CDC: Increase in Extensively Drug-Resistant Shigellosis in the United States


Centers for Disease Control and Prevention (CDC) in a Health consulting Today I reported an increase in XDR (Shigellosis) infections reported through national surveillance systems.


In the United States, the percentage of Shigella infections caused by XDR strains reported to the CDC increased from zero in 2015 to 5% in 2022. Between January 1, 2015, and January 22, 2023, the CDC received reports of 239 isolates of Shigella XDR, with Shigella sonny accounting for the largest proportion (66%) followed by Shigella flexneri (34%).

The mean age of the patients was 42 years (range 1–83). Of the 232 patients for whom information was available, 82% were men, 13% were women, and 5% were children. Of the 41 patients who answered questions about recent sexual activity, 88% reported male-to-male sexual intercourse.

Doctors who treat patients with XDR strains have limited antimicrobial treatment options.
Shigella bacteria are easily transmitted. XDR Shigella strains can disseminate antimicrobial resistance genes
to other intestinal bacteria. Given the potentially serious public health concerns, the CDC is asking Medicare
Professionals should be vigilant about suspected cases of Shigella XDR infection and report them to their local
or state health department and educate patients and communities at increased risk about prevention
and transmission.

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Shigellosis is an acute intestinal infection that is a significant cause of locally acquired, travel-associated bacterial diarrhea in the United States. Shigellosis usually causes inflammatory diarrhea that can be bloody and may also lead to fever, abdominal cramps, and flatulence. The infection is usually self-limiting; However, antimicrobial therapy may be indicated to prevent complications or shorten the duration of the disease. The CDC defines XDR Shigella bacteria as strains resistant to all commonly recommended experimental and alternative antibiotics – azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX) and ampicillin.

Currently, there are no data from clinical studies of XDR Shigella treatment to make recommendations for optimal antimicrobial therapy for these infections. As such, the Centers for Disease Control and Prevention does not have recommendations for optimal antimicrobial therapy for Shigella XDR infection.

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