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Volume 20, Number 5—May 2014

Shigella spp. with Reduced Azithromycin Susceptibility, Quebec, Canada, 2012–2013

Christiane GaudreauComments to Author , Sapha Barkati, Jean-Michel Leduc, Pierre A. Pilon, Julie Favreau, and Sadjia Bekal
Author affiliations: Centre Hospitalier de l’Université de Montréal–Hôpital Saint-Luc, Montreal, Quebec, Canada (C. Gaudreau, S. Barkati, J.-M. Leduc, J. Favreau); Université de Montréal, Montreal (C. Gaudreau, S. Barkati, J.-M. Leduc, P.A. Pilon, S. Bekal); Agence de la Santé et des Services Sociaux de Montréal-Santé Publique, Montreal (P.A. Pilon); Laboratoire de Santé Publique du Québec/Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada (C. Gaudreau, S. Bekal)

Main Article

Table 2

Characteristics and antimicrobial susceptibility of 4 Shigella isolates with reduced azithromycin susceptibility, Montreal, Quebec, Canada, January 2012–April 2013*

Shigella species ST PV† AZM, mg/L‡ AMP, mg/L TMP/SMX, mg/L CIP
mg/L CRO,
 mg/L TET, mg/L CHL, mg/L NAL mm
S. flexneri 2a 15 256 <2 (S) >320 (R) 0.016 <1 >128 0.5 (S) 27
S. flexneri 2a 16 64 >32 (R) >320 (R) 0.016 <1 >128 128 (R) 27
S. flexneri 3a 6 >256 >32 (R) <20 (S) 0.016 <1 >128 >256 (R) 24–28
S. sonnei 101,105§ >256 >32 (R) >320 (R) 0.016 <1 >128 >256 (R) 23–27

*The susceptibility and resistance break points for AMP, CIP, TMP/SMX, CRO, TET, CHL, and NAL were Clinical and Laboratory Standards Institute Enterobacteriaceae break points (12). ST, serotype; PV, pulsovar; AZM, azithromycin; AMP, ampicillin; TMP/SMX, trimethoprim/sulfamethoxazole; CIP, ciprofloxacin; CRO, ceftriaxone; TET, tetracycline; CHL, chloramphenicol; NAL, nalidixic acid; S, susceptible; R: resistant; –, not applicable.
†PV was determined by XbaI and BlnI pulsed-field gel electrophoresis patterns.
‡The criterion for elevated azithro MIC was >16 mg/L (13).
§S. sonnei PVs 101 and 105 were related and had 2 different pulsed-field gel electrophoresis bands.

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  1. DuPont  HL. Shigella species (bacillary dysentery). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases, 7th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 2905–10.
  2. Gaudreau  C, Bruneau  A, Ismaïl  J. Outbreak of Shigella flexneri and Shigella sonnei enterocolitis in men who have sex with men, Québec, 1999 to 2001. Can Commun Dis Rep. 2005;31:8590 .PubMedGoogle Scholar
  3. Gaudreau  C, Ratnayake  R, Pilon  PA, Gagnon  S, Roger  M, Lévesque  S. Ciprofloxacin-resistant Shigella sonnei among men who have sex with men, Canada, 2010. Emerg Infect Dis. 2011;17:174750 . DOIPubMedGoogle Scholar
  4. American Academy of Pediatrics. Shigella infections. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red book, 2012 Report of the Committee on Infectious Diseases, 29th ed. Elk Grove Village (IL): The Academy; 2012. p. 645–7.
  5. World Health Organization. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1. Geneva: The Organization; 2005.
  6. Khan  WA, Seas  C, Dhar  U, Salam  MA, Bennish  ML. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. Ann Intern Med. 1997;126:697703. DOIPubMedGoogle Scholar
  7. Howie  RL, Folster  JP, Bowen  A, Barzilay  EJ, Whichard  JM. Reduced azithromycin susceptibility in Shigella sonnei, United States. Microb Drug Resist. 2010;16:2458. DOIPubMedGoogle Scholar
  8. Nataro  JP, Bopp  CA, Fields  PI, Kaper  JB, Strockbine  NA. Escherichia, Shigella, and Salmonella. In: Versalovic J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, editors. Manual of clinical microbiology, 10th ed. Washington (DC): American Society for Microbiology; 2011. p. 603–26.
  9. Ewing  WH. The genus Shigella. In: Ewing W, Edwards PR, editors. Edwards and Ewing’s identification of Enterobacteriaceae, 4th ed. New York: Elsevier Scientific Publishing Co., Inc.; 1986. p. 135–72.
  10. Ribot  EM, Fair  MA, Gautom  R, Cameron  DN, Hunter  SB, Swaminathan  B, Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella and Shigella for PulseNet. Foodborne Pathog Dis. 2006;3:5967. DOIPubMedGoogle Scholar
  11. Ojo  KK, Ulep  C, Van Kirk  N, Luis  H, Bernardo  M, Leitao  J, The mef(A) gene predominates among seven macrolide resistance genes identified in gram-negative strains representing 13 genera, isolated from healthy Portuguese children. Antimicrob Agents Chemother. 2004;48:34516. DOIPubMedGoogle Scholar
  12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 23th informational suppplement; no. M100–S23, vol. 33, no. 1. Wayne (PA): The Institute; 2013.
  13. Sjölund Karlsson  M, Bowen  A, Reporter  R, Folster  JP, Grass  JE, Howie  RL, Outbreak of infections caused by Shigella sonnei with reduced susceptibility to azithromycin in the United States. Antimicrob Agents Chemother. 2013;57:155960. DOIPubMedGoogle Scholar
  14. Boumghar-Bourtchai  L, Mariani-Kurkdjian  P, Bingen  E, Filliol  I, Dhalluin  A, Ifrane  SA, Macrolide-resistant Shigella sonnei. Emerg Infect Dis. 2008;14:12979. DOIPubMedGoogle Scholar
  15. Centers for Disease Control and Prevention. Outbreak of infections caused by Shigella sonnei with decreased susceptibility to azithromycin—Los Angeles, California, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:171 .PubMedGoogle Scholar

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Page updated: April 17, 2014
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