Changing trends in the prevalence of Shigella species: emergence of multi-drug resistant Shigella sonnei biotype g in Bangladesh

PLoS One. 2013 Dec 18;8(12):e82601. doi: 10.1371/journal.pone.0082601. eCollection 2013.

Abstract

Shigellosis, caused by Shigella species, is a major public health problem in Bangladesh. To determine the prevalence and distribution of different Shigella species, we analyzed 10,827 Shigella isolates from patients between 2001 and 2011. S. flexneri was the predominant species isolated throughout the period. However, the prevalence of S. flexneri decreased from 65.7% in 2001 to 47% in 2011, whereas the prevalence of S. sonnei increased from 7.2% in 2001 to 25% in 2011. S. boydii and S. dysenteriae accounted for 17.3% and 7.7% of the isolates respectively throughout the period. Of 200 randomly selected S. sonnei isolates for extensive characterization, biotype g strains were predominant (95%) followed by biotype a (5%). Resistance to commonly used antibiotics including trimethoprim-sulfamethoxazole, nalidixic acid, ciprofloxacin, mecillinam and ampicillin was 89.5%, 86.5%, 17%, 10.5%, and 9.5%, respectively. All isolates were susceptible to ceftriaxone, cefotaxime, ceftazidime and imipenem. Ninety-eight percent of the strains had integrons belonging to class 1, 2 or both. The class 1 integron contained only dfrA5 gene, whereas among class 2 integron, 16% contained dhfrAI-sat1-aadA1-orfX gene cassettes and 84% harbored dhfrA1-sat2 gene cassettes. Plasmids of ∼5, ∼1.8 and ∼1.4 MDa in size were found in 92% of the strains, whereas only 33% of the strains carried the 120 MDa plasmid. PFGE analysis showed that strains having different integron patterns belonged to different clusters. These results show a changing trend in the prevalence of Shigella species with the emergence of multidrug resistant S. sonnei. Although S. flexneri continues to be the predominant species albeit with reduced prevalence, S. sonnei has emerged as the second most prevalent species replacing the earlier dominance by S. boydii and S. dysenteriae in Bangladesh.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amdinocillin / therapeutic use
  • Ampicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Bangladesh / epidemiology
  • Ciprofloxacin
  • Drug Resistance, Multiple, Bacterial / genetics
  • Dysentery, Bacillary / drug therapy
  • Dysentery, Bacillary / epidemiology
  • Dysentery, Bacillary / microbiology
  • Humans
  • Integrons / genetics
  • Nalidixic Acid / therapeutic use
  • Phylogeny
  • Prevalence
  • Shigella sonnei / drug effects*
  • Shigella sonnei / genetics
  • Shigella sonnei / pathogenicity
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Nalidixic Acid
  • Ciprofloxacin
  • Ampicillin
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Amdinocillin

Grants and funding

This study was funded by icddr,b and its donors which provide unrestricted support to icddr,b for its operations and research. Current donors providing unrestricted support include: Government of the People's Republic of Bangladesh, Australian Agency for International Development (AusAID), Canadian International Development Agency (CIDA), Swedish International Development Cooperation Agency (Sida), and the Department for International Development, UK (DFID). The authors gratefully acknowledge these donors for their support and commitment to icddr,b′s research efforts. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.