis continues in sub-Saharan Africa. Strains are highly resistant to commonly used antibiotics while remaining susceptible to ciprofloxacin, ceftriaxone, and azithromycin.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Diarrhea; Dysentery, Bacillary; Humans; Infant; Infant, Newborn; Mali; Microbial Sensitivity Tests; Shigella

Multidrug-resistant (MDR) Shigella sonnei have become prevalent among men who have sex with men and have become a global public health concern. From June 2017 to April 2019, 32 men were infected with MDR S. sonnei acquired locally, in Montréal, which was suggestive of an outbreak. Antimicrobial susceptibility testing, whole-genome sequencing (WGS), phylogenetic analysis, antimicrobial resistance and virulence characterization, and association to international clusters were performed. The outbreak strain was ceftriaxone- and azithromycin-resistant due to the acquisition of

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Dysentery, Bacillary; Genomics; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Phylogeny; Sexual and Gender Minorities; Shigella sonnei

Nontyphoid Salmonella and Shigella can cause gastroenteritis in humans. Ceftriaxone (CRO) has been used to treat their infection, however, development of CRO resistance are often associated with plasmid-mediated bla. 194 strains of Salmonella serovars and Shigella were tested for CRO susceptibility. Non-susceptibility strains were examined for plasmid-mediated ISEcp-1 tnpA-bla. Among 20 CRO-nonsusceptible isolates of Salmonella Choleraesuis (5), S. Typhimurium (4), S. Mons (1), S. Stanley (2) and Shigella sonnei (8) with plasmid-mediated bla. The CRO susceptibility associated with the ISEcp-1 tnpA-bla

Topics: Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; China; DNA, Bacterial; Drug Resistance, Bacterial; Dysentery, Bacillary; Gene Expression Regulation, Bacterial; Humans; Plasmids; Salmonella; Salmonella Infections; Shigella

Acute dysentery is a prevalent case of hospital admission in developing countries, whose most common cause is believed to be Shigella species. Treatment failure employing oral or intravenous antibiotics is an increasing problem among children with dysentery. This is a prospective descriptive study that aims to find the antibiotic resistance pattern of Shigella spp. isolates from children with acute diarrhea in three children's referral hospitals in Mashhad, northeast-Iran. Between February 2018 to September 2019, a total of 233 stool samples were collected from children with inflammatory diarrhea. Shigella spp. were identified by culture and biochemical standard tests. Moreover, polyvalent Shigella antisera were used for serogrouping. The antibiotic susceptibility was performed by disk diffusion method. During the 9-month study period, a total of 94 non-duplicate clinical Shigella spp. were identified by culture and biochemical tests. Based on slide agglutination with appropriate group-specific polyvalent antisera, Shigella sonnei (70.2%) was found to be the most prevalent Shigella spp. followed by S. flexeneri (23.4%), S. dysentery (1%). Among isolates, S. boydii was not detected and five isolates (5.3%) were nonserotypable isolates. The resistance rate of Shigella spp. to azithromycin, ceftriaxone, ciprofloxacin, co-trimoxazole, nalidixic acid, gentamicin, amoxicillin, ampicillin, doxycycline and cefixime was 25.5%, 43.6%, 3.8%, 82.9%, 15.9%, 26.6%, 40.4%, 57.4%, 41.4%, 22.3%, respectively. The results revealed that the resistance of Shigella spp. to the three most commonly utilized antibiotics (azithromycin, ceftriaxone and, cefixime) is too high to recommend them as empirical therapy for children with acute dysentery in this city.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Drug Resistance, Bacterial; Dysentery, Bacillary; Feces; Hospitals; Humans; Iran; Microbial Sensitivity Tests; Prospective Studies; Referral and Consultation; Shigella

Topics: Acute Retroviral Syndrome; Adult; Anti-HIV Agents; Ceftriaxone; Diarrhea; Dysentery, Bacillary; HIV Infections; Humans; Injections, Intravenous; Male; Shigella flexneri; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; Drug Resistance, Bacterial; Dysentery, Bacillary; Feces; Humans; Male; Microbial Sensitivity Tests; Sexual and Gender Minorities; Shigella flexneri

