The increasing antimicrobial resistance of
            <i>Shigella</i>
            species among Iranian pediatrics: a systematic review and meta-analysis

Baharvand, Amirhossein; Molaeipour, Leila; Alesaeidi, Sogol; Shaddel, Reyhane; Mashatan, Noushin; Amiriani, Taghi; Sudkolaei, Melika Kiaei; Abbasian, Sara; Al-Naqeeb, Bashar Zuhair Talib; Kouhsari, Ebrahim

doi:10.1080/20477724.2023.2179451

Cited by 3 publications

(2 citation statements)

References 54 publications

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“…The rate of ceftriaxone resistance at 32.4% (95% CI: 30.0-35.1%) also follows the same pattern as that of Iran at 28% (95% CI: 10-49%). However, a declining rate was observed in the case of trimethoprim-sulfamethoxazole at 74% (95% CI: 65.0-84.3%) and ampicillin at 43.0% (95% CI: 25.6-72.4%), whereas the resistance rate of trimethoprim-sulfamethoxazole and ampicillin was found to be 84% (95% CI: 73-93%) and 69% (95% CI: 56-80%), respectively, in Iran [50]. Ciprofloxacin is used as the first line of treatment for shigellosis for all ages presenting with bloody diarrhea, whereas ceftriaxone and azithromycin are considered for the second line of treatment [51].…”

Section: Discussionmentioning

confidence: 93%

Prevalence of Antibiotic-Resistant Shigella spp. in Bangladesh: A Systematic Review and Meta-Analysis of 44,519 Samples

et al. 2023

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Shigella is the leading global etiological agent of shigellosis, especially in poor and underdeveloped or developing nations with insufficient sanitation such as Bangladesh. Antibiotics are the only treatment option for the shigellosis caused by Shigella spp. as no effective vaccine exists. However, the emergence of antimicrobial resistance (AMR) poses a serious global public health concern. Therefore, a systematic review and meta-analysis were conducted to establish the overall drug resistance pattern against Shigella spp. in Bangladesh. The databases of PubMed, Web of Science, Scopus, and Google Scholar were searched for relevant studies. This investigation comprised 28 studies with 44,519 samples. Forest and funnel plots showed any-drug, mono-drug, and multi-drug resistance. Any fluoroquinolone had a resistance rate of 61.9% (95% CI: 45.7%–83.8%), any trimethoprim–sulfamethoxazole—60.8% (95% CI: 52.4%–70.5%), any azithromycin—38.8% (95% CI: 19.6%–76.9%), any nalidixic acid—36.2% (95% CI: 14.2%–92.4%), any ampicillin—34.5% (95% CI: 25.0%–47.8%), and any ciprofloxacin—31.1% (95% CI: 11.9%–81.3%). Multi-drug-resistant Shigella spp. exhibited a prevalence of 33.4% (95% CI: 17.3%–64.5%), compared to 2.6% to 3.8% for mono-drug-resistant strains. Since resistance to commonly used antibiotics and multidrug resistance were higher, a judicious use of antibiotics, the promotion of infection control measures, and the implementation of antimicrobial surveillance and monitoring programs are required to tackle the therapeutic challenges of shigellosis.

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Section: Discussionmentioning

confidence: 93%

Prevalence of Antibiotic-Resistant Shigella spp. in Bangladesh: A Systematic Review and Meta-Analysis of 44,519 Samples

et al. 2023

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“…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][25][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.…”

Section: Regional Differences In Bacterial Resistancementioning

confidence: 99%

Resistance in Enteric Shigella and nontyphoidal Salmonella: emerging concepts

Yang,

Xiang,

Qiu

2023

Current Opinion in Infectious Diseases

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Purpose of review The emergence of globally resistant enteric Shigella and nontyphoidal Salmonella strains (NTS) has limited the selection of effective drugs, which has become a major challenge for the treatment of infections. The purpose of this review is to provide the current opinion on the antimicrobial-resistant enteric Shigella and nontyphoidal Salmonella. Recent findings Enteric Shigella and NTS are resistant to almost all classes of antimicrobials in recent years. Those with co-resistance to ciprofloxacin, azithromycin and ceftriaxone, the first-line antibiotics for the treatment of infectious diarrhoea have emerged worldwide. Some of them have caused interregional and international spread by travel, trade, MSM, and polluted water sources. Several strains have even developed resistance to colistin, the last-resort antibiotic used for treatment of multidrug-resistant Gram-negative bacteria infections. Summary The drug resistance of enteric Shigella and NTS is largely driven by the use of antibiotics and horizontal gene transfer of mobile genetic elements. These two species show various drug resistance patterns in different regions and serotypes. Hence treatment decisions for Shigella and Salmonella infections need to take into consideration prevalent antimicrobial drug resistance patterns. It is worth noting that the resistance genes such as bla CTX, mph, ermB, qnr and mcr, which can cause resistance to ciprofloxacin, cephalosporin, azithromycin and colistin are widespread because of transmission by IncFII, IncI1, IncI2 and IncB/O/K/Z plasmids. Therefore, continuous global monitoring of resistance in Shigella and Salmonella is imperative.

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Pharmacokinetics of tebipenem pivoxil used in children suffering from shigellosis: a pilot study in Bangladesh

Nuzhat,

Islam,

Bashar

et al. 2024

Sci Rep

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With increasing antibiotic resistance in gram-negative bacteria, including those causing Shigellosis, evidence of safety and pharmacokinetics data on new oral antibiotics is crucial. We aimed to investigate the safety and pharmacokinetic properties of an oral carbapenem, tebipenem pivoxil, along with it’s ability to produce desired results in childhood shigellosis. This randomized pilot clinical trial was conducted at Dhaka Hospital, icddr,b in 2022 between May and September. Thirty suspected shigellosis cases aged 24–59 months were randomized across two treatment groups equally: tebipenem pivoxil and azithromycin. Pharmacokinetics of tebipenem was assessed among fifteen children who received tebipenem pivoxil using Noncompartmental analysis (NCA). Clinical (absence of fever, abdominal pain/tenderness, diarrhoea, blood in stool, or death before Day-3) and microbiological (absence of Shigella on Day-7 culture) success after the antibiotic interventions were also evaluated. Sociodemographic and clinical characteristics were comparable between the randomization arms. Twelve children, each in the azithromycin arm and tebipenem arm, were positive for Shigella by culture on enrolment. Cmax values of 5053.3, 2546.0, and 3759.2 ng/mL were observed for plasma tebipenem on Day-0, 1, and 2 respectively. Clinical success was observed among seven participants in each arm while two in the azithromycin arm and three in the tebipenem arm failed microbiologically. The tolerability and efficaciousness of tebipenem pivoxil appear to be comparable to azithromycin in treating childhood shigellosis in Bangladesh. We recommend a larger clinical trial to determine non-inferiority of tebipenem in regards to the current treatment guidelines.

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The increasing antimicrobial resistance of Shigella species among Iranian pediatrics: a systematic review and meta-analysis

Cited by 3 publications

References 54 publications

Prevalence of Antibiotic-Resistant Shigella spp. in Bangladesh: A Systematic Review and Meta-Analysis of 44,519 Samples

Prevalence of Antibiotic-Resistant Shigella spp. in Bangladesh: A Systematic Review and Meta-Analysis of 44,519 Samples

Resistance in Enteric Shigella and nontyphoidal Salmonella: emerging concepts

Pharmacokinetics of tebipenem pivoxil used in children suffering from shigellosis: a pilot study in Bangladesh

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