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Antibiotic Resistance and Shigella Infections

CDC Health Advisory: Recommendations for managing and reporting Shigella infections with possible reduced susceptibility to ciprofloxacin.

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Drugs that kill or stop the growth of bacteria germs are called antibiotics. Antibiotic resistance is when a bacteria, such as Shigella, resists the effects of an antibiotic – that is, the germs are not killed and their growth is not stopped.

Compared with most treatable Shigella infections, antibiotic-resistant shigellosis:

  • can be harder to treat,
  • may increase the cost of treatment,
  • and may lengthen the time someone is sick, which increases the chance that the bacteria will spread.

There are an estimated 27,000 antibiotic resistant Shigella infections in the United States each year 1. Anyone can get sick with antibiotic-resistant Shigella.  Some people are more likely to get antibiotic-resistant infections, including international travelers 2,3, gay and bisexual men 48, and those with weakened immune systems 9. To learn more about preventing Shigella infections see the prevention page.

To learn more about antibiotic resistance, see Antibiotic / Antimicrobial Resistance.

How do I know if my infection is drug resistant?

The only way to know if you have antibiotic-resistant Shigella is if your healthcare provider orders laboratory testing of a sample of your stool (poop). Laboratory tests can check which antibiotics may help treat your infection. If you are being treated with antibiotics for shigellosis but do not feel better within a couple of days, tell your healthcare provider. You may need additional tests to check whether the type of Shigella bacteria you have is resistant to the antibiotics.

What should I do if I have an antibiotic-resistant Shigella infection

Please follow the advice of your healthcare provider. Not all Shigella infections require antibiotics for treatment, but if you are started on antibiotics and do not feel better within a couple of days, tell your healthcare provider. Help keep others from getting sick by following the recommendations below:

  • Wash your hands carefully with soap and water after using the toilet.
  • Stay home while you are sick.
    • If you work in healthcare, childcare, or the food service industry, follow your local health department’s guidance about when it is safe to return to work.
  • Do not prepare food for others, if possible, while you are sick.
  • Wait to have sex (vaginal, anal, and oral) for one week after you no longer have diarrhea.  Because Shigella germs may be in stool for several weeks, follow safe sex practices, or ideally avoid having sex, for several weeks after you have recovered.

Prevent antibiotic resistant Shigella

The use of antibiotics is the single most important factor leading to antibiotic resistance around the world 10. Simply using antibiotics creates resistance. These drugs should only be used to manage infections. Avoiding infections in the first place reduces the need for antibiotics and reduces the likelihood that resistance will develop. Antibiotic-resistant Shigella infections can be prevented by:

More Information

To learn more about preventing antibiotic-resistant infections, see Protecting Yourself and your Family.

References
  1. CDC. Antibiotic resistance threats in the United States, 2013. [PDF – 114 pages] 2013.
  2. Kantele A. As far as travelers’ risk of acquiring resistant intestinal microbes is considered, no antibiotics (absorbable or nonabsorbable) are safe. Clin Infect Dis. 2015;60(12):1872–3.
  3. Kendall ME, Crim S, Fullerton K, Han PV, Cronquist AB, Shiferaw B, Ingram LA, Rounds J, Mintz ED, Mahon BE. Travel-associated enteric infections diagnosed after return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2009. Clin Infect Dis. 2012;54 Suppl 5:S480-7.doi: 10.1093/cid/cis052.
  4. 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(5): 854–6.
  5. Gaudreau C, Ratnayake R, Pilon PA, Gagnon S, Roger M, Levesque S. Ciprofloxacin-resistant Shigella sonnei among men who have sex with men, Canada, 2010. Emerg Infect Dis. 2011;17(9):1747-50.
  6. Hoffmann C, Sahly H, Jessen A, Ingiliz P, Stellbrink HJ, Neifer S, Schewe K, Dupke S, Baumgarten A, Kuschel A, Krznaric I. High rates of quinolone-resistant strains of Shigella sonnei in HIV-infected MSM. [PDF – 5 pages] Infection. 2013;41(5):999-1003.
  7. Heiman KE, Karlsson M, Grass J, Howie B, Kirkcaldy RD, Mahon B, Brooks J, Bowen A. 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(6):132-3.
  8. Bowen A, Eikmeier D, Talley P, Siston A, Smith S, Hurd J, Smith K, Leano F, Bicknese A, Norton C, Campbell D. 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(21):597-8.
  9. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. US Department of Health and Human Services.
  10. Holmes AH, Moore LS, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, Guerin PJ, Piddock LJ. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2016;387(10014):176-87.
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