Epidemiology and Infection

Gastroenteritis

Changing species distribution and antimicrobial susceptibility pattern of Shigella over a 29-year period (1980–2008)

F. KHATUNa1 c1, A. S. G. FARUQUEa1, J. L. KOECKa2a3, P. OLLIAROa4, P. MILLETa2, N. PARISa5, M. A. MALEKa1, M. A. SALAMa1 and S. LUBYa1

a1 International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh

a2 Centre René Labusquière, Université Victor Segalen Bordeaux 2, Bordeaux, France

a3 Service de Biologie Clinique, Hôpital Militaire Robert Piqué, Bordeaux, France

a4 UNICEF/UNDP/WB/WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland

a5 Société OPTIMA, Merignac, France

SUMMARY

We studied changes in species distribution and antimicrobial resistance patterns of Shigella during 1980–2008, using the Diarrhoeal Diseases Surveillance system of Dhaka Hospital of ICDDR,B. In hospitalized patients Shigella prevalence decreased steadily from 8–12% in the 1980s to 3% in 2008. Endemic S. flexneri was the most commonly isolated species (54%). Epidemic S. dysenteriae type 1 had two peaks in 1984 and 1993, but was not found after 2000, except for one case in 2004. The therapeutic options are now limited: in 2008 a total of 33% of S. flexneri were resistant to ciprofloxacin and 57% to mecillinam. In the <5 years age group, severely underweight, wasted and stunted children were more at risk of shigellosis compared to well-nourished children (P<0·001). Although hospitalization for Shigella diarrhoea is decreasing, the high levels of antimicrobial resistance and increased susceptibility of malnourished children continue to pose an ongoing risk.

(Accepted April 16 2010)

(Online publication May 18 2010)

Correspondence:

c1 Author for correspondence: F. Khatun, MBBS, M.Sc., Public Health Sciences Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka-1212, Bangladesh. (Email: kfatema@icddrb.org)

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