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Comparative Study
. 2021 Sep;58(3):106378.
doi: 10.1016/j.ijantimicag.2021.106378. Epub 2021 Jun 23.

Circulation of multi-drug-resistant Shigella sonnei and Shigella flexneri among men who have sex with men in Barcelona, Spain, 2015-2019

Albert Moreno-Mingorance  1 , Paula Espinal  2 , Virginia Rodriguez  3 , Lidia Goterris  3 , Anna Fàbrega  3 , Judit Serra-Pladevall  3 , M Jesús Barberà  4 , Mireia Alberny  5 , Héctor Martín-González  2 , Thais Cornejo-Sánchez  2 , Mayuli Armas  6 , Alba Mir-Cros  1 , Alex Raventós  7 , Belén Viñado  8 , Tomàs Pumarola  8 , M Nieves Larrosa  9 , Juan José González-López  10
Affiliations
Comparative Study

Circulation of multi-drug-resistant Shigella sonnei and Shigella flexneri among men who have sex with men in Barcelona, Spain, 2015-2019

Albert Moreno-Mingorance et al. Int J Antimicrob Agents. 2021 Sep.

Abstract

Background: In high-income countries, shigellosis is mainly found in travellers to high-risk regions or in men who have sex with men (MSM). This study investigated the genomic characteristics and the features of antimicrobial resistance of MSM-associated Shigella flexneri and Shigella sonnei circulating in Barcelona, Spain, elucidating their connectivity with contemporaneous Shigella spp. from other countries.

Methods: Antimicrobial susceptibility, whole-genome sequencing, genomic characterization and phylogenetic analysis were performed in MSM-associated Shigella spp. recovered from 2015 to 2019. Reference genomes of MSM-associated Shigella spp. were included for contextualization and to determine their connection with international outbreaks.

Results: In total, 44 S. flexneri and 26 S. sonnei were identified among MSM. Overall, 80% showed resistance to azithromycin, 65.7% showed resistance to trimethoprim-sulphamethoxazole and 32.8% showed resistance to ciprofloxacin; 27.1% were resistant to all three antimicrobials. mphA and/or ermB, and qnrS and mutations in the quinolone resistance determining regions were found in the azithromycin- and ciprofloxacin-resistant isolates, respectively. Additionally, two isolates carried blaCTX-M-27. Single-nucleotide-polymorphism-based analysis revealed that the isolates were organized into different lineages, most of which were closely related to dominant MSM-associated lineages described previously in the UK and Australia.

Conclusions: This study investigated the circulation of lineages of S. flexneri and S. sonnei among MSM in Spain that were mainly resistant to first-/second-line oral treatments, and closely related to dominant MSM-associated lineages described previously in the UK and Australia. These data reinforce the urgent need for the implementation of public health measures focusing on the early detection and prevention of transmission of this emerging pathogen, which is contributing to the antimicrobial resistance crisis in sexually transmitted infections.

Keywords: Azithromycin resistance; MSM; Sexually transmitted infections; Shigellosis; Whole-genome sequencing.

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