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Locke RK, Greig DR, Jenkins C, Dallman TJ, Cowley LA. Acquisition and loss of CTX-M plasmids in Shigella species associated with MSM transmission in the UK. Microb Genom 2021; 7. [PMID: 34427554 PMCID: PMC8549364 DOI: 10.1099/mgen.0.000644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Shigellosis in men who have sex with men (MSM) is caused by multidrug resistant Shigellae, exhibiting resistance to antimicrobials including azithromycin, ciprofloxacin and more recently the third-generation cephalosporins. We sequenced four blaCTX-M-27-positive MSM Shigella isolates (2018–20) using Oxford Nanopore Technologies; three S. sonnei (identified as two MSM clade 2, one MSM clade 5) and one S. flexneri 3a, to explore AMR context. All S. sonnei isolates harboured Tn7/Int2 chromosomal integrons, whereas S. flexneri 3a contained the Shigella Resistance Locus. All strains harboured IncFII pKSR100-like plasmids (67-83kbp); where present blaCTX-M-27 was located on these plasmids flanked by IS26 and IS903B, however blaCTX-M-27 was lost in S. flexneri 3a during storage between Illumina and Nanopore sequencing. IncFII AMR regions were mosaic and likely reorganised by IS26; three of the four plasmids contained azithromycin-resistance genes erm(B) and mph(A) and one harboured the pKSR100 integron. Additionally, all S. sonnei isolates possessed a large IncB/O/K/Z plasmid, two of which carried aph(3’)-Ib/aph(6)-Id/sul2 and tet(A). Monitoring the transmission of mobile genetic elements with co-located AMR determinants is necessary to inform empirical treatment guidance and clinical management of MSM-associated shigellosis.
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Affiliation(s)
| | - David R Greig
- Gastrointestinal Reference Services, Public Health England, London, UK.,Division of Infection and Immunity, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, EH25 9RG, UK
| | - Claire Jenkins
- Gastrointestinal Reference Services, Public Health England, London, UK
| | - Tim J Dallman
- Gastrointestinal Reference Services, Public Health England, London, UK.,Division of Infection and Immunity, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, EH25 9RG, UK
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Sadouki Z, Day MR, Doumith M, Chattaway MA, Dallman TJ, Hopkins KL, Elson R, Woodford N, Godbole G, Jenkins C. Comparison of phenotypic and WGS-derived antimicrobial resistance profiles of Shigella sonnei isolated from cases of diarrhoeal disease in England and Wales, 2015. J Antimicrob Chemother 2018; 72:2496-2502. [PMID: 28591819 DOI: 10.1093/jac/dkx170] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/02/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives Phenotypic and genotypic methods for the detection of antimicrobial resistance (AMR) in Shigella sonnei in England and Wales were compared and evaluated. Methods WGS data from 341 isolates of S. sonnei isolated between June 2015 and January 2016 were mapped to genes known to be associated with phenotypic AMR. Antimicrobial susceptibility testing was performed on all viable isolates (n = 335). Results Fifteen of 335 isolates had a discrepancy between phenotypic and genotypic testing for 1 of the 10 antimicrobial classes tested, equating to 15 (0.45%) discordant results out of a possible 3350 isolate/antimicrobial combinations. All 15 mismatched results were genotypically resistant but phenotypically susceptible. Eleven of the 15 discrepancies were observed in streptomycin resistance profiles. The most common resistance profile was trimethoprim, sulphonamides, tetracyclines and streptomycin, occurring in 97 (28.4%) isolates. Resistances to ciprofloxacin and the third-generation cephalosporins, not detected in England and Wales prior to 2002, were identified in 18.2% and 12% of isolates, respectively. Three hundred and four (89.1%) isolates were MDR. There was no significant association between any of the AMR determinants tested and recent foreign travel in male or female cases. The number of isolates of S. sonnei harbouring blaTEM-1 and ermB/mphA was significantly higher in men who reported no recent travel outside the UK. Conclusions The use of WGS for routine public health surveillance is a reliable method for rapid detection of emerging AMR in isolates of S. sonnei.
