Health care providers should be vigilant about suspecting — and reporting — extensively drug-resistant (XDR) Shigella infections amid a recent increase, according to an advisory from the Centers for Disease Control and Prevention (CDC).
Shigellosis should be considered in the differential diagnosis of acute diarrhea. Young children are among the patients at higher risk.
Strains of XDR Shigella bacteria are resistant to all commonly recommended empiric and alternative antibiotics: azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole and ampicillin. Hence, the CDC does not have recommendations for optimal antimicrobial treatment of these infections.
In the U.S., the percentage of Shigella infections caused by XDR strains has increased from zero in 2015 to 5% in 2022. Since 2015, the CDC has received reports of 239 XDR Shigella isolates. Of 232 patients with available information, 5% were children.
While shigellosis has mostly affected young children (ages 1-4 years) in the U.S., there has been in increase in antimicrobial-resistant Shigella infections among adults, especially gay, bisexual and other men who have sex with men; people experiencing homelessness; international travelers; and those living with HIV.
It usually causes inflammatory diarrhea that can be bloody and may lead to fever, abdominal cramps and tenesmus. Infections generally are self-limiting.
Shigellosis is a nationally notifiable disease.
Consult the CDC advisory for additional guidance.