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Shigella sonnei antibiotic resistance appears in South Korea
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A young boy who brought a case of Shigella sonnei back to South Korea from Vietnam last fall illustrates the increasing role antimicrobial resistance can play in the spread of Shigella infections, according to data published in Emerging Infectious Diseases.
“Shigella spp. are etiologic agents of gastrointestinal disease worldwide and are frequently associated with outbreaks because of their low infectious doses and person-to-person transmission,” researchers at the Center for Infectious Diseases at the Korea National Institute of Health wrote. “For the treatment of persons who have severe infections, fluoroquinolones are among the first-line agents for adults; additionally, oral extended-spectrum cephalosporins are used to treat young children. However, the current emergence and spread of drug resistance in Shigella strains could hinder empirical antimicrobial therapy, leading to treatment failure.”
The investigators studied a patient, aged 8 years, who visited family in Vietnam — where S. sonnei infection is highly epidemic — and returned home with severe diarrhea. Upon return to his day care center, several children experienced abdominal cramping and vomiting in addition to diarrhea, the researchers wrote. Fecal samples from six children were sent to a local health laboratory in October and tested positive for S. sonnei, while the index case-patient’s grandparents also tested positive for the bacterium.
The Korea Centers for Disease Control and Prevention was notified of the S. sonnei cases, which were all phase 2. Further investigation led to 11 laboratory-confirmed cases and four additional suspected cases. The researcher wrote that the S. sonnei strain identified was similar genetically to a ciprofloxacin-resistant strain isolated from another South Korean who returned from Vietnam in 2012.
Ten of the ill patients were treated successfully with cefotaxime or ciprofloxacin, but five had their antibiotic treatments changed to cabapenems (meropenems or imipenems) after continuing positive stool cultures. Symptomatic patients were isolated to prevent spread of the infection, the researchers wrote.
In addition to these measures, public health workers encouraged strictly enforced hand washing at the day care center; environmental disinfection of the facility; stringent hygiene at households impacted by the outbreak; and additional education about Shigellosis, the researchers reported.
“These findings suggest that, despite the lack of direct evidence, various antimicrobial drug-resistant S. sonnei clones have been imported across geographic regions and may eventually spread globally and lead to increased illness and death rates,” the researchers wrote. “Because international travel can contribute to the spread of multidrug-resistant pathogens, enhanced surveillance is necessary to control the dissemination of antimicrobial drug resistance. Improved hygiene, infection control plans, and better education for travelers are also required.” – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.
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