CDC: ‘Consider shigellosis’ for acute diarrhea amid surge in drug resistant cases
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The CDC issued a health advisory alerting clinicians to a spike in extensively drug-resistant shigellosis in the United States, urging them to consider this infection in cases of acute diarrhea, especially among higher risk patients.
“In 2022, about 5% of Shigella infections reported to the CDC were caused by [extensively drug-resistant (XDR)] strains, compared with 0% in 2015,” the agency noted in its health advisory. “Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible [and] XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria.”
The CDC has previously defined XDR Shigella bacteria as strains resistant to all regularly recommended antibiotics, including azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole and ampicillin.
“Currently, there are no data from clinical studies of treatment of XDR Shigella to inform recommendations for the optimal antimicrobial treatment of these infections,” the agency stated. “As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR Shigella infections.”
Although, historically, shigellosis has primarily affected children aged 1 to 4 years in the U.S., the CDC noted that drug-resistant Shigella strains have been increasingly reported among adult populations, including gay, bisexual and other men who have sex with men (MSM), individuals experiencing homelessness, international travelers and individuals living with HIV.
According to the CDC, between January 1, 2015, and January 22, 2023, the agency has received reports of 239 XDR Shigella isolates, consisting predominantly of Shigella sonnei (66%) and Shigella flexneri (34%).
“Consider shigellosis in the differential diagnosis of acute diarrhea, especially for patients at higher risk for Shigella infection, including young children, MSM, people experiencing homelessness, international travelers, immunocompromised persons [and] people living with HIV,” the CDC noted. “If shigellosis is suspected, ask the patient about relevant exposures and social history, including sexual activity, housing status and international travel.”
The CDC reported that it will continue to monitor for XDR Shigella infections and Shigella isolates with “unique or worrisome antimicrobial susceptibility patterns and genetic resistance markers”. Additionally, an analysis is currently being conducted of antimicrobial-resistant Shigella infections in the U.S. using data from the National Antimicrobial Resistance Monitoring System for Enteric Bacteria.
Given the severity of this public health threat, the CDC has urged health care providers to remain vigilant in reporting suspected cases of XDR shigellosis to local or state health department, as well as educate patients and communities at heightened risk regarding prevention and transmission.
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