title: Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe-America and Asia-Africa from 1998 to 2009.
abstract: Shigella is becoming an increasing public health problem due to development of multiple antimicrobial resistance, frequently resulting in treatment failure. A systematic review was conducted based on a literature search of computerised databases. Random or fixed-effects models were used, based on the P-value considering the possibility of heterogeneity between studies, for meta-analysis. Statistical analyses were performed using STATA 10.0. In the area of Asia-Africa, resistance rates to nalidixic acid and ciprofloxacin were 33.6% [95% confidence interval (CI) 21.8-46.6%] and 5.0% (95% CI 2.8-7.8%), respectively, 10.5 and 16.7 times those of Europe-America. Moreover, resistance to nalidixic acid and ciprofloxacin in Asia-Africa progressively increased each year, reaching 64.5% (95% CI 13.8-99.3%) and 29.1% (95% CI 0.9-74.8%), respectively, in 2007-2009, whilst isolates in Europe-America remained at low levels of resistance (<5.0% and <1.0%, respectively). All Shigella flexneri strains showed higher resistance than Shigella sonnei in Europe-America: overall, 3.5% (95% CI 1.4-6.4%) vs. 2.6% (95% CI 1.0-5.0%) resistant to nalidixic acid and 1.0% (95% CI 0.3-2.2%) vs. 0.1% (95% CI 0.0-0.3%) resistant to ciprofloxacin. In Asia-Africa, a similar trend was found for ciprofloxacin [3.0% (95% CI 1.4-5.3%) vs. 0.5% (95% CI 0.2-0.8%)], whereas the trend was reversed for nalidixic acid [32.6% (95% CI 14.5-53.9%) vs. 44.3% (95% CI 26.9-62.5%). In conclusion, quinolone resistance in Shigella has increased at an alarming speed, reinforcing the importance of continuous monitoring of antimicrobial resistance in Shigella.
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road No. 300, Nanjing 210029, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Gu
authors.forename: Yan
authors.initials: Y
authors.lastname: Cao
authors.forename: Shiyang
authors.initials: S
authors.lastname: Pan
authors.forename: Ling
authors.initials: L
authors.lastname: Zhuang
authors.forename: Rongbin
authors.initials: R
authors.lastname: Yu
authors.forename: Zhihang
authors.initials: Z
authors.lastname: Peng
authors.forename: Huimin
authors.initials: H
authors.lastname: Qian
authors.forename: Yongyue
authors.initials: Y
authors.lastname: Wei
authors.forename: Lianying
authors.initials: L
authors.lastname: Zhao
authors.forename: Genyan
authors.initials: G
authors.lastname: Liu
authors.forename: Mingqing
authors.initials: M
authors.lastname: Tong
mesh_terms: D000349:Africa / Q000453:epidemiology; D000569:Americas / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001208:Asia / Q000453:epidemiology; D002939:Ciprofloxacin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000382:microbiology*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D009268:Nalidixic Acid / Q000494:pharmacology*; D015995:Prevalence; D012763:Shigella flexneri / Q000187:drug effects* / Q000302:isolation & purification; D012764:Shigella sonnei / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D009268:Nalidixic Acid; D002939:Ciprofloxacin