Lane, CR and Sutton, B and Valcanis, M and Kirk, M and Walker, C and Lalor, K and Stephens, N, Travel destinations and sexual behavior as indicators of antibiotic resistant Shigella strains - Victoria, Australia, Clinical Infectious Diseases, 62, (6) pp. 722-729. ISSN 1058-4838 (2016) [Refereed Article]
Copyright 2015 The Authors
Background. Knowledge of relationships between antibiotic susceptibility of Shigella isolates and travel destination or other risk factors can assist clinicians in determining appropriate antibiotic therapy prior to susceptibility testing. We describe relationships between resistance patterns and risk factors for acquisition in Shigella isolates using routinely collected data for notified cases of shigellosis between 2008 and 2012 in Victoria, Australia.
Methods. We included all shigellosis patients notified during the study period, where Shigella isolates were tested for antimicrobialsensitivity using Clinical and Laboratory Standards Institute breakpoints. Cases were interviewed to collect data on risk factors,including recent travel. Data were analyzed using Stata 13.1 to examine associations between risk factors and resistant strains.
Results. Of the 500 cases of shigellosis, 249 were associated with overseas travel and 210 were locally acquired. Forty-six of 51 isolates of Indian origin displayed decreased susceptibility or resistance to ciprofloxacin. All isolates of Indonesian origin were susceptible to ciprofloxacin. Twenty-six travel-related isolates were resistant to all tested oral antimicrobials. Male-to-male sexual contact was the primary risk factor for 80% (120/150) of locally acquired infections among adult males, characterized by distinct periodic Shigella sonnei outbreaks.
Conclusions. Clinicians should consider travel destination as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group.
|Item Type:||Refereed Article|
|Keywords:||shigellosis, travel medicine, sexually transmitted diseases, bacterial, drug resistance,antibiotic resistance, shigella|
|Research Division:||Health Sciences|
|Research Field:||Epidemiology not elsewhere classified|
|Objective Group:||Public health (excl. specific population health)|
|Objective Field:||Disease distribution and transmission (incl. surveillance and response)|
|UTAS Author:||Stephens, N (Dr Nicola Stephens)|
|Year Published:||2016 (online first 2015)|
|Web of Science® Times Cited:||14|
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