Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 17;64(12):e01518-20.
doi: 10.1128/AAC.01518-20. Print 2020 Nov 17.

Prolonged Outbreak of Multidrug-Resistant Shigella sonnei Harboring blaCTX-M-27 in Victoria, Australia

Danielle J Ingle #  1   2 , Patiyan Andersson #  3 , Mary Valcanis  3 , Jessica Barnden  3 , Anders Gonçalves da Silva  3 , Kristy A Horan  3 , Torsten Seemann  3 , Marion Easton  4 , Deborah A Williamson  3   5 , Norelle L Sherry  3   5 , Benjamin P Howden  1   6
Affiliations

Prolonged Outbreak of Multidrug-Resistant Shigella sonnei Harboring blaCTX-M-27 in Victoria, Australia

Danielle J Ingle et al. Antimicrob Agents Chemother. .

Abstract

In Australia, cases of shigellosis usually occur in returned travelers from regions of shigellosis endemicity or in men who have sex with men. Resistance to multiple antibiotics has significantly increased in Shigella sonnei isolates and represents a significant public health concern. We investigate an outbreak of multidrug-resistant S. sonnei in Victoria, Australia. We undertook whole-genome sequencing of 54 extended-spectrum-beta-lactamase (ESBL)-producing S. sonnei isolates received at the Microbiological Diagnostic Unit Public Health Laboratory between January 2019 and March 2020. The population structure and antimicrobial resistance profiles were identified by genomic analyses, with 73 previously characterized Australian S. sonnei isolates providing context. Epidemiological data, including age and sex of the shigellosis cases, were also collected. There was a significant increase in cases of ESBL S. sonnei from July 2019. Most of the ESBL S. sonnei isolates (65%) fell within a single cluster that was predominantly comprised of male cases that were characterized by the presence of the blaCTX-M-27 gene conferring resistance to extended-spectrum cephalosporins. These isolates were also multidrug resistant, including resistance to azithromycin and co-trimoxazole and reduced susceptibility to ciprofloxacin. Our data uncovered a prolonged clonal outbreak of ESBL S. sonnei infection that was likely first introduced by returned travelers and has subsequently been circulating locally in Australia. The emergence of a local outbreak of ESBL S. sonnei with a multidrug-resistant profile, including reduced susceptibility to ciprofloxacin, represents a significant public health threat.

Keywords: ESBL; Shigella; epidemiology; genomics.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Population structure and antimicrobial resistance profiles of ESBL Shigella sonnei. (A) Midpoint-rooted phylogenetic tree of 54 ESBL Shigella sonnei and 73 contextual isolates. The tips are colored by ESBL status for the novel isolates and by membership to previously established lineages for the contextual isolates. The sex of the patient is shown to the right of the phylogeny. Known genetic determinants for critical antimicrobials are shown as a heatmap. *, partial match (partial gene recovery occurs when 50% to 90% of a protein in the AMRfinder database is covered by a contig at >90% identity). (B) Epidemic curve of ESBL S. sonnei, colored by ESBL gene, received at MDU PHL between 1 January 2019 and 30 March 2020. (C) Patient characteristics of 35 S. sonnei isolates in ESBL outbreak lineage with the histogram stratified by age group and sex.
See this image and copyright information in PMC

References

    1. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque AS, Zaidi AK, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acácio S, Biswas K, O'Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM. 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 382:209–222. doi:10.1016/S0140-6736(13)60844-2. - DOI - PubMed
    1. Troeger C, Blacker BF, Khalil IA, Rao PC, Cao S, Zimsen SR, Albertson SB, Stanaway JD, Deshpande A, Abebe Z, Alvis-Guzman N, Amare AT, Asgedom SW, Anteneh ZA, Antonio CAT, Aremu O, Asfaw ET, Atey TM, Atique S, Avokpaho EFGA, Awasthi A, Ayele HT, Barac A, Barreto ML, Bassat Q, Belay SA, Bensenor IM, Bhutta ZA, Bijani A, Bizuneh H, Eda-Orjuela CAC, Dadi AF, Dandona L, Dandona R, Do HP, Dubey M, Dubljanin E, Edessa D, Endries AY, Eshrati B, Farag T, Feyissa GT, Foreman KJ, Forouzanfar MH, Fullman N, Gething PW, Gishu MD, Godwin WW, Gugnani HC, Gupta R, Hailu GB, Hassen HY, Hibstu DT, Ilesanmi OS, Jonas JB, et al., GBD 2016 Diarrhoeal Disease Collaborators. 2018. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 18:1211–1228. doi:10.1016/S1473-3099(18)30362-1. - DOI - PMC - PubMed
    1. Baker KS, Dallman TJ, Field N, Childs T, Mitchell H, Day M, Weill F-X, Lefevre S, Tourdjman M, Hughes G, Jenkins C, Thomson N. 2018. Genomic epidemiology of Shigella in the United Kingdom shows transmission of pathogen sublineages and determinants of antimicrobial resistance. Sci Rep 8:7389. doi:10.1038/s41598-018-25764-3. - DOI - PMC - PubMed
    1. Ingle DJ, Easton M, Valcanis M, Seemann T, Kwong JC, Stephens N, Carter GP, Gonçalves da Silva A, Adamopoulos J, Baines SL, Holt KE, Chow EPF, Fairley CK, Chen MY, Kirk MD, Howden BP, Williamson DA. 2019. Co-circulation of multidrug-resistant Shigella among men who have sex with men in Australia. Clin Infect Dis 69:1535–1544. doi:10.1093/cid/ciz005. - DOI - PubMed
    1. Williamson DA, Ingle DJ, Howden BP. 2019. Extensively drug-resistant shigellosis in Australia among men who have sex with men. N Engl J Med 381:2477–2479. doi:10.1056/NEJMc1910648. - DOI - PubMed

Publication types

LinkOut - more resources