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Last Friday the CDC released a HAN (Health Alert Network) Advisory (see below) on the recent rise in Extensively-Drug-Resistant Shigellosis in the United States. Today, about 1 in 20 Shigella infections in the United States is classified as XDR, while a decade ago, it was virtually unheard of.
Increase in Extensively Drug-Resistant Shigellosis in the United States
Distributed via the CDC Health Alert Network
February 24, 2023, 11:30 AM ET
CDCHAN-00486
Summary
The Centers for Disease Control and Prevention (CDC) has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems [1]. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains, compared with 0% in 2015. Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible. XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission.
Shigellosis is an acute enteric infection that is an important cause of domestically acquired and travel-associated bacterial diarrhea in the United States. Shigellosis usually causes inflammatory diarrhea that can be bloody and may also lead to fever, abdominal cramping, and tenesmus. Infections are generally self-limiting; however, antimicrobial treatment may be indicated to prevent complications or shorten the duration of illness [2]. CDC defines XDR Shigella bacteria as strains that are resistant to all commonly recommended empiric and alternative antibiotics — azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin.
Currently, there are no data from clinical studies of treatment of XDR Shigella to inform recommendations for the optimal antimicrobial treatment of these infections. As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR Shigella infections.
Later today the CDC will hold an online COCA Call for clinicians on this growing concern. These presentations are often technical, and are of greatest interest to clinicians and healthcare providers, but also may be of interest to the general public.
As always, If you are unable to attend the live presentation, these (and past) webinars are archived and available for later viewing at this LINK.
Epidemiology, Testing, and Management of Extensively Drug-Resistant Shigellosis
Overview
The Centers for Disease Control and Prevention (CDC) has detected an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems. XDR shigellosis is resistant to all generally recommended antibiotics in the United States, making it difficult to treat. XDR shigellosis is a serious public health threat: XDR Shigella bacteria have limited antimicrobial treatment options, are easily transmissible, and can spread antimicrobial resistance genes to other enteric bacteria. Clinicians should understand the nuances of testing and managing infections, especially when treating patients from populations at increased risk of drug-resistant shigellosis including: young children; gay, bisexual, and other men who have sex with men; people experiencing homelessness; international travelers; and people living with HIV.
During this COCA Call, subject matter experts from CDC, the Colorado Department of Public Health and Environment, and the UK Health Security Agency will provide updates on the current domestic and global epidemiology of XDR shigellosis, discuss its relevance for clinicians in the United States, describe infection presentation, explain the importance of having a detailed sexual and travel history, share approaches for clinical management, and review how clinicians should test and report shigellosis.
Presenters
Naeemah Logan, MD
LCDR, U.S. Public Health Service
Medical Officer
National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) Team
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Meseret Birhane, MPH, MAS
Surveillance Epidemiologist
National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) Team
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Louise Francois Watkins, MD, MPH
Medical Officer
National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) Team
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Laura Hinkle Bachmann, MD, MPH, FIDSA, FACP
Chief Medical Officer
Division of STD Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Rachel Jervis, MPH
Program Manager
Foodborne, Enteric, Waterborne, and Wastewater Diseases Program
Colorado Department of Public Health and Environment
Gauri Godbole, MD, FRCPath
Consultant Medical Microbiologist
UK Health Security Agency
Hannah Charles, MSc, DFPH
Senior Epidemiologist
UK Health Security Agency
Call Materials
Materials will be available prior to the webinar.
Call Details
When:
Tuesday, February 28, 2023,
2:00 PM – 3:00 PM ET
Webinar Link:
https://www.zoomgov.com/j/1609840852
Webinar ID: 160 984 0852
Passcode: 204251
Telephone:
US: +1 669 254 5252 or +1 646 828 7666
or
+1 646 964 1167 or +1 669 216 1590
or
+1 415 449 4000 or +1 551 285 1373
One-tap mobile:
US: +16692545252,,1609840852#,,,,*204251#
or +16468287666,,1609840852#,,,,*
