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Co-circulation of Multidrug-resistant Shigella Among Men Who Have Sex With Men in Australia.
- Source :
-
Clinical Infectious Diseases . Nov2019, Vol. 69 Issue 9, p1535-1544. 10p. - Publication Year :
- 2019
-
Abstract
- Background In urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages. Methods A population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews. Results Rates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigella sonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates. Conclusions Our contemporary data highlight the ongoing public health threat posed by resistant Shigella , both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection. [ABSTRACT FROM AUTHOR]
- Subjects :
- *PREVENTION of sexually transmitted diseases
*ANTI-infective agents
*CIPROFLOXACIN
*DRUG resistance in microorganisms
*DRUG utilization
*GENOMES
*INTERVIEWING
*MULTIDRUG resistance
*GENETIC mutation
*ORAL drug administration
*PHYLOGENY
*PUBLIC health
*PUBLIC health surveillance
*SHIGELLA
*SULFAMETHOXAZOLE
*TRIMETHOPRIM
*BIOINFORMATICS
*GENOMICS
*AZITHROMYCIN
*MEN who have sex with men
*SEQUENCE analysis
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 69
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 139164316
- Full Text :
- https://doi.org/10.1093/cid/ciz005