Shigella flexneri is one of the most prominent pathogenic bacteria in developing countries. In the battle against shigellosis and other bacterial diseases, antibiotic resistance has become an increasing global public health threat. Although the serious phenomenon of multidrug resistance (MDR) has been identified as one of the top three burdens on human health, resistance mechanisms are still poorly understood at the molecular level. In this study, we analyzed genomic data and the evolution of resistance in Shigella flexneri under sequential selection stress from three separate antibiotics: ciprofloxacin (CIP), ceftriaxone (CRO), and tetracycline. Through whole-genome sequencing, 82 chromosomal antibiotic resistance genes were identified. Re-sequencing of the evolved populations identified single nucleotide polymorphisms (SNPs) that contributed to MDR and SNPs that were specific to a single drug. A total of 40 SNPs in 8 genes and 3 intergenic regions, including mutations in metG (L582R) and 1538924, 1538924, and 1538924, appeared under each antibiotic. Several nonsynonymous mutations in gyrB (S464Y), ydgA (E378A), rob (R156H), and narX (K75E) were observed under selective pressure from CIP or CRO. Based on a bioinformatic analysis and previous reports, we discuss the contribution of these mutated genes to resistance. Therefore, more circumspect selection and use of antimicrobial drugs for treating shigellosis is necessary.

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Computational Biology; DNA, Bacterial; DNA, Intergenic; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Gene Ontology; Genes, Bacterial; Genome, Bacterial; Humans; Molecular Sequence Annotation; Phylogeny; Polymorphism, Single Nucleotide; Shigella flexneri; Tetracycline; Whole Genome Sequencing

A 45-year-old man was presented at the emergency department with altered neurological status and a 1-day history of diarrhoea and fever. The patient's sexual history revealed multiple male partners. As bacterial meningitis or viral encephalitis was suspected, treatment was started accordingly. Cerebrospinal fluid investigations only showed a slight increase of leucocytes, and microbiological studies remained negative. Stool culture revealed

Topics: Acyclovir; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Drug Therapy, Combination; Dysentery, Bacillary; Encephalitis; Feces; Fever; Humans; Male; Middle Aged; Sexual and Gender Minorities; Shigella flexneri; Treatment Outcome; Unsafe Sex

In March 2017, a 45-year-old Italian man who has sex with men was admitted to the Infectious Diseases Department of Trieste Hospital (northeast Italy), because of fever, abdominal pain and dysentery. The patient had neither foreign travel history nor sexual contact with non-Italian partners. Stool cultures grew multidrug-resistant Shigella flexneri (resistant to ampicillin, chloramphenicol, streptomycin, tetracycline, trimethoprim, amoxicillin/clavulanic acid and ciprofloxacin) and whole genome sequencing detailed the resistance features. The phylogenetic analysis showed that the strain was unrelated to any previously reported strain. The patient was treated successfully with ceftriaxone. We hereby report the first case of locally-acquired, multidrug-resistant S. flexneri infection in Italy and also the emergence of a new clone.

Topics: Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Feces; Genes, Bacterial; Genome, Bacterial; Homosexuality, Male; Humans; Male; Middle Aged; Phylogeny; Quinolones; Shigella flexneri; Treatment Outcome; Whole Genome Sequencing

Shigella flexneri is an emerging pathogen in men who have sex with men (MSM); recent outbreaks related to sexual practices have been noted in this population in the UK and other developed countries. While the majority of cases of shigellosis present with gastroenteritis, some vulnerable patients with underlying immunosuppression can develop complications like bacteraemia and may present atypically as an acute surgical emergency. This case report highlights such a case of S. flexneri bacteraemia in a man who had sex with men.

Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Anti-Retroviral Agents; Ceftriaxone; Dysentery, Bacillary; HIV Infections; Homosexuality, Male; Humans; Immunosuppression Therapy; Male; Shigella flexneri; Treatment Outcome

To describe the clinical and microbiological characteristics of women presenting with acute gastroenteritis due to infection with Salmonella spp. or Shigella spp.. A cross-sectional retrospective study was conducted using data for patients with specimens positive for Shigella spp. and Salmonella spp. attending two major women's hospitals in Porto Alegre, Brazil, between January 2003 and July 2014. Women were included if they had symptoms compatible with bacterial acute diarrhea. Isolates were evaluated to determine antimicrobial susceptibility and patient clinical profile.. Among 45 eligible patients, Salmonella spp. was identified in 32 (71%) and Shigella spp. in 13 (29%). The highest antimicrobial sensitivity rates were observed for ciprofloxacin and ceftriaxone (n=44, 98% for both) whereas the greatest resistance rate was seen for ampicillin (n=20, 44%). Seven (16%) of the women were pregnant.. Ciprofloxacin, ceftriaxone, and sulfamethoxazole/trimethoprim are suitable choices for the treatment of bacterial acute diarrhea. However, the maternal and fetal safety profile of prescribed medications should be considered when treating pregnant patients.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Brazil; Ceftriaxone; Ciprofloxacin; Cross-Sectional Studies; Diarrhea; Dysentery, Bacillary; Female; Humans; Microbial Sensitivity Tests; Pregnancy; Retrospective Studies; Salmonella; Salmonella Infections; Shigella; Sulfamethoxazole; Trimethoprim; Young Adult

To identify clinical and microbiological characteristics of Shigella infections among cancer patients.. The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised medical records from December 2011 to November 2013 which were reviewed to identify persons with laboratory-confirmed Shigella infections. Demographic information, clinical history, seasonal variation, microbiological details, treatment given, and outcomes in term of symptoms resolution and mortality at two weeks were noted.. Shigella infection was diagnosed in 45 cancer patients. The mean age of the patients was 36.02±19.30 years (range: 1-64 years), with 35(78%) patients being >18 years of age. Overall, 16(35.5%) patients had presented during winter months and 40(89%) presented as emergencies. Diarrhoea was present in 44(98%) patients and among them 20(45%) had dysentery whereas 28(64%) had fever and 21(47%) had abdominal pain. Of the total 45 cases, 41(91%) had isolates from stool. Besides, 39(87%) Shigella isolates were further speciated and Shigella flexneri was the most commonly isolated serotype in 25(64.1%). Overall, 42(93%) strains were sensitive to cefixime and ceftriaxone. Mean duration of symptoms resolution was 3.92±1.51 days (range: 1-10 days). No mortality was noted at 2 weeks.. Shigella flexneri was the most common serotype isolated. Majority of the isolates were sensitive to 3rd generation cephalosporins (cefixime/ceftriaxone).

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefixime; Ceftriaxone; Child; Child, Preschool; Comorbidity; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasms; Pakistan; Retrospective Studies; Shigella flexneri; Young Adult

Shigellosis presents with varied clinical features are dictated by the species involved, virulence factors of the strain, and the host immune status. We studied the species, virulence genes, and antibiotic susceptibility pattern of the Shigella strains isolated from 33 children aged less than 12 years, with clinical features of shigellosis. Identification and antibiotic sensitivity of Shigella species were done using disc diffusion and E-test. Multiplex PCR was done for the detection of virulence genes (ipaH, ial, set1A, set1B, sen, and stx) and ESBL genes. Parents of the children were interviewed using structured questionnaire to assess the severity of the disease; 26 (79%) of the isolates were Shigella flexneri. Ciprofloxacin and ceftriaxone resistance was seen in 23 (69%) and 3 (9%) Shigella isolates respectively. Two ceftriaxone-resistant strains were found to harbour blaCTX gene and the third blaTEM gene. Virulence gene ipaH was detected in 100% of strains while ial, sen, setlA, and setlB were detected in 85%, 61%, 48%, and 48% respectively.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Dysentery, Bacillary; Feces; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Shigella; Shigella flexneri; Virulence Factors

Topics: beta-Lactamases; Ceftriaxone; Cephalosporin Resistance; Dysentery, Bacillary; Feces; Humans; India; Infant; Microbial Sensitivity Tests; Shigella flexneri

Shigellosis is endemic in many resource-poor countries due to feco-oral transmission, resulting in considerable morbidity and mortality. There is rapid emergence of multi-drug resistant (MDR) Shigella spp. resulting in poor reliability of first line antibiotics like quinolones, co-trimoxazole and ampicillin. Ceftriaxone has been used as a reserved antibiotic for treatment of MDR Shigella spp. The authors report a case of ceftriaxone resistant Shigella flexneri successfully managed with meropenem. As occurrence of ceftriaxone resistant Shigella is still rare, the objective of reporting this case is to highlight the possible failure of ceftriaxone in treating shigellosis which if not detected timely can result in mortality.

Topics: Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases, Emerging; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Female; Humans; Infant; Shigella

Plasmid mediated antimicrobial resistance in the Enterobacteriaceae is a global problem. The rise of CTX-M class extended spectrum beta lactamases (ESBLs) has been well documented in industrialized countries. Vietnam is representative of a typical transitional middle income country where the spectrum of infectious diseases combined with the spread of drug resistance is shifting and bringing new healthcare challenges.. We collected hospital admission data from the pediatric population attending the hospital for tropical diseases in Ho Chi Minh City with Shigella infections. Organisms were cultured from all enrolled patients and subjected to antimicrobial susceptibility testing. Those that were ESBL positive were subjected to further investigation. These investigations included PCR amplification for common ESBL genes, plasmid investigation, conjugation, microarray hybridization and DNA sequencing of a bla(CTX-M) encoding plasmid.. We show that two different bla(CTX-M) genes are circulating in this bacterial population in this location. Sequence of one of the ESBL plasmids shows that rather than the gene being integrated into a preexisting MDR plasmid, the bla(CTX-M) gene is located on relatively simple conjugative plasmid. The sequenced plasmid (pEG356) carried the bla(CTX-M-24) gene on an ISEcp1 element and demonstrated considerable sequence homology with other IncFI plasmids.. The rapid dissemination, spread of antimicrobial resistance and changing population of Shigella spp. concurrent with economic growth are pertinent to many other countries undergoing similar development. Third generation cephalosporins are commonly used empiric antibiotics in Ho Chi Minh City. We recommend that these agents should not be considered for therapy of dysentery in this setting.

Topics: Adolescent; Bacterial Proteins; beta-Lactamases; Ceftriaxone; Child; Child, Preschool; Cluster Analysis; Drug Resistance, Bacterial; Dysentery, Bacillary; Humans; Infant; Infant, Newborn; Plasmids; Polymerase Chain Reaction; Sequence Analysis, DNA; Shigella; Vietnam

Shigellosis is a disease of public health importance in developing countries. It may cause self-limited diarrhea to severe dysentery. Emergence of multi drug resistant (MDR) strains is a growing concern globally. Ceftriaxone and ciprofloxacin are the drugs of choice for MDR cases. Here, we report a case of MDR Shigella flexneri from an immunocompromised patient. The strain was resistant to ceftriaxone [minimum inhibitory concentration (MIC) ≥ 64 μg/ml], limiting the treatment option. Simultaneously, the strain was also found to be resistant to ciprofloxacin (MIC ≥ 4 μg/ml). However, it was susceptible to ceftazidime (MIC 4 μg/ml). This is the first case of ceftriaxone resistant Shigella spp. reported from our hospital.

Topics: Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Humans; Immunocompromised Host; Microbial Sensitivity Tests; Middle Aged; Shigella flexneri

Shigellosis is a common cause of morbidity, especially in the very young and old, in developing countries. The disease is treated with antibiotics. Surveillance of antimicrobial resistance trends is essential owing to the global emergence of antimicrobial resistance.. The study involved 1,573 isolates of Shigella species (1996-2007) that were analyzed for trends in antimicrobial resistance.. The majority of the specimens (1046; 66.5%) were from the pediatric population, and of these 887 (84.8%) were under 5 years of age (p = 0.001). S. flexineri was the most frequent species (54.5%) isolated. Isolation of S. sonnei increased from 15.4 % (1996) to 39% (2007) (p = 0.001). Although none of the isolates was found sensitive to all the antibiotics tested, 58% (n =9 07) were resistant to ampicillin and 85% (n = 1,338) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Out of a total of 198 (12.6%) nalidixic acid resistant isolates, 6 (3.0%) were also resistant to ofloxacin. Overall 1.7 % of isolates were resistant to ofloxacin, 2.4% to ceftriaxone and 2.3% were resistant to combination of ampicillin, nalidixic acid and TMP-SMX.. Ofloxacin is still an effective drug for treatment of acute shigellosis in Pakistan. Emergence of resistance to ceftriaxone in Shigella may have grave implications in treatment of severe shigellosis in very young patients.

Topics: Adolescent; Adult; Age Factors; Ampicillin; Anti-Infective Agents; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Dysentery, Bacillary; Humans; Infant; Microbial Sensitivity Tests; Nalidixic Acid; Ofloxacin; Pakistan; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

The need to limit unnecessary antibiotic treatments and recent studies with unusual antibiotics in pediatrics (fluoroquinolones) or in digestive tract infections (azithromycin) have led to update the treatment of acute gastro-enteritis. In 2007, the European Society for Pediatric Infectious Diseases and the European Society for Gastroenterology Hepatology and Nutrition have issued guidelines. The proven shigellosis as well as the strong suspicion have to be treated promptly with antibiotics, mainly azithromycin. There is no argument to treat moderate salmonella gastroenteritis or carriage. However, the severe cases and those occurring in high risk patient must be treated (ciprofloxacin or ceftriaxone). It is recommended to treat diarrhoea due to Campylobacter jejuni in case of early diagnosis. The presumptive antibiotic treatment should be limited but can not be dismissed, in invasive cases gastro-enteritis, especially in traveller children.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Campylobacter Infections; Campylobacter jejuni; Ceftriaxone; Child; Ciprofloxacin; Diarrhea; Dysentery, Bacillary; Escherichia coli Infections; Gastroenteritis; Humans; Salmonella Infections

Antimicrobial resistance of Shigella isolates in Bangladesh, during 2001-2002, was studied and compared with that of 1991-1992 to identify the changes in resistance patterns and trends. A significant increase in resistance to trimethoprim-sulphamethoxazole (from 52% to 72%, p < 0.01) and nalidixic acid (from 19% to 51%, p < 0.01) was detected. High, but unchanged, resistance to tetracycline, ampicillin, and chloramphenicol, low resistance to mecillinam (resistance 3%, intermediate 3%), and to emergence of resistance to azithromycin (resistance 16%, intermediate 62%) and ceftriaxone/cefixime (2%) were detected in 2001-2002. Of 266 recent isolates, 63% were resistant to > or =3 anti-Shigella drugs (multidrug-resistant [MDR]) compared to 52% of 369 strains (p < 0.007) in 1991-1992. Of 154 isolates tested by E-test in 2001-2002, 71% were nalidixic acid-resistant (minimum inhibitory concentration [MIC] > or =32 microg/mL) and had 10-fold higher MIC90 (0.25 microg/mL) to ciprofloxacin than that of nalidixic acid-susceptible strains exhibiting decreased ciprofloxacin susceptibility, which were detected as ciprofloxacin-susceptible and nalidixic acid-resistant by the disc-diffusion method. These strains were frequently associated with MDR traits. High modal MICs were observed to azithromycin (MIC 6 microg/mL) and nalidixic acid (MIC 128 micdrog/mL) and low to ceftriaxone (MIC 0.023 microg/mL). Conjugative R-plasmids-encoded extended-spectrum beta-lactamase was responsible for resistance to ceftriaxone/cefixime. The growing antimicrobial resistance of Shigella is worrying and mandates monitoring of resistance. Pivmecillinam or ciprofloxacin might be considered for treating shigellosis with caution.

Topics: Anti-Bacterial Agents; Azithromycin; Bangladesh; Ceftriaxone; Ciprofloxacin; Colony Count, Microbial; Dose-Response Relationship, Drug; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Humans; Microbial Sensitivity Tests; Sentinel Surveillance; Shigella; Species Specificity; Treatment Outcome

We document the first report of plasmid-encoded CMY-2-type AmpC beta-lactamase identified among Shigella sonnei isolates resistant to ceftriaxone and obtained after an outbreak of bacillary dysentery in Taiwan. One hundred eighty-two children in two elementary schools in Yu-Li, Taiwan, where an outbreak occurred after a typhoon hit this area in 2001, were enrolled in this study. Clinical and epidemiologic data on the infected children were collected. Pulsed-field gel electrophoresis (PFGE) was performed on the isolates to determine the genetic relatedness of outbreak strains. Plasmid analysis and PCR were performed to identify beta-lactamase genes responsible for ceftriaxone resistance. Forty-seven children from the two elementary schools were culture positive for S. sonnei in this outbreak. Twenty-three children were asymptomatic. Of the total isolates 55.3% were resistant to ampicillin. One hundred percent of the isolates obtained from children in school A were initially susceptible to both ampicillin and ceftriaxone. Of isolates obtained from school B 96.2% were nonsusceptible to ceftriaxone. However, two isolates from school A developed resistance to ampicillin during the course of treatment. All 18 available isolates showed closely related PFGE patterns (4, 4a, 4b, and 4c). CMY-2-type AmpC beta-lactamase was responsible for ceftriaxone resistance in ceftriaxone-nonsusceptible isolates; Southern blot hybridization confirmed that such a resistance gene was located on the plasmid. This is the first report of plasmid-mediated CMY-2-type AmpC beta-lactamase in S. sonnei. Ampicillin-resistant isolates can develop during the course of antibiotic treatment.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Ceftriaxone; Child; Child, Preschool; Disease Outbreaks; Drug Resistance, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Male; Microbial Sensitivity Tests; Plasmids; Shigella sonnei; Taiwan

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Biological Evolution; Ceftriaxone; Chloramphenicol; Ciprofloxacin; Drug Resistance, Bacterial; Dysentery, Bacillary; Gentamicins; Humans; Shigella; Turkey

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Dysentery, Bacillary; Glycogen Storage Disease Type I; Humans; Infant; Infusions, Intravenous; Male; Pneumonia, Bacterial; Radiography; Shigella sonnei

Topics: Anticonvulsants; Brain; Brain Edema; Ceftriaxone; Cephalosporins; Child, Preschool; Diarrhea; Dysentery, Bacillary; Feces; Female; Humans; Phenytoin; Seizures; Shigella flexneri; Tomography, X-Ray Computed

Administration of ceftriaxone for 5 days has been shown to be highly efficient in the treatment of severe shigellosis in children. Our study, involving 40 children, demonstrated that a 2-day course of ceftriaxone was as beneficial as a 5-day course and constituted effective therapy for children with severe shigellosis.

Topics: Adolescent; Ceftriaxone; Child; Child, Preschool; Diarrhea, Infantile; Dose-Response Relationship, Drug; Dysentery, Bacillary; Humans; Infant; Shigella flexneri; Shigella sonnei; Treatment Outcome

Topics: Ceftriaxone; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Shigella flexneri; Shigella sonnei

Drug resistance patterns of shigella strains were investigated in a prospective manner in Etimesgut district during a period of 1 year. Thirty strains shigella were isolated, belonged to three subgroups with preponderance of Sh. flexneri (70%), followed by Sh. sonnei (27%) and Sh. boydii (3%). The resistance was highest with streptomycin (80%), followed by trimethoprim-sulfamethoxazole (TMP-SMZ) (53%) and ampicillin (43%). Only three strains (10%) were sensitive to all eight antibiotics tested. Sixteen (53%) were resistant to three or more antibiotics. The data showed an increase in resistance to the commonly used antimicrobial agents--namely IMP-SMZ and ampicillin. IMP-SMZ is no longer the drug of choice in severe shigellosis, at least in this region of Turkey.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Ceftriaxone; Chloramphenicol Resistance; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Nalidixic Acid; Ofloxacin; Prospective Studies; Serotyping; Shigella; Shigella boydii; Shigella flexneri; Shigella sonnei; Streptomycin; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey