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. 2020 Apr 18;7(4):ofaa113.
doi: 10.1093/ofid/ofaa113. eCollection 2020 Apr.

Evidence of Failure of Oral Third-Generation Cephalosporin Treatment for Shigella sonnei Infection

Jennifer P Collins  1   2 , Cindy R Friedman  2 , Meseret G Birhane  2 , Beth E Karp  2 , Anthony Osinski  3 , Mary W Montgomery  4 , Deepam Thomas  5 , Jonathan Barkley  6 , Martha C Sanchez  7 , Samir Hanna  8 , Azizat A Adediran  9 , Jessica C Chen  9 , Hayat Caidi  9 , Louise Francois Watkins  2
Affiliations

Evidence of Failure of Oral Third-Generation Cephalosporin Treatment for Shigella sonnei Infection

Jennifer P Collins et al. Open Forum Infect Dis. .

Abstract

In 2017, state health departments notified the Centers for Disease Control and Prevention about 4 patients with shigellosis who experienced persistent illness after treatment with oral third-generation cephalosporins. Given increasing antibiotic resistance among Shigella, these cases highlight the need to evaluate the efficacy of oral cephalosporins for shigellosis.

Keywords: Shigella sonnei; antibiotic resistance; antibiotic treatment failure; cephalosporin; shigellosis.

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Figures

Figure 1.
Figure 1.
High-quality single nucleotide polymorphism (hqSNP) analysis of Shigella sonnei isolates. This hqSNP analysis contains 9 isolates from 4 patients. SNP differences for each patient’s isolates before cephalosporin treatment (indicated by *) and after are shown. The isolates in Clade A cluster in 0–12 SNPs. The isolates in Clade B are related by 0–2 SNPs but are unrelated to the other isolates (67–81 SNPs). Clinical laboratory antimicrobial susceptibility testing (AST) was performed at the time of patient illness. Surveillance AST was performed later by the Centers for Disease Control and Prevention; results were not available during patients’ illnesses. Interpretive categories for AST results are based on Clinical and Laboratory Standards Institute breakpoints, according to the following minimum inhibitory concentration (MIC) values (S, susceptible; R, resistant): ampicillin (S: ≤8 µg/mL; R: ≥32 µg/mL); amoxicillin-clavulanate (amox-clav; S: ≤8/4 µg/mL; R: ≥32/16 µg/mL); trimethoprim-sulfamethoxazole (TMP-SMX; S: ≤2/38 µg/mL; R: ≥4/76 µg/mL); ciprofloxacin (S: ≤0.25 µg/mL; R: ≥1 µg/mL); levofloxacin (S: ≤0.5 µg/mL; R: ≥2 µg/mL); ceftriaxone: (S: ≤1 µg/mL; R: ≥4 µg/mL); cefoxitin (S: ≤8 µg/mL; R: ≥32 µg/mL). AST results for azithromycin were interpreted using epidemiological cutoff values; isolates were reported as susceptible (MIC ≤ 16 ug/mL) or with decreased susceptibility (MIC ≥ 32 µg/mL). Abbreviations: CDC, Centers for Disease Control and Prevention; EDLB, Enteric Diseases Laboratory Branch; NCBI, National Center for Biotechnology Information.
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References

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