Rise in Highly Contagious Antibiotic-Resistant Shigella: What to Be Cautious About

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Antibiotic-resistant Shigella is a growing concern in the United States, as cases of bacterial infection continue to rise.

The U.S. Centers for Disease Control and Prevention (CDC) has warned of increasing cases of antibiotic-resistant strains of these bacteria, called XDR Shigella, which are resistant to all commonly recommended antibiotics.

The agency reported that the proportion of approximately 450,000 annual Shigella infections in the United States resistant to all known antibiotic treatments has risen from none in 2015, 0.4 percent in 2019, and 5 percent in 2022, indicating potentially greater spread.

Percentage of Shigella isolates that showed an extensively drug-resistant (XDR)* phenotype or genotype in the United States, by year, 2015–2022. (CDC）

Highly Contagious

Shigella is a type of bacteria that causes shigellosis, a highly contagious illness that affects the digestive system.

It’s typically spread through contaminated food or water, or person-to-person contact.

It spreads when infected fecal matter enters the body orally or through the nose. This can occur through sexual activity or via poor hand washing after contact with fecal matter, unsanitary food handling, or swimming in contaminated water. Shigella most often infects young children—but it can infect people of any age.

The rise of antibiotic-resistant Shigella is particularly concerning because it means that some strains of the bacteria are no longer responding to the antibiotics that are typically used to treat shigellosis, which include azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin.

Dr. Linda Yancey, an infectious disease specialist at Memorial Hermann Health System in Houston, Texas, told The Epoch Times that this highlights the issue of increasingly antibiotic-resistant pathogens.

“There is a growing chance that the antibiotics we normally use to treat Shigella might not work anymore,” she said.

The CDC warned that this new form of Shigella is a serious public health threat, and says evidence indicates (pdf) this infection is spreading among immunocompromised, gay and bisexual men, and international travelers.

A European Centre for Disease Prevention and Control alert announced 221 confirmed and 37 potential cases among people who traveled to West Africa since September 2022. Those travelers returned to roughly a dozen countries, including the United States.

Don't Need to Be Overly Concerned: Expert

Symptoms of shigellosis include diarrhea, fever, and stomach cramps, and in some cases, the illness can be severe or even life-threatening.

Yancey noted that there are currently many other antibiotics that can be used, and in general, people don't need to be specifically concerned about this particular outbreak. Shigella is very common worldwide. In developed countries, it’s seldom fatal, but it can make people sick enough to require hospitalization.

According to a report published in 2018, about 500,000 cases occur in the United States, but only 40 people die of it annually.

While complications from infection are rare, they can include bloodstream infections, reactive arthritis, seizure, and hemolytic uremic syndrome (HUS).

Antibiotic-Resistant Bugs: A Growing Threat

“The rise of drug-resistant bacteria of all kinds is a growing public health threat,” Yancey cautioned. “Because of overuse of antibiotics for many years, we have driven the emergence of bacteria that are harder and harder to treat.”

A 2019 World Health Organization report found antibiotic resistance is rising to dangerously high levels in all parts of the world. This is due to pathogens emerging with new resistance mechanisms that are spreading globally, threatening our ability to treat common infectious diseases.

A 2022 report shows high levels (above 50 percent) of resistance were reported in bacteria frequently causing bloodstream infections in hospitals, like Klebsiella pneumoniae and Acinetobacter species. These life-threatening infections require treatment with last-resort antibiotics, such as carbapenems.

Despite the rise of antibiotic-resistant Shigella, the overall risk to public health in the United States remains relatively low, and health care providers are ready to treat these antibiotic-resistant strains.

“Patients with Shigella are started on IV fluids for hydration and given antibiotics,” explained Yancey. She pointed out that doctors are aware of the resistant patterns and if they suspect someone has a drug-resistant strain, they will start broad-spectrum antibiotics.

“These [antibiotics] can be narrowed down once culture results have come back,” said Yancy.

The CDC recommends using antibiotics “only when clinically indicated.”

The agency emphasized (pdf), “In this era of rapidly emerging resistance, it's important to remember that antibiotics can have side effects and sometimes do more harm than good.”

It is important for health care providers to be aware of the potential for antibiotic-resistant Shigella and to take appropriate steps to prevent the spread of the bacteria. This may include testing for antibiotic resistance when diagnosing and treating shigellosis and implementing infection control measures in health care settings.

The CDC says people infected with shigellosis must stay home if they work in health care, food service, or childcare. During illness and for several weeks after it resolves, people should wash hands often, avoid touching food intended for others, refrain from swimming, and not have any sexual contact.

Reducing Your Chances of Infection

According to the CDC, you can reduce the risk of Shigella infection by following these steps:

• Carefully wash your hands with soap and water before preparing food and eating, and after changing a diaper or helping clean another person who has defecated.
• If you care for a child in diapers who is infected, promptly throw away soiled diapers in a covered, lined garbage can. Wash the child’s and your own hands carefully with soap and water immediately after diapering, and promptly disinfect the changing surface.
• Avoid swallowing water from ponds, lakes, and untreated swimming pools.

Travelers to places with poor sanitation, and where food and water could be unsafe, are more likely to be infected.

They are also at increased risk of infection with types of Shigella that are antibiotic resistant. When traveling internationally, keep safe eating and drinking habits.