Multi Drug Resistant Shigella flexneri An Emerging Threat to Community
Shigellosis remains to be a considerable public health problem in many parts of the world and is endemic in India. Among the different studies conducted across India the isolation rate of Shigella varies from 2-6%, with Shigella flexneri to be the most prevalent serogroup. Unlike other acute diarrheal illness that require adequate fluid replacement (oral or intravenous), shigellosis additionally needs antimicrobial therapy to curtail the duration of illness and to prevent transmission to the close contacts. But like many other bacterial pathogens the frequency of antibiotic resistance among Shigella species is on the rise, and emergence of multi drug resistance (MDR) Shigella is a growing concern globally. The third generation cephalosporins and the fluoroquinolones are the mainstay of treatment in MDR cases, however emergence of strains resistant to even these drugs have been reported worldwide and also from various parts of India. Additionally strains of Shigella spp. that produce extended spectrum β-lactamase (ESBL), conferring resistance to third generation cephalosporins have also been reported thus limiting the treatment options for clinicians. We here report a case of 43 years old man suffering from diarrhea due to MDR strain of Shigella flexneri found resistant to all cephalosporins (1st, 2nd, and 3rd generation) and fluoroquinolones, susceptible only to meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. Though the patient was treated successfully, but spread of such clones may pose a greater threat to the community and a comprehensive strategy for resistance control involving regulation of drug availability, antimicrobial drug quality assurance and discouraging antimicrobial abuse needs to be evolved.