Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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

Anna BowenComments to Author , Julian Grass, Amelia Bicknese, Davina Campbell, Jacqueline Hurd, and Robert D. Kirkcaldy
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

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.

Main Article

References
  1. Scallan  E, Hoekstra  RM, Angulo  FJ, Tauxe  RV, Widdowson  MA, Roy  SL, Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis. 2011;17:7–15. DOIPubMedGoogle Scholar
  2. DuPont  HL, Levine  MM, Hornick  RB, Formal  SB. Inoculum size in shigellosis and implications for expected mode of transmission. J Infect Dis. 1989;159:1126–8. DOIPubMedGoogle Scholar
  3. Christopher  PR, David  KV, John  SM, Sankarapandian  V. Antibiotic therapy for Shigella dysentery. Cochrane Database Syst Rev. 2010; (8):CD006784.PubMedGoogle Scholar
  4. Kimberlin  DWBM, Jackson  MA, Long  SS, editors. Shigella infections. In: Red book: 2015 report of the Committee on Infectious Diseases. 30th ed. Elk Grove (IL): American Academy of Pediatrics; 2015. p. 706–9.
  5. Gilbert  DN, editor. Sanford guide to antimicrobial therapy. 45th ed. Sperryville (VA): Antimicrobial Therapy, Inc.; 2015.
  6. Serafino Wani  RL, Filson  SA, Chattaway  MA, Godbole  G. Invasive shigellosis in MSM. Int J STD AIDS. 2015;Oct 1:pii: 0956462415610275.PubMedGoogle Scholar
  7. Baker  KS, Dallman  TJ, Ashton  PM, Day  M, Hughes  G, Crook  PD, Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional study. Lancet Infect Dis. 2015;15:913–21. DOIPubMedGoogle Scholar
  8. Bowen  A, Eikmeier  D, Talley  P, Siston  A, Smith  S, Hurd  J, ; Centers for Disease Control and Prevention (CDC). Notes from the field: outbreaks of Shigella sonnei infection with decreased susceptibility to azithromycin among men who have sex with men—Chicago and metropolitan Minneapolis–St. Paul, 2014. MMWR Morb Mortal Wkly Rep. 2015;64:597–8.PubMedGoogle Scholar
  9. Bowen  A, Hurd  J, Hoover  C, Khachadourian  Y, Traphagen  E, Harvey  E, ; Centers for Disease Control and Prevention (CDC). Importation and domestic transmission of Shigella sonnei resistant to ciprofloxacin—United States, May 2014–February 2015. MMWR Morb Mortal Wkly Rep. 2015;64:318–20.PubMedGoogle Scholar
  10. Centers for Disease Control and Prevention. HAN 379: ciprofloxacin- and azithromycin-nonsusceptible shigellosis in the United States [cited 2016 Jan 20]. http://content.govdelivery.com/accounts/USCDC/bulletins/107d50c
  11. Centers for Disease Control and Prevention (CDC). Notes from the field: 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
  12. Chiou  CS, Izumiya  H, Kawamura  M, Liao  YS, Su  YS, Wu  HH, The worldwide spread of ciprofloxacin-resistant Shigella sonnei among HIV-infected men who have sex with men, Taiwan. Clin Microbiol Infect. 2016;22:383.e11–6. DOIPubMedGoogle Scholar
  13. Gaudreau  C, Barkati  S, Leduc  JM, Pilon  PA, Favreau  J, Bekal  S. Shigella spp. with reduced azithromycin susceptibility, Quebec, Canada, 2012–2013. Emerg Infect Dis. 2014;20:854–6. DOIPubMedGoogle Scholar
  14. 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;17:1747–50. DOIPubMedGoogle Scholar
  15. Heiman  KE, Karlsson  M, Grass  J, Howie  B, Kirkcaldy  RD, Mahon  B, ; Centers for Disease Control and Prevention (CDC). Notes from the field: Shigella with decreased susceptibility to azithromycin among men who have sex with men—United States, 2002–2013. MMWR Morb Mortal Wkly Rep. 2014;63:132–3.PubMedGoogle Scholar
  16. Hoffmann  C, Sahly  H, Jessen  A, Ingiliz  P, Stellbrink  HJ, Neifer  S, High rates of quinolone-resistant strains of Shigella sonnei in HIV-infected MSM. Infection. 2013;41:999–1003. DOIPubMedGoogle Scholar
  17. Lane  CR, Sutton  B, Valcanis  M, Kirk  M, Walker  C, Lalor  K, Travel destinations and sexual behavior as indicators of antibiotic resistant Shigella strains—Victoria, Australia. Clin Infect Dis. 2016;62:722–9. DOIPubMedGoogle Scholar
  18. Centers for Disease Control and Prevention. National Outbreak Reporting System [cited 2016 Feb 29]. http://www.cdc.gov/nors/
  19. Centers for Disease Control and Prevention. National surveillance of bacterial foodborne illness (enteric diseases) [cited 2016 Feb 29]. http://www.cdc.gov/nationalsurveillance/shigella-surveillance.html
  20. Centers for Disease Control and Prevention. National Notifiable Diseases Surveillance System (NNDSS) [cited 2016 Feb 29]. http://wwwn.cdc.gov/nndss/
  21. Centers for Disease Control and Prevention. Outbreak Response Team [cited 2016 Jan 20]. http://www.cdc.gov/ncezid/dfwed/orpb/ort.html
  22. Centers for Disease Control and Prevention. PulseNet [cited 2016 Feb 29]. http://www.cdc.gov/pulsenet/
  23. Centers for Disease Control and Prevention. National Antimicrobial Monitoring System for Enteric Bacteria (NARMS) [cited 2016 Feb 29]. http://www.cdc.gov/narms/index.html
  24. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Wayne (PA): The Institute; 2016.
  25. Iwamoto  M, Huang  JY, Cronquist  AB, Medus  C, Hurd  S, Zansky  S, ; Centers for Disease Control and Prevention (CDC). Bacterial enteric infections detected by culture-independent diagnostic tests—FoodNet, United States, 2012–2014. MMWR Morb Mortal Wkly Rep. 2015;64:252–7.PubMedGoogle Scholar
  26. Centers for Disease Control and Prevention. Shigella–shigellosis: prevention and control [cited 2016 Feb 29]. http://www.cdc.gov/shigella/prevention-control.html
  27. Centers for Disease Control and Prevention. Shigella infections among gay and bisexual men [cited 2016 Jan 29]. http://www.cdc.gov/shigella/msm.html

Main Article

Page created: August 16, 2016
Page updated: August 16, 2016
Page reviewed: August 16, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external