title: Elevated Risk for Antimicrobial Drug-Resistant Shigella Infection among Men Who Have Sex with Men, United States, 2011-2015.
abstract: Shigella spp. cause ≈500,000 illnesses in the United States annually, and resistance to ciprofloxacin, ceftriaxone, and azithromycin is emerging. We investigated associations between transmission route and antimicrobial resistance among US shigellosis clusters reported during 2011-2015. Of 32 clusters, 9 were caused by shigellae resistant to ciprofloxacin (3 clusters), ceftriaxone (2 clusters), or azithromycin (7 clusters); 3 clusters were resistant to >1 of these drugs. We observed resistance to any of these drugs in all 7 clusters among men who have sex with men (MSM) but in only 2 of the other 25 clusters (p<0.001). Azithromycin resistance was more common among MSM-associated clusters than other clusters (86% vs. 4% of clusters; p<0.001). For adults with suspected shigellosis, clinicians should culture feces; obtain sex histories; discuss shigellosis prevention; and choose treatment, when needed, according to antimicrobial drug susceptibility. Public health interviews for enteric illnesses should encompass sex practices; health messaging for MSM must include shigellosis prevention.
authors.forename: Anna
authors.initials: A
authors.lastname: Bowen
authors.forename: Julian
authors.initials: J
authors.lastname: Grass
authors.forename: Amelia
authors.initials: A
authors.lastname: Bicknese
authors.forename: Davina
authors.initials: D
authors.lastname: Campbell
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hurd
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kirkcaldy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000266:history / Q000382:microbiology / Q000635:transmission*; D005260:Female; D049674:History, 21st Century; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012306:Risk; D012760:Shigella / Q000187:drug effects* / Q000235:genetics; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Shigella; United States; antimicrobial resistance; azithromycin; bacteria; ceftriaxone; fluoroquinolones; men who have sex with men; shigellosis