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CC BY-NC-ND 4.0 · J Lab Physicians 2018; 10(02): 140-144
DOI: 10.4103/JLP.JLP_93_17
Original Article

Antibiotic susceptibility pattern of Shigella isolates in a tertiary healthcare center

Anitha Madhavan
Department of Microbiology, Government TD Medical College, Alappuzha, Kerala, India
,
Sobha Balakrishnan
Department of Microbiology, Government TD Medical College, Alappuzha, Kerala, India
,
Jayalakshmi Vasudevapanicker
Department of Microbiology, Government TD Medical College, Alappuzha, Kerala, India
› Author Affiliations Financial support and sponsorship Nil.
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ABSTRACT

BACKGROUND AND OBJECTIVES: Shigellosis is one of the most common causes of morbidity and mortality in children in developing countries. To the best of our knowledge, there is no published data in the study area on the antimicrobial susceptibility pattern and prevalence of Shigella species among diarrheagenic cases. Therefore, a retrospective analysis was done to find the Shigella serotypes, common age group affected, and antimicrobial resistance pattern of Shigella isolates in South Kerala

METHODS: Stool samples collected from cases of dysentery and diarrhea from January 2011 to December 2016 were processed. Standard bacteriological methods were used to isolate, identify, and determine the antimicrobial susceptibility pattern of Shigella isolates. The data were analyzed using SPSS version 16.

RESULTS: Among 1585 stool samples, 48(3%) yielded Shigella . The most common serogroup isolated was Shigella sonnei (62.5%) followed by Shigella flexneri. Of 48 isolates, 44(91.6%) isolates were found to be multidrug resistant. Over the 5-year period, the isolates show 100% resistance to nalidixic acid, ciprofloxacin, and cotrimoxazole. Eight isolates were found to be resistant to ceftriaxone and cefotaxime. The presence of Extended spectrum betalactamase (ESBL) was phenotypically confirmed in five isolates.

CONCLUSION: Even though S. flexneri is the most common Shigella-causing diarrhea, S. sonnei was found to be the most important species responsible in our study. Multidrug resistance was common (91.6%) and the most common multidrug resistance profile was ampicillin-nalidixic acid-cotrimoxazole-ciprofloxacin. Regular monitoring of antibiotic susceptibility pattern including detection of beta lactamases should be done in all microbiology laboratories. Guidelines for therapy should be monitored and modified based on regional susceptibility reports.

Key words

Antibiotic susceptibility pattern - multidrug resistance - retrospective analysis - Shigella dysentery


Publication History

Received: 21 May 2017

Accepted: 21 August 2017

Article published online:
19 February 2020

© 2018.

