Tags

Type your tag names separated by a space and hit enter

Azithromycin non-susceptible Shigella circulating in Israel, 2014-2016.
PLoS One 2019; 14(10):e0221458Plos

Abstract

Shigella species remains a major diarrhoeagenic agent, affecting mostly children, with global high incidence and high mortality rate specially in developing areas. Although azithromycin is recommended for treatment of shigellosis, there are currently no CLSI susceptibility breakpoints, accordingly no routine antimicrobial susceptibility test is performed in the clinical laboratory. The purpose of this study was to estimate the prevalence, resistance profile and molecular epidemiology of azithromycin non-susceptible Shigella strains in Israel during a three year period. Shigella isolates (n = 1,170) referred to the National Reference Center during 2014-2016, were included in this study. Serotyping was performed by slide agglutination. Resistance genes, mph(A) and erm(B), were identified by PCR and the phenotype profile was determined by broth microdilution (BMD). Genetic relatedness was assessed by wgMLST. Decreased susceptibility to azithromycin (DSA) phenotype and genotype were detected in various Shigella species and serotypes related to diverse genetic backgrounds and antimicrobial profiles: 6% (26/423) of Shigella flexneri and 2% (16/747) of Shigella sonnei displayed DSA (MIC16 mg/L). Correlation of this phenotype with the presence of mph(A) and erm(B) genes was confirmed. All DSA-strains displayed resistance to ≥3 different antimicrobial classes. Among DSA-strains, 14% were resistant to quinolones and 5% displayed resistance to ceftriaxone. Most of these strains (32/42) were isolated from children in the southern and central regions of Israel. Clonality and significant relatedness was confirmed by PFGE and wgMLST. The presence of macrolide resistance genes among the different species and lineages reflects the transmissible nature of these genes. The emergence of DSA-Shigella reinforces the necessity to establish clinical breakpoints that would warrant routine testing, reporting and surveillance for this drug of choice.

Authors+Show Affiliations

Government Central Laboratories, Ministry of Health, