Abstract
Recent (1984 to 1992) trends in the antimicrobial resistance of Shigella isolates in Israel were studied by analyzing the results of 106,000 stool cultures, 3,511 of which yielded Shigella spp. Over the study period, resistance to trimethoprim-sulfamethoxazole (TMP-SMX) increased from 59 to 92% (P = 0.0038) and that to ampicillin increased from 13 to 86% (P < 0.0001). Resistances to nalidixic acid, chloramphenicol, and broad-spectrum cephalosporins remained low. Shigella sonnei, which currently accounts for 90% of Shigella infections, was more resistant than S. flexneri to TMP-SMX (81 versus 57%, P < 10(-6)), ampicillin (42 versus 32%, P < 10(-5)), and tetracycline (38 versus 28%, P < 10(-5)). S. boydii and S. dysenteriae were relatively rare. Seasonality in antimicrobial resistance was found, with summer isolates being less resistant to TMP-SMX, ampicillin, or both than isolates obtained over the rest of the year (P < 10(-5)). We conclude that the resistance of shigellae, especially S. sonnei, to TMP-SMX and ampicillin is increasing to approximately 90%. Resistance should be recorded locally, and empiric therapy for suspected shigellosis should be changed accordingly.
Full Text
The Full Text of this article is available as a PDF (343.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ashkenazi S., Amir J., Waisman Y., Rachmel A., Garty B. Z., Samra Z., Varsano I., Nitzan M. A randomized, double-blind study comparing cefixime and trimethoprim-sulfamethoxazole in the treatment of childhood shigellosis. J Pediatr. 1993 Nov;123(5):817–821. doi: 10.1016/s0022-3476(05)80867-4. [DOI] [PubMed] [Google Scholar]
- Ashkenazi S., May-Zahav M., Dinari G., Gabbay U., Zilberberg R., Samra Z. Recent trends in the epidemiology of Shigella species in Israel. Clin Infect Dis. 1993 Nov;17(5):897–899. doi: 10.1093/clinids/17.5.897. [DOI] [PubMed] [Google Scholar]
- Bennish M., Eusof A., Kay B., Wierzba T. Multiresistant Shigella infections in Bangladesh. Lancet. 1985 Aug 24;2(8452):441–441. doi: 10.1016/s0140-6736(85)92756-4. [DOI] [PubMed] [Google Scholar]
- Chatkaeomorakot A., Echeverria P., Taylor D. N., Seriwatana J., Leksomboon U. Trimethoprim-resistant Shigella and enterotoxigenic Escherichia coli strains in children in Thailand. Pediatr Infect Dis J. 1987 Aug;6(8):735–739. doi: 10.1097/00006454-198708000-00008. [DOI] [PubMed] [Google Scholar]
- Dan M., Michaeli D., Treistman J. The epidemiology of shigellosis in Israel. Ann Trop Med Parasitol. 1988 Apr;82(2):159–162. doi: 10.1080/00034983.1988.11812223. [DOI] [PubMed] [Google Scholar]
- DuPont H. L. Shigella. Infect Dis Clin North Am. 1988 Sep;2(3):599–605. [PubMed] [Google Scholar]
- Fontaine O. Antibiotics in the management of shigellosis in children: what role for the quinolones? Rev Infect Dis. 1989 Jul-Aug;11 (Suppl 5):S1145–S1150. doi: 10.1093/clinids/11.supplement_5.s1145. [DOI] [PubMed] [Google Scholar]
- Gangarosa E. J., Perera D. R., Mata L. J., Mendizábal-Morris C., Guzmán G., Reller L. B. Epidemic Shiga bacillus dysentery in Central America. II. Epidemiologic studies in 1969. J Infect Dis. 1970 Sep;122(3):181–190. doi: 10.1093/infdis/122.3.181. [DOI] [PubMed] [Google Scholar]
- Green M. S., Block C., Cohen D., Slater P. E. Four decades of shigellosis in Israel: epidemiology of a growing public health problem. Rev Infect Dis. 1991 Mar-Apr;13(2):248–253. doi: 10.1093/clinids/13.2.248. [DOI] [PubMed] [Google Scholar]
- Griffin P. M., Tauxe R. V., Redd S. C., Puhr N. D., Hargrett-Bean N., Blake P. A. Emergence of highly trimethoprim-sulfamethoxazole-resistant Shigella in a native American population: an epidemiologic study. Am J Epidemiol. 1989 May;129(5):1042–1051. doi: 10.1093/oxfordjournals.aje.a115208. [DOI] [PubMed] [Google Scholar]
- Keusch G. T., Bennish M. L. Shigellosis: recent progress, persisting problems and research issues. Pediatr Infect Dis J. 1989 Oct;8(10):713–719. [PubMed] [Google Scholar]
- Kruse H., Kariuki S., Søli N., Olsvik O. Multiresistant Shigella species from African AIDS patients: antibacterial resistance patterns and application of the E-test for determination of minimum inhibitory concentration. Scand J Infect Dis. 1992;24(6):733–739. doi: 10.3109/00365549209062458. [DOI] [PubMed] [Google Scholar]
