Abstract
Globally, shigellosis remains the second leading cause of diarrhea-associated deaths among children under five years of age, and the infections are disproportionately higher in resource-limited settings due to overcrowding, poor sanitation, and inadequate safe drinking water. The emergence and global spread of multidrug-resistant (MDR) Shigella are exacerbating the shigellosis burden. We adopted a cross-sectional study design to determine the distribution and antimicrobial susceptibility (AST) patterns of Shigella serogroups among children aged below five years presenting with diarrhea at Banadir Hospital in Mogadishu, Somalia, from August to October 2019. Stool and rectal swab samples were collected from 180 children consecutively enrolled using a convenient sampling technique and processed following standard bacteriological methods. AST was determined using the Kirby–Bauer disc diffusion method and interpreted as per the Clinical Laboratory Standard Institute (2018) guidelines. Shigellosis prevalence was 20.6% (37/180), and S. flexneri (26/37 (70.3%)) was the predominant serogroup. All the serogroups were 100% resistant to ampicillin (AMP), trimethoprim-sulfamethoxazole (SXT), and tetracycline (TE). Ceftriaxone (CRO) resistance was the highest among S. sonnei (66.7%) isolates. 19.2% of S. flexneri and S. sonnei (50%) serogroups were resistant to ciprofloxacin (CIP), but all S. dysenteriae type 1 isolates remained (100%) susceptible. Forty percent of CIP-susceptible S. dysenteriae type 1 were resistant to CRO. Seven MDR Shigella phenotypes were identified, dominated by those involving resistance to AMP, SXT, and TE (100%). Our findings showed a high prevalence of shigellosis with S. flexneri as the most predominant serogroup among children under five years of age in Banadir Hospital, Somalia. AMP and SXT are no longer appropriate treatments for shigellosis in children under five years in Banadir Hospital. MDR Shigella strains, including those resistant to CIP and CRO, have emerged in Somalia, posing a public health challenge. Therefore, there is an urgent need for AMR surveillance and continuous monitoring to mitigate the further spread of the MDR Shigella strains in Banadir Hospital and beyond.
Highlights
Approximately 165 million episodes of bacillary dysentery and about 1.1 million associated deaths occur annually [1]
In cases where stool samples were not available, rectal swabs were collected and immediately placed in the Cary Blair Transport Medium. e samples were transported in an icebox to the National Public Health Reference Laboratory (NPHRL) in Mogadishu, Somalia, for analysis within 2-3 hours
Our finding suggests that AMP and SXT are no longer appropriate empiric therapy for the treatment of bacillary dysentery among children under five years in Banadir Hospital, Somalia
Summary
Approximately 165 million episodes of bacillary dysentery (shigellosis) and about 1.1 million associated deaths occur annually [1]. Developing countries, whereby 69% of the episodes and 61% of deaths occur among children under five years, bear the highest burden of these infections (99%) [2]. E causative agent of bacillary dysentery is Shigella bacteria. The pathogen is grouped into four distinct serogroups, namely Shigella dysenteriae (Shiga bacillus), S. flexneri, S. boydii, and S. sonnei. E distribution of these serogroups varies geographically, whereby S. flexneri and S. sonnei are predominant in developing and developed countries, respectively [1]. Ciprofloxacin is the World Health Organization (WHO) first-line treatment option for dysentery. Shigella strains resistant to these antibiotics are increasingly emerging and spreading globally, posing a serious public health threat [5]
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