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  • REFERENCES

  • 1 Kotloff KL, Winickoff JP, Ivanoff B, Clemens JD, Swerdlow DL, Sansonetti PJ, et al. Global burden of Shigella infections: Implications for vaccine development and implementation of control strategies. Bull World Health Organ 1999;77:651-66.
  • 2 Niyogi SK. Shigellosis. J Microbiol 2005;43:133-43.
  • 3 Kuo CY, Su LH, Perera J, Carlos C, Tan BH, Kumarasinghe G, et al. Antimicrobial susceptibility of Shigella isolates in eight Asian countries, 2001-2004. J Microbiol Immunol Infect 2008;41:107-11.
  • 4 Nüesch-Inderbinen M, Heini N, Zurfluh K, Althaus D, Hächler H, Stephan R, et al. Shigella antimicrobial drug resistance mechanisms, 2004-2014. Emerg Infect Dis 2016;22:1083-5.
  • 5 Ananthanarayanan R. Ananthanarayanan and Panikers Textbook of Microbiology. 9th ed. Himayatnagar, Hyderabad: University Press; 2013. p. 288.
  • 6 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: 21st Informational Supplement M100-S21. Vol. 31. Wayne, PA: CLSI; 2011. p. 48.
  • 7 Taneja N, Mewara A, Kumar A, Verma G, Sharma M. Cephalosporin-resistant Shigella flexneri over 9 years (2001-2009) in India. J Antimicrob Chemother 2012;67:1347-53.
  • 8 Taneja N. Changing epidemiology of shigellosis and emergence of ciprofloxacin-resistant Shigellae in India. J Clin Microbiol 2007;45:678-9.
  • 9 Nair GB, Ramamurthy T, Bhattacharya MK, Krishnan T, Ganguly S, Saha DR, et al. Emerging trends in the etiology of enteric pathogens as evidenced from an active surveillance of hospitalized diarrhoeal patients in Kolkata, India. Gut Pathog 2010;2:4.
  • 10 Yismaw G, Negeri C, Kassu A. A five-year antimicrobial resistance pattern of Shigella isolated from stools in the Gondar University Hospital, Northwest Ethiopia. Trop Doct 2008;38:43-5.
  • 11 Mandal J, Ganesh V, Emelda J, Mahadevan S, Parija SC. The recent trends of shigellosis: A JIPMER perspective. J Clin Diagn Res 2012;6:1474-7.
  • 12 Ballal M, Devadas SM, Chakraborty R, Shetty V. Emerging trends in the etiology and antimicrobial susceptibility pattern of enteric pathogens in rural Coastal India. Int J Clin Med 2014;5:425-32.
  • 13 Tejashree A, Vijaykumar GS, Rao R, Mahale RP, Gopalakrishnan R, Ponna Y. Spectrum of enteric pathogens in a tertiary hospital. Transworld Med J 2013;1:69-73.
  • 14 von Seidlein L, Kim DR, Ali M, Lee H, Wang X, Thiem VD, et al. Amulticentre study of Shigella diarrhoea in six Asian countries: Disease burden, clinical manifestations, and microbiology. PLoS Med 2006;3:e353.
  • 15 Vinh H, Nhu NT, Nga TV, Duy PT, Campbell JI, Hoang NV, et al. Achanging picture of shigellosis in Southern Vietnam: Shifting species dominance, antimicrobial susceptibility and clinical presentation. BMC Infect Dis 2009;9:204.
  • 16 World Health Organization. Guidelines for the Control of Shigellosis, Including Epidemics due to Shigella dysenteriae type 1. WHO Document Production Services. Geneva, Switzerland: World Health Organization; 2005. p. 11-3.
  • 17 Nandy S, Mitra U, Rajendran K, Dutta P, Dutta S. Subtype prevalence, plasmid profiles and growing fluoroquinolone resistance in Shigella from Kolkata, India (2001-2007): A hospital-based study. Trop Med Int Health 2010;15:1499-507.
  • 18 Bhattacharya D, Sugunan AP, Bhattacharjee H, Thamizhmani R, Sayi DS, Thanasekaran K, et al. Antimicrobial resistance in Shigella – Rapid increase and widening of spectrum in Andaman Islands, India. Indian J Med Res 2012;135:365-70.
  • 19 Kumar A, Oberoi A, Alexander VS. Prevalence and antimicrobial susceptibility patterns of Shigella in stool samples in a tertiary healthcare hospital of Punjab. CHRISMED J Health Res 2014;1:33-5.
  • 20 Nath R, Saikia L, Choudhury G, Sharma D. Drug resistant Shigella flexneri in and around Dibrugarh, North-East India. Indian J Med Res 2013;137:183-6.
  • 21 Ashkenazi S, May-Zahav M, Dinari G, Gabbay U, Zilberberg R, Samra Z, et al. Recent trends in the epidemiology of Shigella species in Israel. Clin Infect Dis 1993;17:897-9.
  • 22 Thompson CN, Thieu NT, Vinh PV, Duc AN, Wolbers M, Vinh H, et al. Clinical implications of reduced susceptibility to fluoroquinolones in paediatric Shigella sonnei and Shigella flexneri infections. J Antimicrob Chemother 2016;71:807-15.
  • 23 Varghese SR, Aggarwal A. Extended spectrum beta-lactamase production in Shigella isolates – A matter of concern. Indian J Med Microbiol 2011;29:76-8.
  • 24 Rahman M, Shoma S, Rashid H, Siddique AK, Nair GB, Sack DA, et al. Extended-spectrum beta-lactamase-mediated third-generation cephalosporin resistance in Shigella isolates in Bangladesh. J Antimicrob Chemother 2004;54:846-7.
  • 25 Khan WA, Seas C, Dhar U, Salam MA, Bennish ML. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med 1997;126:697-703.