Comparative in vitro activity of tigecycline and other antimicrobial agents against Shigella species from Kuwait and the United Arab of Emirates

Abstract

Shigella species isolated from stool samples of symptomatic patients of all age groups at the Mubarak Al Kabir Hospital and Infectious Diseases Hospital, Kuwait and Tawam Hospital, UAE during a 2-year period were investigated for their susceptibility to tigecycline and several other antibiotics by determining the minimum inhibitory concentrations (MICs) using the E test method. A total of 100 and 42 strains were collected from UAE and Kuwait, respectively. The extent of drug resistance in the Shigella spp. isolates from these two countries was analyzed by criteria recommended by the Clinical and Laboratory Standards Institute (CLSI). Amikacin, cefotaxime, cefuroxime, ciprofloxacin, imipenem, meropenem, piperacillin-tazobactam and tigecycline had excellent activities against all isolates from UAE and Kuwait with MIC(90s) of 12, 0.094, 4, 0.012, 0.25, 0.032, 3 and 0.25 microg/ml and 4, 1, 4, 0.125, 0.38, 0.19, 3 and 0.25 microg/ml, respectively. Half of all isolates from both countries were resistant to ampicillin. None of the isolates in Kuwait was resistant to amoxicillin-clavulanic acid compared with 22% in UAE. Resistance to chloramphenicol was recorded in 50 and 36% of the isolates in Kuwait and UAE, respectively. The percentages of non-susceptibility to trimethoprim-sulfamethoxazole and tetracycline were very high in Kuwait and UAE (76% vs. 92% and 76% vs. 98%, respectively). Notably, one isolate, S. flexneri, from UAE had reduced susceptibility to ciprofloxacin (MIC, 0.25 microg/ml). Four (2.8%) of the isolates were ESBL producers by the E test ESBL method but could not be confirmed by PCR using primers for bla(CTX-M), bla(SHV) and bla(TEM). In conclusion, Shigella spp. isolated from symptomatic patients in Kuwait and the UAE demonstrated high rates of resistance to the first-line antibiotics but very susceptible to the carbapenems, cephalosporins, fluoroquinolones and tigecycline. Tigecycline holds promise as a potential drug of choice for the therapy of severe shigellosis.

Drug resistance profiles and clonality of sporadic Shigella sonnei isolates in Ankara, Turkey

“…In our study, resistance to ceftriaxone and cefixime was only detected in five (12%) ESBL-producing isolates. ESBL-positive S. sonnei isolates were also reported in Lebanon (8%) ( Sabra et al , 2009 ), Kuwait (2.8%) ( Jamala et al , 2010 ), China, and India ( Izumiya et al , 2009 ). One of the ESBL-positive isolates carried bla SHV-12 and four harbored bla CTX-M-15 genes.…”

Prevalence of Multidrug-Resistant and Extended-Spectrum Beta-Lactamase-Producing Shigella Species in Asia: A Systematic Review and Meta-Analysis

“…was recorded in a study conducted in Vietnam (75.8%, 95% CI: 63.3–85.8) [ 67 ], whereas the lowest prevalence of ESBL-producing Shigella spp. was recorded in the U.A.E (4.0%, 95% CI: 1.1–9.9) in a single study [ 33 ]. Regionally, Southeast Asia represented the highest prevalence of ESBL-producing Shigella spp., with a prevalence of 52.5% (95% CI: 6.8–98.3), followed by East Asia (31.0%, 95% CI: 0.9–61.0), the Middle East (20.7%, 95% CI: 6.7–34.7) and South Asia (9.7%, 95% CI: 2.3–17.1) ( Table 5 ).…”

“… * Data from Kuwait and the U.A.E were reported by a single study (Jamal, W., 2010) [ 33 ]. 1 CI, confidence interval; 2 MDR, multidrug-resistant; 3 NA, not available.…”

Prevalence and trends of aminoglycoside resistance in Shigella worldwide, 1999-2010

“…The common route of infection by these pathogens is the ingestion of contaminated food and drinks[5]. Infection by Shigella species is an important global public health problem[6]. Shigella infections, especially S. flexneri and S. sonnei infections, can lead to illness ranging from mild, self-limited diarrhea to severe dysentery with frequent passages of blood and mucus, high fever, cramps, tenesmus, and in rare cases, bacteremia.…”