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Co-circulation of multidrug-resistant Shigella among men who have sex with men in Australia


Ingle, DJ and Easton, M and Valcanis, M and Seemann, T and Kwong, JC and Stephens, N and Carter, GP and Goncalves da Silva, A and Adamopoulos, J and Baines, SL and Holt, KE and Chow, EPF and Fairley, CK and Chen, MY and Kirk, MD and Howden, BP and Williamson, DA, Co-circulation of multidrug-resistant Shigella among men who have sex with men in Australia, Clinical Infectious Diseases pp. 1-10. ISSN 1058-4838 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 The Authors.

DOI: doi:10.1093/cid/ciz005


Background: In urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages.

Methods: A population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews.

Results: Rates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigellasonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates.

Conclusions: Our contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection.

Item Details

Item Type:Refereed Article
Keywords:shigellosis, epidemiology, genomics, antimicrobial resistance, sexually transmitted infections,multidrug resistant Shigella
Research Division:Health Sciences
Research Group:Epidemiology
Research Field:Epidemiology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Disease distribution and transmission (incl. surveillance and response)
UTAS Author:Stephens, N (Associate Professor Nicola Stephens)
ID Code:132646
Year Published:2019
Web of Science® Times Cited:50
Deposited By:Medicine
Deposited On:2019-05-15
Last Modified:2019-06-06

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