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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio The prevalence of extensively drug-resistant Shigella is surging in the U.S., with isolates jumping from 0% in 2011 to 8.5% in 2023, according to a CDC report analyzing trends and epidemiologic characteristics for these bacterial strains. In another stark shift, more than 96% of patients who contracted extensively drug-resistant (XDR) Shigella during this period were adults. Historically, Shigella infection burden has been concentrated in pediatric populations and most often caused by drug-susceptible strains.
Image: Ali Rezaie, MD. Reprinted with permission.
\u201cShigellosis is one of those intestinal infections that responds well to antibiotics, by and large,\u201d William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told Healio. \u201cBut now we have strains of Shigella that are labeled extensively drug resistant, which means we don\u2019t have an FDA-approved antimicrobial that can be used against them.\u201d Shigella is highly infectious and can be contracted through as few as 10 bacterial cells. Species of Shigella with XDR designation are resistant to ampicillin, azithromycin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole. \u201cFor the majority of patients with shigellosis, it is a self-limited disease that goes away after roughly 7 days with supportive care,\u201d Ali Rezaie, MD, MSc, medical director of the GI motility program and associate professor at Cedars-Sinai, told Healio. \u201cBut for patients who do need treatment and have a resistant [strain], oral antibiotics won\u2019t work.\u201d Typically, patients require treatment if they are immunocompromised, develop severe shigellosis or are hospitalized for another serious condition. The rise in XDR shigellosis incidence is aligned with broader trends in drug-resistant bacterial infections. \u201cIt is not surprising to see that Shigella is becoming more resistant,\u201d Rezaie said. \u201cWe are seeing this in other sorts of bacteria as well, highlighting the need for more research into antimicrobial modalities.\u201d Among pathogen-antibiotic pairings monitored by WHO between 2018 and 2023, resistance rose more than 40%. Limiting antibiotic use is one strategy to minimize bacterial drug resistance. Jason E. Zucker \u201cWhen we think about Shigella clinically, we want to be judicious with our use of antibiotics, and we want to make sure that we\u2019re offering antibiotics to those people who really will benefit from them,\u201d Jason E. Zucker, MD, assistant professor of medicine at Columbia University Medical Center and medical director of the New York City STD Prevention Training Center, said. Who is at risk? Shigella is commonly spread via fecal-oral transmission, sexual contact or contaminated food or water sources. In particular, sexual contact among men who have sex with men is a notable pathway for Shigella transmission, according to research cited in the CDC report. \u201cAlthough anyone can get Shigella, we see higher rates among gay, bisexual and other men who have sex with men, in part because it can be passed through sexual contact,\u201d Zucker said. The CDC was unable to gather data on sexual behavior for its report, but did note that 86.2% of individuals with XDR shigellosis were men. Seasonal transition can also be an issue. William Schaffner \u201cIn summertime, people go out, vacation and may develop new relationships or partners,\u201d Schaffner, also a Healio | Infectious Disease News Editorial Board Member, said. \u201cThey should exercise caution, because not only are we concerned about HIV and other sexually transmitted infections, but now we have to add XDR shigellosis to the list.\u201d Of the 116 individuals with XDR shigellosis for whom HIV status was known, 46.6% were HIV-positive. \u201cWith Shigella, there is always the stated concern about anyone who is immunocompromised,\u201d Schaffner said. \u201cPeople with HIV infection, particularly if they are not well treated, would fall into that category.\u201d The median age of individuals who contracted XDR Shigella was 41 years, according to the CDC. Only around 4% of cases occurred in children or adolescents. \u201cTraditionally we think of shigellosis involving mostly children, and then their mothers, who are often the caregivers at home,\u201d Schaffner said. Schaffner highlighted that addressing XDR Shigella may require a shift away from this line of thought, with a focus on at-risk adult populations. \u201cWe have also seen multiple Shigella outbreaks among people experiencing homelessness over the past few years, often driven by limited access to handwashing and sanitation,\u201d Zucker said. Donald Dumford Donald Dumford, MD, an infectious disease specialist at Cleveland Clinic Akron General, also weighed in on individuals who may be more susceptible to infection as drug-resistant strains become more common. \u201cPeople who may live in crowded conditions, such as prisons or nursing homes, might be at higher risk,\u201d Dumford said. \u201cAlthough we haven\u2019t seen outbreaks of XDR Shigella in nursing homes, that might be a population to be concerned for in the future.\u201d Stopping the spread Dumford advised clinicians to counsel at-risk patients on harm reduction strategies, including talking to their partners about whether they have had recent diarrheal illness. \u201cOnce patients are symptom-free, they should wait 2 weeks before any sexual contact,\u201d he said. \u201cThere are also recommendations for bathing before and after sex, to reduce the bacterial burden as much as possible.\u201d Dumford also emphasized the importance of reminding patients about hand hygiene. \u201cWhenever we\u2019re talking about gastrointestinal infections and that fecal-oral route, we have to remind people about the common-sense stuff,\u201d Dumford said. \u201cThe big common-sense advice is to wash your hands. \u201cWhether it\u2019s Shigella, some other bacteria like C. diff or a virus like norovirus, that is the best way to get it off of yourself and your hands before you bring your hands to your mouth,\u201d he added. Dumford also outlined other reminders clinicians should share with their patients. \u201cWhen a patient has a mild strain, we<\/p>\n","protected":false},"author":1,"featured_media":3402,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3401","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3401"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3401\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3402"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3401"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3401"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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