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Affiliation(s)
- Zahra Sadouki
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.,Division of Infection & Immunity, University College London, Gower Street, London WC1E 6BT, UK
| | - Martin R Day
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Michel Doumith
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Marie A Chattaway
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Timothy J Dallman
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Katie L Hopkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Richard Elson
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Neil Woodford
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9?5EQ, UK
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Rubinstein E, Lagacé-Wiens P. Quinolones. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sousa MÂB, Mendes EN, Collares GB, Péret-Filho LA, Penna FJ, Magalhães PP. Shigella in Brazilian children with acute diarrhoea: prevalence, antimicrobial resistance and virulence genes. Mem Inst Oswaldo Cruz 2013; 108:30-5. [PMID: 23440111 PMCID: PMC3974317 DOI: 10.1590/s0074-02762013000100005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/22/2012] [Indexed: 11/30/2022] Open
Abstract
Diarrhoeal disease is still considered a major cause of morbidity and mortality among children. Among diarrhoeagenic agents, Shigella should be highlighted due to its prevalence and the severity of the associated disease. Here, we assessed Shigella prevalence, drug susceptibility and virulence factors. Faeces from 157 children with diarrhoea who sought treatment at the Children's Hospital João Paulo II, a reference children´s hospital in Belo Horizonte, state of Minas Gerais, Brazil, were cultured and drug susceptibility of the Shigella isolates was determined by the disk diffusion technique. Shigella virulence markers were identified by polymerase chain reaction. The bacterium was recovered from 10.8% of the children (88.2% Shigella sonnei). The ipaH, iuc, sen and ial genes were detected in strains isolated from all shigellosis patients; set1A was only detected in Shigella flexneri. Additionally, patients were infected by Shigella strains of different ial, sat, sen and set1A genotypes. Compared to previous studies, we observed a marked shift in the distribution of species from S. flexneri to S. sonnei and high rates of trimethoprim/sulfamethoxazole resistance.
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Affiliation(s)
- Mireille Ângela Bernardes Sousa
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Gu B, Cao Y, Pan S, Zhuang L, Yu R, Peng Z, Qian H, Wei Y, Zhao L, Liu G, Tong M. Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe-America and Asia-Africa from 1998 to 2009. Int J Antimicrob Agents 2012; 40:9-17. [PMID: 22483324 DOI: 10.1016/j.ijantimicag.2012.02.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/25/2011] [Accepted: 02/06/2012] [Indexed: 11/25/2022]
Abstract
Shigella is becoming an increasing public health problem due to development of multiple antimicrobial resistance, frequently resulting in treatment failure. A systematic review was conducted based on a literature search of computerised databases. Random or fixed-effects models were used, based on the P-value considering the possibility of heterogeneity between studies, for meta-analysis. Statistical analyses were performed using STATA 10.0. In the area of Asia-Africa, resistance rates to nalidixic acid and ciprofloxacin were 33.6% [95% confidence interval (CI) 21.8-46.6%] and 5.0% (95% CI 2.8-7.8%), respectively, 10.5 and 16.7 times those of Europe-America. Moreover, resistance to nalidixic acid and ciprofloxacin in Asia-Africa progressively increased each year, reaching 64.5% (95% CI 13.8-99.3%) and 29.1% (95% CI 0.9-74.8%), respectively, in 2007-2009, whilst isolates in Europe-America remained at low levels of resistance (<5.0% and <1.0%, respectively). All Shigella flexneri strains showed higher resistance than Shigella sonnei in Europe-America: overall, 3.5% (95% CI 1.4-6.4%) vs. 2.6% (95% CI 1.0-5.0%) resistant to nalidixic acid and 1.0% (95% CI 0.3-2.2%) vs. 0.1% (95% CI 0.0-0.3%) resistant to ciprofloxacin. In Asia-Africa, a similar trend was found for ciprofloxacin [3.0% (95% CI 1.4-5.3%) vs. 0.5% (95% CI 0.2-0.8%)], whereas the trend was reversed for nalidixic acid [32.6% (95% CI 14.5-53.9%) vs. 44.3% (95% CI 26.9-62.5%). In conclusion, quinolone resistance in Shigella has increased at an alarming speed, reinforcing the importance of continuous monitoring of antimicrobial resistance in Shigella.
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Affiliation(s)
- Bing Gu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road No. 300, Nanjing 210029, China
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Antimicrobial resistance among Salmonella and Shigella isolates in five Canadian provinces (1997 to 2000). CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 17:243-50. [PMID: 18382635 DOI: 10.1155/2006/980328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe rates of antimicrobial resistance (AMR) among Salmonella and Shigella isolates reported in five Canadian provinces, focusing on clinically important antimicrobials. METHODS The authors retrospectively investigated AMR rates among 6219 Salmonella and 1673 Shigella isolates submitted to provincial public health laboratories in Alberta, Newfoundland and Labrador, Ontario, Prince Edward Island and Saskatchewan from 1997 to 2000; these isolates were estimated to represent 41% of Salmonella cases and 72% of Shigella cases reported by the study provinces. RESULTS Among Salmonella isolates, 27% (1704 of 6215) were resistant to ampicillin, 2.2% (135 of 6122) to trimethoprim/ sulfamethoxazole, 1.5% (14 of 938) to nalidixic acid, 1.2% (one of 84) to lomafloxacin and 0.08% (five of 6163) to ciprofloxacin. Among Shigella isolates, 70% (1144 of 1643) were resistant to trimethoprim/sulfamethoxazole, 65% (1079 of 1672) to ampicillin, 3.1% (eight of 262) to nalidixic acid, 0.49% (eight of 1636) to ciprofloxacin, 0.14% (one of 700) to ceftriaxone and 0.08% (one of 1292) to ceftazidime. CONCLUSIONS Higher rates of resistance to clinically important antimicrobials (including ciprofloxacin) were observed among both Salmonella and Shigella isolates than has previously been reported. Current Canadian data on rates of AMR for these pathogens are required.
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Sihvonen LM, Toivonen S, Haukka K, Kuusi M, Skurnik M, Siitonen A. Multilocus variable-number tandem-repeat analysis, pulsed-field gel electrophoresis, and antimicrobial susceptibility patterns in discrimination of sporadic and outbreak-related strains of Yersinia enterocolitica. BMC Microbiol 2011; 11:42. [PMID: 21349206 PMCID: PMC3053224 DOI: 10.1186/1471-2180-11-42] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/25/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We assessed the potential of multilocus variable-number tandem-repeat analysis (MLVA), pulsed-field gel electrophoresis (PFGE), and antimicrobial susceptibility testing for discriminating 104 sporadic and outbreak-related Yersinia enterocolitica (YE) bio/serotype 3-4/O:3 and 2/O:9 isolates. MLVA using six VNTR markers was performed in two separate multiplex PCRs, and the fluorescently labeled PCR products were accurately sized on an automated DNA sequencer. RESULTS MLVA discriminated 82 sporadic YE 3-4/O:3 and 2/O:9 strains into 77 types, whereas PFGE with the restriction enzyme NotI discriminated the strains into 23 different PFGE pulsotypes. The discriminatory index for a sporadic strain was 0.862 for PFGE and 0.999 for MLVA. MLVA confirmed that a foodborne outbreak in the city of Kotka, Finland in 2003 had been caused by a multiresistant YE 4/O:3 strain that was distinctly different from those of epidemiologically unrelated strains with an identical PFGE pulsotype. The multiresistance of Y. enterocolitica strains (19% of the sporadic strains) correlated significantly (p = 0.002) with travel abroad. All of the multiresistant Y. enterocolitica strains belonged to four PFGE pulsotypes that did not contain any susceptible strains. Resistance to nalidixic acid was related to changes in codons 83 or 87 that stemmed from mutations in the gyrA gene. The conjugation experiments demonstrated that resistance to CHL, STR, and SUL was carried by a conjugative plasmid. CONCLUSIONS MLVA using six loci had better discriminatory power than PFGE with the NotI enzyme. MLVA was also a less labor-intensive method than PFGE and the results were easier to analyze. The conjugation experiments demonstrated that a resistance plasmid can easily be transferred between Y. enterocolitica strains. Antimicrobial multiresistance of Y. enterocolitica strains was significantly associated with travel abroad.
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Affiliation(s)
- Leila M Sihvonen
- Department of Infectious Disease Surveillance and Control, Bacteriology Unit, National Institute for Health and Welfare (THL), Helsinki, FI-00271, Finland
| | - Susanna Toivonen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, FI-00014, Finland
| | - Kaisa Haukka
- Department of Infectious Disease Surveillance and Control, Bacteriology Unit, National Institute for Health and Welfare (THL), Helsinki, FI-00271, Finland
| | - Markku Kuusi
- Department of Infectious Disease Surveillance and Control, Epidemiological Surveillance and Response Unit, National Institute for Health and Welfare (THL), Helsinki, FI-00271, Finland
| | - Mikael Skurnik
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, FI-00014, Finland
- Helsinki University Central Hospital Laboratory Diagnostics, Helsinki, Finland
| | - Anja Siitonen
- Department of Infectious Disease Surveillance and Control, Bacteriology Unit, National Institute for Health and Welfare (THL), Helsinki, FI-00271, Finland
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Howe R, Williams E. Quinolones. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Comparative in vitro activity of tigecycline and other antimicrobial agents against Shigella species from Kuwait and the United Arab of Emirates. J Infect Public Health 2010; 3:35-42. [DOI: 10.1016/j.jiph.2009.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/14/2009] [Accepted: 10/18/2009] [Indexed: 11/21/2022] Open
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Izumiya H, Tada Y, Ito K, Morita-Ishihara T, Ohnishi M, Terajima J, Watanabe H. Characterization of Shigella sonnei isolates from travel-associated cases in Japan. J Med Microbiol 2009; 58:1486-1491. [PMID: 19589900 DOI: 10.1099/jmm.0.011809-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Shigella sonnei infection in industrialized countries is often associated with foreign travel. A total of 195 S. sonnei isolates in Japan, isolated from cases associated with foreign travel, were analysed by biotyping and molecular typing using PFGE and multilocus variable-number tandem-repeat analysis (MLVA); their antimicrobial susceptibilities were also evaluated. The isolates were from 26 countries, most of which were Asian. Molecular typing revealed a correlation among the genotypes, biotypes and their geographical areas of origin. The isolates were classified into two biotypes, a and g. Biotype g isolates (n=178) were further divided into distinct clusters mainly on the basis of their geographical areas of origin by both PFGE and MLVA. Isolates from South Asian countries constituted one of the distinct clusters. Biotype g isolates from countries other than South Asia constituted other distinct clusters. Most of the isolates from other countries and continents, excluding the South Asian countries, were included in one major cluster by PFGE analysis. However, by MLVA, they were further divided into minor subclusters mainly on the basis of their countries of origin. MLVA was also demonstrated to be useful in molecular epidemiological analysis, even when only seven loci were applied, resulting in a high resolution with Simpson's index of diversity (D) of 0.993. A core drug-resistance pattern of streptomycin, sulfisoxazole, tetracycline and trimethoprim-sulfamethoxazole was observed in 108 isolates, irrespective of their geographical areas of origin, but the frequency of resistance to nalidixic acid was high among the South Asian and East Asian isolates. Two isolates from China and India were resistant to cefotaxime and harboured the bla(CTX-M-14) and bla(CTX-M-15) genes, respectively; these isolates were also resistant to nalidixic acid, which is a matter of concern in terms of shigellosis treatment. Use of a combination of methods was found to be effective for epidemiological investigation in the case of S. sonnei infection.
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Affiliation(s)
- Hidemasa Izumiya
- Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuki Tada
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kenichiro Ito
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Makoto Ohnishi
- Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Jun Terajima
- Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Haruo Watanabe
- Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
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Foodborne antimicrobial resistance as a biological hazard - Scientific Opinion of the Panel on Biological Hazards. EFSA J 2008. [DOI: 10.2903/j.efsa.2008.765] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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HAUKKA K, SIITONEN A. Emerging resistance to newer antimicrobial agents among Shigella isolated from Finnish foreign travellers. Epidemiol Infect 2007; 136:476-82. [PMID: 17578602 PMCID: PMC2870835 DOI: 10.1017/s0950268807008862] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In Finland, most cases of shigellosis are related to travel abroad. Antimicrobial drug resistance of 1814 Shigella strains isolated from Finnish patients during 1990-2005 was studied using discs of 12 antimicrobial agents. Since 2000, the E-test has been performed to determine ciprofloxacin minimum inhibitory concentrations of nalidixic acid-resistant isolates. The proportion of multi-resistant strains (resistant to >or =4 antimicrobials) was highest among isolates from China and India, but is increasing significantly in other parts of Asia. Resistance to nalidixic acid has become common among the strains from the Far East, and the first isolates also resistant to ciprofloxacin were detected during 2004-2005. All the ciprofloxacin-resistant isolates belonged to the S. flexneri 2a serotype. All the nalidixic acid-resistant S. flexneri strains had reduced susceptibility to ciprofloxacin, whereas 23% of the nalidixic acid-resistant S. sonnei strains were still completely susceptible to ciprofloxacin.
