title: Travel Destinations and Sexual Behavior as Indicators of Antibiotic Resistant Shigella Strains--Victoria, Australia.
abstract: BACKGROUND
  Knowledge of relationships between antibiotic susceptibility of Shigella isolates and travel destination or other risk factors can assist clinicians in determining appropriate antibiotic therapy prior to susceptibility testing. We describe relationships between resistance patterns and risk factors for acquisition in Shigella isolates using routinely collected data for notified cases of shigellosis between 2008 and 2012 in Victoria, Australia.
  
  
  METHODS
  We included all shigellosis patients notified during the study period, where Shigella isolates were tested for antimicrobial sensitivity using Clinical and Laboratory Standards Institute breakpoints. Cases were interviewed to collect data on risk factors, including recent travel. Data were analyzed using Stata 13.1 to examine associations between risk factors and resistant strains.
  
  
  RESULTS
  Of the 500 cases of shigellosis, 249 were associated with overseas travel and 210 were locally acquired. Forty-six of 51 isolates of Indian origin displayed decreased susceptibility or resistance to ciprofloxacin. All isolates of Indonesian origin were susceptible to ciprofloxacin. Twenty-six travel-related isolates were resistant to all tested oral antimicrobials. Male-to-male sexual contact was the primary risk factor for 80% (120/150) of locally acquired infections among adult males, characterized by distinct periodic Shigella sonnei outbreaks.
  
  
  CONCLUSIONS
  Clinicians should consider travel destination as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group.
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra.|Health Protection Branch, Victorian Department of Health and Human Services, Melbourne.|Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Australia.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lane
authors.affiliation: Health Protection Branch, Victorian Department of Health and Human Services, Melbourne.
authors.forename: Brett
authors.initials: B
authors.lastname: Sutton
authors.affiliation: Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Valcanis
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra.
authors.forename: Martyn
authors.initials: M
authors.lastname: Kirk
authors.affiliation: Health Protection Branch, Victorian Department of Health and Human Services, Melbourne.
authors.forename: Cathryn
authors.initials: C
authors.lastname: Walker
authors.affiliation: Health Protection Branch, Victorian Department of Health and Human Services, Melbourne.
authors.forename: Karin
authors.initials: K
authors.lastname: Lalor
authors.affiliation: Health Protection Branch, Victorian Department of Health and Human Services, Melbourne.
authors.forename: Nicola
authors.initials: N
authors.lastname: Stephens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D004405:Dysentery, Bacillary / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D012725:Sexual Behavior; D000072339:Sexual and Gender Minorities; D012760:Shigella / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D012764:Shigella sonnei / Q000187:drug effects / Q000302:isolation & purification; D014195:Travel; D057236:Travel Medicine / Q000379:methods; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002939:Ciprofloxacin
keywords: bacterial; drug resistance; sexually transmitted diseases; shigellosis; travel medicine