Azithromycin non-susceptible Shigella circulating in Israel, 2014–2016

Autoři: Analía V. Ezernitchi aff001;  Elizabeta Sirotkin aff001;  Dana Danino aff002;  Vered Agmon aff001;  Lea Valinsky aff001;  Assaf Rokney aff001
Působiště autorů: Government Central Laboratories, Ministry of Health, Jerusalem, Israel aff001;  Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel aff002;  Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article


Shigella species remains a major diarrhoeagenic agent, affecting mostly children, with global high incidence and high mortality rate specially in developing areas. Although azithromycin is recommended for treatment of shigellosis, there are currently no CLSI susceptibility breakpoints, accordingly no routine antimicrobial susceptibility test is performed in the clinical laboratory. The purpose of this study was to estimate the prevalence, resistance profile and molecular epidemiology of azithromycin non-susceptible Shigella strains in Israel during a three year period. Shigella isolates (n = 1,170) referred to the National Reference Center during 2014–2016, were included in this study. Serotyping was performed by slide agglutination. Resistance genes, mph(A) and erm(B), were identified by PCR and the phenotype profile was determined by broth microdilution (BMD). Genetic relatedness was assessed by wgMLST. Decreased susceptibility to azithromycin (DSA) phenotype and genotype were detected in various Shigella species and serotypes related to diverse genetic backgrounds and antimicrobial profiles: 6% (26/423) of Shigella flexneri and 2% (16/747) of Shigella sonnei displayed DSA (MIC16 mg/L). Correlation of this phenotype with the presence of mph(A) and erm(B) genes was confirmed. All DSA-strains displayed resistance to ≥3 different antimicrobial classes. Among DSA-strains, 14% were resistant to quinolones and 5% displayed resistance to ceftriaxone. Most of these strains (32/42) were isolated from children in the southern and central regions of Israel. Clonality and significant relatedness was confirmed by PFGE and wgMLST. The presence of macrolide resistance genes among the different species and lineages reflects the transmissible nature of these genes. The emergence of DSA-Shigella reinforces the necessity to establish clinical breakpoints that would warrant routine testing, reporting and surveillance for this drug of choice.

Klíčová slova:

Antimicrobial resistance – Comparative genomics – Israel – Polymerase chain reaction – Shigella – Streptomycin – Shigella flexneri – Shigellosis


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