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Title: Increasing spectrum in antimicrobial Resistance of shigella isolates in Bangladesh: resistance to azithromycin and ceftriaxone and decreased susceptibility to ciprofloxacin
Authors: Mahbubur Rahman, Mahbubur
Shoma, Shereen
Rashid, Harunur
Arifeen, Shams El
Baqui, A.H.
Siddique, A.K.
Nair, G.B.
Sack, David A.
Keywords: Azithromycin
Drug resistance
Microbial sensitivity tests
Nalidixic acid
Issue Date: 9-Sep-2007
Series/Report no.: J Health Popul Nutr
2007 Jun;25(2):158-167
Abstract: Antimicrobial resistance of Shigella isolates in Bangladesh, during 2001-2002, was studied and com­pared with that of 1991-1992 to identify the changes in resistance patterns and trends. A significant increase in resistance to trimethoprim-sulphamethoxazole (from 52% to 72%, p<0.01) and nalidixic acid (from 19% to 51%, p<0.01) was detected. High, but unchanged, resistance to tetracycline, am­picillin, and chloramphenicol, low resistance to mecillinam (resistance 3%, intermediate 3%), and to emergence of resistance to azithromycin (resistance 16%, intermediate 62%) and ceftriaxone/ce­fixime (2%) were detected in 2001-2002. Of 266 recent isolates, 63% were resistant to ≥3 anti-Shigella drugs (multidrug-resistant [MDR]) compared to 52% of 369 strains (p<0.007) in 1991-1992. Of 154 isolates tested by E-test in 2001-2002, 71% were nalidixic acid-resistant (minimum inhibitory con­centration [MIC] ≥32 µg/mL) and had 10-fold higher MIC 90 (0.25 µg/mL) to ciprofloxacin than that of nalidixic acid-susceptible strains exhibiting decreased ciprofloxacin susceptibility, which were de­tected as ciprofloxacin-susceptible and nalidixic acid-resistant by the disc-diffusion method. These strains were frequently associated with MDR traits. High modal MICs were observed to azithromy­cin (MIC 6 µg/mL) and nalidixic acid (MIC 128 µg/mL) and low to ceftriaxone (MIC 0.023 µg/mL). Conjugative R-plasmids-encoded extended-spectrum ß-lactamase was responsible for resistance to ceftriaxone/cefixime. The growing antimicrobial resistance of Shigella is worrying and mandates monitoring of resistance. Pivmecillinam or ciprofloxacin might be considered for treating shigellosis with caution.
URI: http://hdl.handle.net/123456789/173
Appears in Collections:Public health sciences research papers

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