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

Abstract

Shigellosis remains one of the leading causes of morbidity and mortality worldwide and is the second leading cause of diarrheal mortality among all age groups. However, the global emergence of antimicrobial-resistant Shigella strains, limiting the choice of effective drugs for shigellosis, has become the major challenge in the treatment of Shigella infections. The aim of this systematic review and meta-analysis was to provide an updated picture of the prevalence of antimicrobial-resistant Shigella species in Asia. A comprehensive and systematic search was performed on three electronic databases (PubMed, ScienceDirect and Scopus), in which 63 eligible studies published between 2010 and 2022 were identified. From our meta-analysis of proportions using a random-effects model, the overall prevalence of Shigella spp. in Asian patients was estimated to be 8.0% (95% CI: 5.5–10.5). The pooled prevalence rates of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing Shigella strains were 68.7% (95% CI: 59.9–77.5) and 23.9% (95% CI: 12.9–34.8), respectively. Concerning recommended antimicrobial drugs for Shigella, the prevalence of resistance was highest for ciprofloxacin (29.8%) and azithromycin (29.2%), followed by ceftriaxone (23.8%), in spite of their importance as first- and second-line treatments for shigellosis. In contrast, resistance to carbapenems, such as ertapenem (0.0%), imipenem (0.1%) and meropenem (0.0%), was almost non-existent among the 49 tested antibiotics. The significantly high prevalence estimation suggests that the multidrug-resistant Shigella is a pressing threat to public health worthy of careful and justified interventions. Effective antibiotic treatment strategies, which may lead to better outcomes for the control and treatment of shigellosis in Asia, are essential.

Identification and antibiotic pattern analysis of bacillary dysentery causing bacteria isolated from stool samples of infected patients

“…Isolate S-2 ( S. flexneri 2a), S-3 ( S. flexneri 2a), S-5 ( S. flexneri 2a), S-7 ( S. sonnei ) and S-18 ( S. sonnei ) were drug resistant while isolate S-10 ( S. flexneri 2a), S-4 ( E. coli ), S-6 ( S. flexneri 2a), S-8 ( S. enterica ) S-9 ( S. flexneri 2a), S-13 ( S. flexneri 2a), S-15 ( S. sonnei ), S-16 ( S. flexneri 2a) and S-1 ( S. sonnei ) were multidrug resistant. The pooled prevalence rates of MDR and extended-spectrum beta-lactamase (ESBL)-producing Shigella bacteria were 68.7% and 23.9%, respectively, according to a comprehensive and systematic study done by Salleh et al ( 2022 ). Ali Ali Nor et al ( 2021 ) reported that all the serogroups were 100% resistant to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline, where ceftriaxone resistance was the highest among S. sonnei (66.7%).…”

“…The MDR pathogen poses an immediate danger to public health, necessitating prudent and justifiable responses. Effective antibiotic treatment techniques that may result in improved results for the control and treatment of shigellosis in Asia are necessary (Salleh et al 2022 ).…”

Resistance in Enteric Shigella and nontyphoidal Salmonella: emerging concepts

“…Shigella isolates from Africa have high resistance to trimethoprim/sulfamethoxazole, tetracycline and ampicillin, while their resistance to ciprofloxacin, azithromycin and third-generation cephalosporin antibiotics is low [24–26]. In addition to the high resistance of Shigella isolates in Asia to tetracycline, ampicillin and other older antibiotics, it is concerning that the resistance to azithromycin, ciprofloxacin and ceftriaxone is already at a high level or shows an upward trend [2,27,28]. Whereas shigellosis is endemic in Asia and Africa, burdening mostly children younger than 5 years, in developed regions, such as Europe, the Americas and Australia, Shigella infections are more common among gay or bisexual men, people with HIV, and homeless people or travellers.…”

“…Enteric Shigella and nontyphoidal Salmonella (NTS) are widely recognized as predominant bacterial pathogens responsible for foodborne illnesses and are regarded as a significant public health concern globally [1,2]. Although acute diarrhoea caused by Shigella and NTS can be unpleasant, these diseases are usually self-limiting, and symptoms usually resolve within a few days with appropriate fluid and electrolyte management.…”

“…The use of antibiotics is an important means to shorten duration of illness and reduce infectivity [1]. However, with the increasing use of antibiotics, resistance of Shigella and NTS to different antibiotics continues to emerge, and these bacteria show high rates of multidrug resistance globally [2,3]…”