Jpn. J. Infect. Dis., 56, 33-34, 2003

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Laboraoty and Epidemiology Communications

Multiresistant Shigella Species Isolated from Childhood Diarrhea Cases in Kolkata, India

Swapan Kumar Niyogi* and Gururaja Perumal Pazhani

Division of Microbiology, National Institute of Cholera and Enteric Diseases, Kolkata 700 010, India

Communicated by Haruo Watanabe

(Accepted February 26, 2003)


*Corresponding author: Mailing address: National Institute of Cholera and Enteric Diseases, P-33, C.I.T. Road, Scheme XM, Beliaghata, Kolkata 700 010, India. Tel: +91-33-350 0448, Fax: +91-33-350 5066, E-mail: niyogisk@hotmail.com


Antimicrobial therapy for shigellosis reduces the duration and severity of the disease and can also prevent potentially lethal complications (1). However, over the past few decades Shigella spp. have become progressively resistant to most of the first-line drugs used, and the prevalence of multidrug-resistant strains is an important concern of treatment (2,3). In this report we analyze the occurrence rate and multidrug-resistance pattern of Shigella isolates obtained from childhood diarrhea cases.

From January 2001 to June 2002, a total of 1,295 stool samples was collected from children suffering from acute diarrhea who attended the Diarrhoea Treatment Unit at Dr. B.C. Roy Memorial Hospital for Children, Kolkata, and were cultured for Shigella spp. All isolates were confirmed serologically by slide agglutination using commercially purchased antisera (Denka Seiken, Tokyo). Antimicrobial susceptibility tests were performed using an agar diffusion technique method in accord with the National Committee for Clinical Laboratory Standards guidelines (4). The sixty-eight strains of Shigella spp. isolated were distributed as follows: 37 (54.4%) were S. flexneri, 19 (28%) were S. sonnei, 9 (13.2%) were S. boydii, and 3 (4.4%) were S. dysenteriae. Antimicrobial susceptibility testing of Shigella spp. showed a high degree of resistance to the commonly used antimicrobials, including ampicillin (41%), co-trimoxazole (95%), tetracycline (87%), and nalidixic acid (59%), and low level resistance against norfloxacin (9%) and ciprofloxacin (6%). We observed a different antimicrobial resistance pattern among four Shigella spp., necessitating the identification of serogroups along with resistance patterns for purposes of treatment of shigellosis. Overall, 90% of Shigella isolates were found resistant to two or more antimicrobial agents. Multidrug resistance also varied significantly among species (Table 1).

Antimicrobial resistance has been occurring among Shigella spp. since the 1940s, when sulfonamide resistance among Shigella organisms was first recognized in Japan (5). By 1970, widespread resistance of this disease to sulfonamides limited their therapeutic usefulness (6). In 1984, an epidemic of shigellosis, caused primarily by multidrug-resistant S. dysenteriae 1, broke out in the eastern part of India and caused many deaths in and around Kolkata (7). During this period, the efficacy of nalidixic acid in the treatment of multi-resistant S. dysenteriae 1 infection was reported from Kolkata (8). However, within a short period, the widespread use of this drug resulted in the emergence of nalidixic acid-resistant S. dysenteriae type 1 (9). The development of resistance of Shigella spp. to common drugs in Kolkata had been reported earlier (10). Shigella isolates resistant to multiple drugs have been reported from several parts of the world (11,12). Our results revealed that multi-resistant strains of Shigella are present in Kolkata, and emphasize the importance of maintaining surveillance of these strains in order to assess local susceptibility patterns and empiric therapy. Multidrug resistance is an emerging problem in the clinical management of shigellosis, particularly in children in third world countries where diarrheal diseases are a major cause of childhood morbidity and mortality.

The authors thank Mr. S. K. Das for typing this manuscript.

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