Abstract
BackgroundShigellosis is the second leading cause of diarrheal death globally. The global burden has been complicated by the emergence of Shigella strains resistant to first line antibiotic treatments such as ciprofloxacin. This study aims to describe the epidemiologic distribution of the most common Shigella species, and their antimicrobial susceptibility patterns to ciprofloxacin and nalidixic acid (NA) in Latin America.MethodsLaboratory data from 19 countries were obtained through the Latin American Network for Antimicrobial Resistance Surveillance (ReLAVRA) from 2000–2015. The Clinical Laboratory Standards Institute reduced susceptibility breakpoints for Enterobacteriaceae was used to interpret the disc diffusion tests for Shigella susceptibility to ciprofloxacin and NA. Negative binominal regression was used to analyze longitudinal trends of Shigella isolates antimicrobial susceptibility.Results79,548 Shigella isolates were tested and reported between 2000–2015. The most common isolated species were S. flexneri (49%), and S. sonnei (28%). There was a steady increase in the proportion of S. sonnei isolates within the region(p<0.001). The average annual percentage increase (AAPI) in nonsusceptibility was 18.4% (p<0.001) for ciprofloxacin (baseline = 0.3); and 13.2%(p<0.001) for NA (baseline = 3). AAPI nonsusceptibility to ciprofloxacin was 13.3% for S. flexneri (p<0.04); and 39.9% for S. sonnei (p<0.001). Honduras, Dominican Republic, Venezuela, and Chile reported the highest increase in nonsusceptibility to ciprofloxacin among all Shigella isolates.ConclusionThere is an increasing trend in Shigella nonsusceptibility to ciprofloxacin and NA, including among the most common shigella species, in Latin America. This rise of nonsusceptibility among Shigella species to commonly used treatments such as ciprofloxacin is alarming and threatens the control and management of this currently treatable infection. Improved data quality, collection and reporting is needed in Latin America to respond effectively to the rising trends observed. This includes the need for quality isolate level epidemiological data; molecular data, and data on antibiotic consumption and use.
Highlights
Shigellosis is the second leading cause of diarrheal death in the world (164,300 deaths annually, CI: 85 000–278 700), and one of three leading causes of diarrheal deaths in children younger than 5 years [1, 2]
This study aims to describe the epidemiologic distribution of the most common Shigella species, and their antimicrobial susceptibility patterns to ciprofloxacin and nalidixic acid (NA) in Latin America
This study aims to describe the epidemiological distribution of the most common Shigella species, their antimicrobial susceptibility patterns and resistance trends to the quinolone’s ciprofloxacin and nalidixic acid, in Latin America
Summary
Shigellosis is the second leading cause of diarrheal death in the world (164,300 deaths annually, CI: 85 000–278 700), and one of three leading causes of diarrheal deaths in children younger than 5 years [1, 2]. Each of the four-main species cause shigellosis, vary in terms of virulence and antimicrobial resistance patterns. The emergence of antibiotic-resistant Shigella strains to traditional first-line shigellosis drugs, (ampicillin, trimethoprim-sulfamethoxazole and nalidixic acid) has been a well-recognized public health concern [2, 4, 5]. In response to the increase of antibiotic resistance to these agents, the World Health Organization (WHO) recommended the use of the ciprofloxacin, as alternative empiric antimicrobial treatment for shigellosis [5]. Ciprofloxacin, which was formerly used as a backup drug to treat shigellosis, is currently recommended as the drug of first choice for all patients of all ages presenting with bloody diarrhea; with ceftriaxone and azithromycin as second line treatments [5]. This study aims to describe the epidemiologic distribution of the most common Shigella species, and their antimicrobial susceptibility patterns to ciprofloxacin and nalidixic acid (NA) in Latin America
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