The Centers for Disease Control and Prevention (CDC) have issued a warning to healthcare professionals and the public regarding an increase in the number of cases of Shigella, a highly contagious bacteria that causes an infection known as shigellosis. The new forms of this bacteria are extensively drug-resistant (XDR) and are resistant to all five of the antimicrobial treatments typically used. According to Dr. Louise Francois Watkins, a medical officer at the CDC, these new forms of Shigella were never seen before 2016 and have been increasing in prevalence ever since.
Dr. Francois Watkins further explained that most Shigella strains are resistant to one or some of the drugs, but not all five, making these new XDR strains a serious concern. While the new strains remain relatively uncommon, the risk to the general public is low. However, the CDC wants to ensure that people are aware of the issue, so infected individuals can receive proper medical care. Treatment of shigellosis typically includes bed rest and plenty of fluids, along with antibiotics for non-XDR strains. However, because of limited data, the CDC does not yet have official alternative recommendations for treating XDR strains.
According to the CDC’s health alert, approximately 450,000 cases of Shigella infections are reported annually, and none were caused by extensively drug-resistant strains in 2015. However, in 2022, about 5% of the cases were caused by XDR strains. The XDR form of the bacteria is more prevalent among adults than children, with the CDC finding most cases of XDR Shigella among men who have sex with men, people experiencing homelessness, international travelers, and people living with HIV.
“XDR Shigella has a real, alarming capacity to spread globally, especially among these vulnerable populations,” says Dr. Naeemah Logan, a CDC medical officer. Other strains of Shigella are also becoming increasingly drug-resistant, and there are concerns that the bacteria’s drug-resistant gene mutations could jump to other bacteria, such as E. coli.
Dr. Francois Watkins notes that the problem of antimicrobial resistance is bigger than Shigella, and one of the main drivers of antibiotic resistance is inappropriate antibiotic use. People should only take antibiotics as prescribed, she advises. In addition to using antibiotics appropriately, handwashing and sanitizing are the most important measures people can take to protect themselves from Shigella. People who are sexually active should also wash sex toys and themselves with soap and water before and after sex. People who have diarrhea should avoid swimming pools and water parks, and they should avoid having sex for two weeks after symptoms resolve.
While shigellosis usually goes away without antibiotic treatment, it can cause prolonged illness, with approximately 6,400 patients in the U.S. requiring hospitalization each year. Doctors prescribe antibiotics to speed up recovery, prevent transmission, or avoid complications in vulnerable patients, such as those who are immunocompromised. However, this option is not available for the XDR strains.
In summary, the emergence of extensively drug-resistant Shigella is a serious public health concern, and the CDC is taking steps to raise awareness of this issue. Handwashing, sanitizing, and appropriate antibiotic use are critical to protecting oneself from Shigella. Those who are infected should seek medical attention to receive proper treatment and to prevent transmission.
