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A CDC analysis shows extensively drug-resistant Shigella infections rose to 8.5% in 2023. Most cases occurred in adult men, with no FDA-approved oral antibiotics available for treatment.
By Hermes-Vector AI Desk
Cases of extensively drug-resistant (XDR) Shigella infections are increasing in the United States, according to a report from the Centers for Disease Control and Prevention (CDC). The bacterial illness, which causes diarrhea, fever and stomach pain, is showing growing resistance to common antibiotics, leaving doctors with limited treatment options.
The CDC analyzed nearly 17,000 Shigella isolates collected between Jan. 1, 2011, and Oct. 20, 2023. Among the 16,788 isolates with resistance data, 510 were classified as extensively drug-resistant. This classification means the bacteria were resistant to five commonly used antibiotics: ampicillin, azithromycin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole.
The percentage of isolates classified as extensively drug-resistant increased from 0% between 2011 and 2015 to 8.5% in 2023. Most of these drug-resistant cases occurred in 2022 and 2023, accounting for 415 cases, or more than 84% of the total reported during the study period.
The CDC report indicates that patients with extensively drug-resistant Shigella were predominantly adults. Nearly 96% of patients with available age and sex information were at least 18 years old, and 86.2% were men. The median age of patients was 41.
Regarding hospitalization, the CDC analysis found that of the 258 patients with available hospitalization information, 97 — or 37.6% — were hospitalized. No deaths were reported in the dataset. While other experts have cited different hospitalization rates for Shigella infections generally, the CDC’s specific data for this drug-resistant subset indicates a hospitalization rate of 37.6%.
Previous studies have identified sexual contact among men who have sex with men as an important transmission route, though the CDC noted that sexual exposure information in this specific analysis was incomplete and was not analyzed. Dr. Naeemah Logan, an epidemiologist with the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, described the situation as "a very concerning pattern of XDR Shigella strains that are being seen among vulnerable populations."
The findings are concerning because there are no Food and Drug Administration-approved oral antibiotics specifically available to treat extensively drug-resistant Shigella infections. Doctors may need to rely on laboratory testing to determine which medications, if any, are likely to work.
Dr. Ferric Fang, professor at the University of Washington School of Medicine, noted that Shigella "falls through the cracks in public health between sexually transmitted infections and foodborne infections."
The CDC said the study likely underestimated the number of extensively drug-resistant infections because not all Shigella-positive specimens were cultured or genetically sequenced. Reporting and testing practices also varied by state and local jurisdiction. Health officials urged clinicians to order antimicrobial susceptibility testing when possible and report cases promptly.
The rise in extensively drug-resistant Shigella strains poses a significant public health challenge due to the lack of approved oral treatments. With the majority of cases occurring in adult men and a significant portion requiring hospitalization, improved surveillance and targeted prevention strategies are needed to limit the spread of these resistant strains. The shift in transmission patterns, including sexual contact, requires updated public health messaging and clinical awareness.
Sources
This article was drafted with AI assistance and checked against the sources above. Company claims are reported as claims. Cover image is AI-generated.
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