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Affiliation(s)
- K. HAUKKA
- Enteric Bacteria Laboratory, Department of Bacterial and Inflammatory Diseases, National Public Health Institute (KTL), Helsinki, Finland
| | - A. SIITONEN
- Enteric Bacteria Laboratory, Department of Bacterial and Inflammatory Diseases, National Public Health Institute (KTL), Helsinki, Finland
- Author for correspondence: Professor A. Siitonen, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. ()
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Sivapalasingam S, Nelson JM, Joyce K, Hoekstra M, Angulo FJ, Mintz ED. High prevalence of antimicrobial resistance among Shigella isolates in the United States tested by the National Antimicrobial Resistance Monitoring System from 1999 to 2002. Antimicrob Agents Chemother 2006; 50:49-54. [PMID: 16377666 PMCID: PMC1346809 DOI: 10.1128/aac.50.1.49-54.2006] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Shigella spp. infect approximately 450,000 persons annually in the United States, resulting in over 6,000 hospitalizations. Since 1999, the National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria has tested every 10th Shigella isolate from 16 state or local public health laboratories for susceptibility to 15 antimicrobial agents. From 1999 to 2002, NARMS tested 1,604 isolates. Among 1,598 isolates identified to species level, 1,278 (80%) were Shigella sonnei, 295 (18%) were Shigella flexneri, 18 (1%) were Shigella boydii, and 7 (0.4%) were Shigella dysenteriae. Overall, 1,251 (78%) were resistant to ampicillin and 744 (46%) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Prevalence of TMP-SMX- or ampicillin- and TMP-SMX-resistant Shigella sonnei isolates varied by geographic region, with lower rates in the South and Midwest regions (TMP-SMX resistance, 27% and 30%, respectively; ampicillin and TMP-SMX resistance, 25% and 22%, respectively) and higher rates in the East and West regions (TMP-SMX resistance, 66% and 80%, respectively; ampicillin and TMP-SMX resistance, 54% and 65%, respectively). Nineteen isolates (1%) were resistant to nalidixic acid (1% of S. sonnei and 2% of S. flexneri isolates); 12 (63%) of these isolates had decreased susceptibility to ciprofloxacin. One S. flexneri isolate was resistant to ciprofloxacin. All isolates were susceptible to ceftriaxone. Since 1986, resistance to ampicillin and TMP-SMX has dramatically increased. Shigella isolates in the United States remain susceptible to ciprofloxacin and ceftriaxone.
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Affiliation(s)
- Sumathi Sivapalasingam
- Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Abstract
PURPOSE OF REVIEW Inherited marrow failure syndromes (IMFSs) are rare genetic diseases with varying degrees of cytopenia. Many of the syndromes are also characterized by nonhematological manifestations and a high risk of cancer. This review summarizes recent advances in understanding the genetic background of the common IMFSs. RECENT FINDINGS Over recent years, numerous known and novel genes have been found to be associated with IMFSs. Although the functions of the proteins are largely unknown, they are postulated to play critical roles in fundamental cellular processes such as DNA repair, telomere maintenance, RNA metabolism, ribosomal biogenesis, growth-factor-signaling pathways and cell survival. For example, the telomere-related genes, DKC1 and TERC, have been identified as causes of dyskeratosis congenita. Also, homozygosity for the common cancer-associated gene, BRCA2, has been found to cause a rare subtype of Fanconi anemia. SUMMARY The knowledge of the genetics of IMFSs has started to be translated into clinical practice. The identification of IMFS-related genes provided new diagnostic tools and better classification of the various disorders. Also, these advances enabled the design of clinical trials using gene therapy and preimplantation genetic diagnosis followed by in-vitro fertilization for selection of suitable embryos for hematopoietic stem-cell transplantation.
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Affiliation(s)
- Kathryn Edwards
- Division of Infectious Diseases, CCC-5323 Medical Center North, Vanderbilt University Medical Center, Nashville, Tennessee 37223, USA.
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Abstract
Historically, healthcare providers have reluctantly used systemic quinolone antibiotics to treat infections in children when they have been used at all. Concerns regarding the oral or parenteral use of quinolones in children rose from research observations demonstrating cartilage and joint toxicity in juvenile animal models following the administration of this class of antibiotics to immature animals. A voluntary moratorium on the use of quinolone and fluoroquinolone antibiotics in children resulted in restricting their use to treat in infections in specific settings such as immunocompromised states due to chemotherapy, pseudomonas infections in cystic fibrosis patients, complicated urinary tract infections, and quinolone sensitive infectious disease where parenteral antibiotic administration is not available and quinolones were the only effective therapy. This article aims to review retrospective and prospective safety and efficacy data to provide a comprehensive summary of the systemic use of this class of antibiotics in children.
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Affiliation(s)
- Richard W Grady
- Children's Hospital & Regional Medical Center, The University of Washington Medical Center, 4800 Sandpoint Way, NE, Seattle, WA 98115, USA.
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