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Co-circulation of multidrug-resistant Shigella among men who have sex with men in Australia

journal contribution
posted on 2023-05-20, 03:41 authored by Ingle, DJ, Easton, M, Valcanis, M, Seemann, T, Kwong, JC, Nicola StephensNicola Stephens, Carter, GP, Goncalves da Silva, A, Adamopoulos, J, Baines, SL, Holt, KE, Chow, EPF, Fairley, CK, Chen, MY, Kirk, MD, Howden, BP, Williamson, DA

Background: In urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages.

Methods: A population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews.

Results: Rates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigellasonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates.

Conclusions: Our contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection.

History

Publication title

Clinical Infectious Diseases

Pagination

1-10

ISSN

1058-4838

Department/School

Tasmanian School of Medicine

Publisher

Univ Chicago Press

Place of publication

1427 E 60Th St, Chicago, USA, Il, 60637-2954

Rights statement

Copyright 2019 The Authors.

Repository Status

  • Restricted

Socio-economic Objectives

Disease distribution and transmission (incl. surveillance and response)

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