- Lee L. A., Shapiro C. N., Hargrett-Bean N., Tauxe R. V. Hyperendemic shigellosis in the United States: a review of surveillance data for 1967-1988. J Infect Dis. 1991 Nov;164(5):894–900. doi: 10.1093/infdis/164.5.894. [DOI] [PubMed] [Google Scholar]
- Ling J., Kam K. M., Lam A. W., French G. L. Susceptibilities of Hong Kong isolates of multiply resistant Shigella spp. to 25 antimicrobial agents, including ampicillin plus sulbactam and new 4-quinolones. Antimicrob Agents Chemother. 1988 Jan;32(1):20–23. doi: 10.1128/aac.32.1.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Munshi M. H., Sack D. A., Haider K., Ahmed Z. U., Rahaman M. M., Morshed M. G. Plasmid-mediated resistance to nalidixic acid in Shigella dysenteriae type 1. Lancet. 1987 Aug 22;2(8556):419–421. doi: 10.1016/s0140-6736(87)90957-3. [DOI] [PubMed] [Google Scholar]
- Murray B. E. Problems and mechanisms of antimicrobial resistance. Infect Dis Clin North Am. 1989 Sep;3(3):423–439. [PubMed] [Google Scholar]
- Nelson J. D., Kusmiesz H., Jackson L. H., Woodman E. Trimethoprim-sulfamethoxazole therapy for shigellosis. JAMA. 1976 Mar 22;235(12):1239–1243. [PubMed] [Google Scholar]
- Neu H. C. In vitro activity of a new broad spectrum, beta-lactamase-stable oral cephalosporin, cefixime. Pediatr Infect Dis J. 1987 Oct;6(10):958–962. doi: 10.1097/00006454-198710000-00034. [DOI] [PubMed] [Google Scholar]
- Prado D., López E., Liu H., Devoto S., Woloj M., Contrini M., Murray B. E., Gómez H., Cleary T. G. Ceftibuten and trimethoprim-sulfamethoxazole for treatment of Shigella and enteroinvasive Escherichia coli disease. Pediatr Infect Dis J. 1992 Aug;11(8):644–647. [PubMed] [Google Scholar]
- Preston M. A., Brown S., Borczyk A. Multiply-resistant Shigella sonnei from recent outbreaks in Canada. Can Dis Wkly Rep. 1991 Dec 14;17(50):277–279. [PubMed] [Google Scholar]
- Rahaman M. M., Khan M. M., Aziz K. M., Islam M. S., Kibriya A. K. An outbreak of dysentery caused by Shigella dysenteriae type 1 on a coral island in the Bay of Bengal. J Infect Dis. 1975 Jul;132(1):15–19. doi: 10.1093/infdis/132.1.15. [DOI] [PubMed] [Google Scholar]
- Ries A. A., Wells J. G., Olivola D., Ntakibirora M., Nyandwi S., Ntibakivayo M., Ivey C. B., Greene K. D., Tenover F. C., Wahlquist S. P. Epidemic Shigella dysenteriae type 1 in Burundi: panresistance and implications for prevention. J Infect Dis. 1994 May;169(5):1035–1041. doi: 10.1093/infdis/169.5.1035. [DOI] [PubMed] [Google Scholar]
- Salam M. A., Bennish M. L. Antimicrobial therapy for shigellosis. Rev Infect Dis. 1991 Mar-Apr;13 (Suppl 4):S332–S341. doi: 10.1093/clinids/13.supplement_4.s332. [DOI] [PubMed] [Google Scholar]
- Salam M. A., Bennish M. L. Therapy for shigellosis. I. Randomized, double-blind trial of nalidixic acid in childhood shigellosis. J Pediatr. 1988 Nov;113(5):901–907. doi: 10.1016/s0022-3476(88)80029-5. [DOI] [PubMed] [Google Scholar]
- Smollan G., Block C. Development of antimicrobial drug resistance among Shigellas isolated at an Israeli hospital from 1977 through 1990. Public Health Rev. 1990;18(4):319–327. [PubMed] [Google Scholar]
- Tally F. P., Desjardins R. E., McCarthy E. F., Cartwright K. Safety profile of cefixime. Pediatr Infect Dis J. 1987 Oct;6(10):976–980. doi: 10.1097/00006454-198710000-00037. [DOI] [PubMed] [Google Scholar]
- Tauxe R. V., Puhr N. D., Wells J. G., Hargrett-Bean N., Blake P. A. Antimicrobial resistance of Shigella isolates in the USA: the importance of international travelers. J Infect Dis. 1990 Nov;162(5):1107–1111. doi: 10.1093/infdis/162.5.1107. [DOI] [PubMed] [Google Scholar]
- Varsano I., Eidlitz-Marcus T., Nussinovitch M., Elian I. Comparative efficacy of ceftriaxone and ampicillin for treatment of severe shigellosis in children. J Pediatr. 1991 Apr;118(4 Pt 1):627–632. doi: 10.1016/s0022-3476(05)83392-x. [DOI] [PubMed] [Google Scholar]
- Wharton M., Spiegel R. A., Horan J. M., Tauxe R. V., Wells J. G., Barg N., Herndon J., Meriwether R. A., MacCormack J. N., Levine R. H. A large outbreak of antibiotic-resistant shigellosis at a mass gathering. J Infect Dis. 1990 Dec;162(6):1324–1328. doi: 10.1093/infdis/162.6.1324. [DOI] [PubMed] [Google Scholar]