Shigellosis in Nepal: 13 years review of nationwide surveillance

Abstract

Background Shigella is a major cause of gastroenteritis especially in children. In developing countries, the incidence is frequent and results are often life threatening. Changing epidemiology and emerging antibiotic resistance warrants continuous monitoring of susceptibility. The present study highlights the changing epidemiology and drug resistance patterns of Shigella isolated at different hospitals of Nepal over a period of 13 years (Jan. 2003–Dec. 2015).MethodsThis study was carried out in 12 participating laboratories. Stool specimens received at respective laboratories were processed for isolation and identification of Shigella species and confirmed by serotyping at National Public Health Laboratory. Antimicrobial resistance patterns were determined by Kirby Baeur disc diffusion test.ResultsA total of 332 isolates were identified as Shigella species of which Shigella flexneri (50 %) was the predominant serotype. Shigella dysenteriae, Shigella sonnei, Shigella boydii, and untypable Shigella spp. respectively, accounted for 28.6, 27.54, 10.2, 4.5, and 6.6 % of the total number. Change in prevalent serotype is noted over the years. S. dysenteriae was the prevalent species in Nepal in 2003 and 2004, but since 2005, S. flexneri remained prevalent. Majority of the isolates were recovered from children aged 1–10 years and was statistically significant (p = 0.023) compared to the other age groups. High resistance among all Shigella species to the first-line drugs like ampicillin (88 %), cotrimoxazole (76 %), ciprofloxacin (39 %,) and nalidixic acid (80 %) was observed; 46.1 % of total isolates were multidrug resistant (MDR), and the most common MDR profile was ampicillin, nalidixic acid, and co-trimoxazole. Prevalence of MDR increased significantly in 2010 as compared to 2003. Only few Shigella isolates were resistant to ceftriaxone.ConclusionsThe study revealed S. flexneri as the predominant serogroup in Nepal. Children below 10 years were more prone to the disease. Nalidixic acid, ampicillin, co-trimoxazole, and ciprofloxacin should not be used empirically as the first-line drugs in treatment of shigellosis. Since the distribution of different species of Shigella and their antibiotic susceptibility profile may vary from one geographical location to another and may also change with time, continuous local monitoring of resistance patterns is necessary for appropriate antimicrobial therapy.

Bibliometric analysis of global Lassa fever research (1970–2017): a 47 – year study

“…Both dominated research output in Lassa fever and accounted 64.57% of the total research output. This observation is consistent with previous research in other biomedical research [ 13 , 24 , 30 ]. The United States alone accounted for 40.87% of all research output in this area of study.…”

Serotype Distribution and Antimicrobial Resistance of Shigella Species in Bangui, Central African Republic, from 2002 to 2013

“…No significant association was found between gender and the other serogroups or between Shigella serogroup and age. Contrary to several other reports, 11,12 we observed no significant seasonality in the distribution of Shigella isolates or in serogroup distribution (i.e., erratic variation between months, but no difference between the wet and dry seasons).…”

Antibiotic Resistance Pattern of Shigella spp. Among Gastroenteritis Patients at Tertiary Care Hospital in Pokhara, Nepal

“…was higher (7.3%) in gastroenteritis patients of <15 years old than in patients ≥15 years old (4.5%) which is not statistically significant (p=0.432). This finding is consistent with the study done by Khan et al and Shakya et al found Shigella 42.0% and 38.4% and 30.1% respectively [14,18,32]. The reported high prevalence of Shigella spp.…”

“…They also reported high prevalence of Shigella spp. from male patient compared to the female [14,32]. Shigellosis or severe bacillary dysentery is a disease of public health importance because it is associated with increased mortality and morbidity especially among the children of developing countries [23].…”