Volume 22, Number 9—September 2016
Research
Elevated Risk for Antimicrobial Drug–Resistant Shigella Infection among Men Who Have Sex with Men, United States, 2011–2015
Table 1
Clusters of shigellosis with resistance to CIP, CRO, or AZM, United States, January 2011–December 2015*
Cluster |
PFGE pattern† |
Shigella sp. |
Onset |
No. cases‡ |
No. states with cases |
Transmission route |
Median patient age, y |
Male sex, % |
No. isolates tested by NARMS |
No. isolates with resistance§ |
No. drug classes with resistance§ | Ref | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Penicillins,
AMP |
β-lactam inhibitors,
AMC |
Cephems |
TETs, TET | Aminoglycosides |
Quinolones |
Folate pathway inhibitors |
Phenicols, CHL | Macrolides, AZM | |||||||||||||||||||
FOX |
CEF |
CRO |
STR |
GEN |
NAL |
CIP |
SXZ |
TMP/SXT |
|||||||||||||||||||
With resistance to AZM, CRO, or CIP | |||||||||||||||||||||||||||
1 | J16X01.3056, J16X01.7056 | S. sonnei | 2012 Apr | 43 | 1 | Food (bridge club) | 87 | 57 | 4 | 0 | 0 | 0 | 0 | 0 | 4 | 4 | 0 | 0 | 0 | 4 | 4 | 0 | 4 | 4 | (11) | ||
2 | J16X01.1244, J16X01.0728, J16X01.0038 | S. sonnei | 2014 Apr | 128 | 16 | MSM | 38 | 83 | 14 | 11 | 0 | 3 | 3 | 3 | 11 | 14 | 0 | 0 | 0 | 12 | 12 | 0 | 10 | 6 | |||
3 | J16X01.0618 | S. sonnei | 2014 Apr | 7 | 6 | MSM | 36 | 100 | 4 | 3 | 0 | 0 | 0 | 0 | 4 | 4 | 0 | 0 | 0 | 4 | 4 | 0 | 3 | 5 | |||
4 | J16X01.0232, J16X01.0775 | S. sonnei | 2014 May | >300 | 34 | Person-to-person | 43 | 54 | 32 | 1 | 0 | 0 | 0 | 0 | 26 | 26 | 0 | 32 | 13 | 26 | 26 | 0 | 0 | 5 | (9) | ||
5 | J16X01.3176, J16X01.3056 | S. sonnei | 2014 Jul | 24 | 2 | MSM | 36 | 100 | 21 | 21 | 0 | 0 | 0 | 0 | 21 | 21 | 0 | 0 | 0 | 21 | 21 | 0 | 21 | 5 | (8) | ||
6 | J16X01.0232, J16X01.0775 | S. sonnei | 2014 Sep | 22 | 5 | MSM | 42 | 90 | 12 | 11 | 0 | 0 | 0 | 0 | 12 | 12 | 0 | 12 | 12 | 12 | 12 | 0 | 11 | 6 | (9, 10) | ||
7 | J16X01.0286, J16X01.3294 | S. sonnei | 2015 Mar | 12 | 7 | MSM | 37 | 100 | 2 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 2 | 2 | 1 | 1 | 0 | 0 | 4 | |||
8 | J16X01.1058, J16A26.0030 | S. sonnei | 2015 Apr | 41 | 9 | MSM | 26 | 85 | 7 | 6 | 0 | 0 | 6 | 5¶ | 1 | 7 | 0 | 0 | 0 | 7 | 7 | 0 | 6 | 6 | |||
9 |
JZXN11.0302 |
S. flexneri 4a (IV:-) |
2015 Aug |
6 |
3 |
MSM |
40 |
100 |
3 |
3 |
0 |
0 |
0 |
0 |
3 |
3 |
0 |
0 |
0 |
3 |
3 |
3 |
1 |
6 |
|||
Without resistance to AZM, CRO, or CIP | |||||||||||||||||||||||||||
10 | J16X01.0408, J16A26.0071 | S. sonnei | 2011 Jul | 16 | 1 | Recreational water | 9 | 44 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 3 | |||
11 | J16X01.1290 | S. sonnei | 2011 Sep | 61 | 1 | Person-to-person | 7 | 41 | 5 | 0 | 0 | 0 | 0 | 0 | 0 | 5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |||
12 | J16X01.0283, J16A26.0051 | S. sonnei | 2011 Nov | 12 | 2 | Food | 49 | 92 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 2 | |||
13 | J16X01.0559 | S. sonnei | 2012 Feb | 33 | 1 | Person-to-person | NA | NA | 3 | 3 | 0 | 0 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 3 | 3 | 0 | 0 | 3 | |||
14 | J16X01.0283, J16X01.0199 | S. sonnei | 2012 Mar | 18 | 1 | Person-to-person | 9 | 25 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | |||
15 | J16X01.1986, J16X01.0199, J16X01.2995 | S. sonnei | 2012 Jul | 100 | 1 | Person-to-person | 3 | NA | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |||
16 | J16X01.3073, J16X01.3072 | S. sonnei | 2012 Oct | 29 | 1 | Person-to-person | 8 | 46 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |||
17 | J16X01.2995 | S. sonnei | 2013 Mar | 13 | 1 | Person-to-person | 4 | 33 | 5 | 1 | 0 | 0 | 0 | 0 | 0 | 5 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 3 | |||
18 | J16X01.0408, J16X01.0981, J16X01.3218 | S. sonnei | 2013 Jul | 58 | 4 | Recreational water | 8 | 48 | 6 | 0 | 0 | 0 | 0 | 0 | 5 | 6 | 0 | 0 | 0 | 5 | 5 | 0 | 0 | 3 | |||
19 | J16X01.3157 | S. sonnei | 2014 Feb | 263 | 3 | Person-to-person | 7 | 48 | 19 | 2 | 1 | 0 | 0 | 0 | 3 | 19 | 0 | 0 | 0 | 4 | 7 | 0 | 0 | 4 | |||
20 | J16X01.1166 | S. sonnei | 2014 Mar | 9 | 1 | Food | 31 | 56 | 2 | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 0 | 0 | 0 | 2 | 2 | 0 | 0 | 3 | |||
21 | J16X01.2624 | S. sonnei | 2014 Jul | 8 | 3 | Food | 25 | 34 | 2 | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 0 | 0 | 0 | 2 | 2 | 0 | 0 | 3 | |||
22 | J16X01.0199, J16X01.0283 | S. sonnei | 2014 Jul | 335 | 26 | Person-to-person | 8 | 45 | 21 | 1 | 0 | 0 | 0 | 0 | 6 | 21 | 0 | 0 | 0 | 7 | 14 | 0 | 0 | 3 | |||
23 | J16X01.1166, J16X01.1148 | S. sonnei | 2014 Jul | 474 | 31 | Person-to-person | 8 | 42 | 59 | 7 | 0 | 0 | 0 | 0 | 2 | 59 | 0 | 1 | 0 | 3 | 4 | 0 | 0 | 3 | |||
24 | J16X01.2493, J16X01.0623 | S. sonnei | 2014 Sep | 30 | 5 | Food | 28 | 31 | 5 | 0 | 0 | 0 | 0 | 0 | 3 | 5 | 0 | 0 | 0 | 3 | 4 | 0 | 0 | 3 | |||
25 | J16X01.1254 | S. sonnei | 2014 Oct | 13 | 5 | Person-to-person | 17 | 45 | 4 | 3 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | |||
26 | J16X01.0437, J16X01.0466 | S. sonnei | 2014 Nov | 53 | 4 | Person-to-person | 9 | 51 | 5 | 0 | 0 | 0 | 0 | 0 | 1 | 3 | 0 | 0 | 0 | 1 | 3 | 0 | 0 | 3 | |||
27 | J16X01.1244 | S. sonnei | 2014 Jun | 6 | 1 | Food | 13 | 50 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 2 | |||
28 | J16X01.1166, J16X01.1148, J16X01.2427 | S. sonnei | 2015 May | 982 | 26 | Person-to-person | 7 | 44 | 42 | 16 | 0 | 0 | 0 | 0 | 3 | 42 | 0 | 0 | 0 | 3 | 5 | 0 | 0 | 3 | |||
29 | J16X01.1278 | S. sonnei | 2015 Jun | 34 | 3 | Person-to-person | 7 | 53 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |||
30 | J16X01.2261 | S. sonnei | 2015 Jun | 15 | 3 | Person-to-person | 4 | 38 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |||
31 | J16X01.1298 | S. sonnei | 2015 Jul | 15 | 4 | Person-to-person | 21 | 30 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 2 | |||
32 | ≈27 patterns | S. sonnei | 2015 Oct | 118 | 1 | Person-to-person | 26 | 50 | 7 | 0 | 0 | 0 | 0 | 0 | 3 | 7 | 0 | 0 | 0 | 3 | 4 | 0 | 0 | 3 |
*AMC, amoxicillin/clavulanic acid; AMP, ampicillin; AZM, azithromycin; CEF, ceftiofur; CHL, chloramphenicol; CIP, ciprofloxacin; CRO, ceftriaxone; FOX, cefoxitin; GEN, gentamycin; MSM, men who have sex with men; NAL, nalidixic acid; NARMS, National Antimicrobial Resistance Monitoring System for Enteric Bacteria; NA, not available; PFGE, pulsed-field gel electrophoresis; Ref, reference; STR, streptomycin; SXZ, sulfisoxazole; TET, tetracycline; TMP/SXT, trimethoprim/sulfamethoxazole. Blank cells indicate no previous reference, i.e., clusters that have not previously been published.
†PFGE was performed by PulseNet using enzyme XbaI for S. sonnei and NotI for S. flexneri (22).
‡Clusters 2, 6, and 8 had ongoing transmission as of December 2015.
§As defined by the Clinical and Laboratory Standards Institute; for AZM, resistance was defined as non–wild-type MICs (24).
¶Among 6 isolates tested.
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