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Shigellosis: high rates of antibiotic resistance necessitate new treatment recommendations

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Shigella species cause a potentially severe diarrhoeal illness that is frequently travel-associated and is both foodborne and sexually acquired. There is evidence of increasing antibiotic resistance in Shigella isolates from international studies.1,2 However, there is limited published research on this issue in an Australian context. The current Australian Therapeutic Guidelines recommend either co-trimoxazole or quinolone therapy for suspected or proven shigellosis, but do comment that quinolone resistance is increasing in developing countries and recommend azithromycin as an alternative option, if required.3 Successful treatment of shigellosis reduces the duration of illness and infectivity.

We conducted a study to describe antimicrobial resistance patterns among Shigella isolates in New South Wales during 2013 and 2014, and to identify predictors of resistance using laboratory and epidemiological data from the NSW Notifiable Conditions Information Management System (NCIMS).

A cross-sectional analysis was conducted using cases of shigellosis notified to public health authorities in NSW through NCIMS, with specimens received by the enteric pathogen reference laboratory for NSW — the Institute for Clinical Pathology and Medical Research (ICPMR) at Westmead Hospital — collected…