Drug-Resistant Shigellosis Spreading in the US

International travelers have brought Ciprofloxacin-resistant shigellosis into the US where it is spreading domestically, according to a recent study.

“Travelers need to be aware of the risks of acquiring multidrug-resistant pathogens, carefully wash their hands, and adhere to food and water precautions during international travel,” said the study’s authors.
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“Clinicians should request stool cultures and antimicrobial susceptibilities when they suspect shigellosis, and counsel shigellosis patients to follow meticulous hygiene regimens while ill,” they said.

From May 2014 to February 2015, researchers evaluated 243 cases of shigellosis in 32 US states and Puerto Rico.

Researchers discovered that 95 cases that were resistant to ciprofloxacin occurred in San Francisco, mostly among the homeless. About 85% of the 243 cases were resistant to ciprofloxacin—the first-line treatment recommended for adults—sulfisoxazole, tetracycline, streptomycin, and trimethoprim/sulfamethoxazole, while 5% were resistant to ampicillin and 100% resisted nalidixic acid.

Of the 95 cases that occurred in San Francisco, none had recently traveled internationally. However, about 50% of patients in other locations had traveled abroad.

The complete study is published in the April 3, 2015 issue of the Morbidity and Mortality Weekly Report (MMWR).

-Michelle Canales Butcher

Reference:

Bowen A, Hurd J, Hoover C, et al. Importation and domestic transmission of Shigella sonnei resistant to Ciprofloxacin—United States, May 2014-Febraury 2015. MMWR. 2015;64(12):318-320.