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The Centers for Disease Control and Prevention (CDC) has issued an alert regarding an increase in extensively drug-resistant Shigella infections in the United States.
According to the Agency, 5% of Shigella infections reported in 2022 were caused by extensively drug-resistant strains. These strains are defined as those resistant to azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin.
While the CDC currently does not have recommendations for optimal antimicrobial treatment of these extensively drug-resistant infections, it has issued a possible strategy for clinical management based on a recent publication from the United Kingdom.
Specifically, the study recommends using oral pivmecillinam (which is not commercially available in the US) and fosfomycin (for patients with prolonged symptoms or as an oral step-down after intravenous [IV] treatment). For patients hospitalized with severe infections or complications, IV carbapenems and colistin are recommended. When possible, antimicrobial susceptibility testing should inform treatment selection, in addition to consultation with a specialist knowledgeable in antibiotic-resistant bacteria.
Health care providers are being asked to be vigilant about suspecting and reporting cases of extensively drug-resistant Shigella infection. Shigellosis should be considered in the differential diagnosis in patients with acute diarrhea who are highest risk for Shigella infection (eg, young children, men who have sex with men, people experiencing homelessness, international travelers, immunocompromised persons, and people living with HIV).
Reference
Increase in extensively drug-resistant shigellosis in the United States. US Centers for Disease Control and Prevention. Accessed February 24, 2023. https://emergency.cdc.gov/han/2023/han00486.asp.
