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March 14, 2023
The Centers for Disease Control and Prevention (CDC) National Antimicrobial Resistance Monitoring System (NARMS) has been monitoring an increase of extensively drug-resistant (XDR) Shigella infections (shigellosis) in the United States. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains compared to with 0% in 2015.
CDC defines XDR Shigella bacteria as strains that are resistant to all commonly recommended empiric and alternative antibiotics – azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX) and ampicillin. Because there are no data from clinical studies of treatment of XDR Shigella infections, CDC does not have recommendations for optimal antimicrobial treatment. Healthcare providers should consult with a specialist knowledgeable in the treatment of antibiotic-resistant bacteria to determine the best treatment option if there are concerns for XDR Shigella infections or in cases of treatment failure without AST results.
Currently, multiple local health jurisdictions are seeing an increase in reported Shigella infections. A total of 22 cases were reported between November 2022 and February 2023 in Snohomish County, with 12 of that total reported in February. The Snohomish County Health Department recently provided notice to Donated Food Distributing Organizations (DFDOs) regarding Shigella and the need for preventive measures. No XDR Shigella infections have been identified in Snohomish County in that time. However, many laboratories currently do not do Shigella antimicrobial sensitivity testing (AST) for azithromycin, a common first-choice antibiotic treatment. Laboratories should consider adding azithromycin to their AST for Shigella specimens using recently established clinical breakpoints for azithromycin for Shigella.
Shigella is easily spread person-to-person through the fecal-oral route and through sexual contact, especially in situations with limited access to hygiene facilities. Persons at higher risk of Shigella infection include men who have sex with men, people whose immune systems are weakened due to illness such as HIV or medical treatment such as chemotherapy, young children, and travelers to countries with poor sanitation. People with weakened immune systems are also more likely to develop serious illness, including bacteremia.
This health advisory adapted from Public Health Seattle & King County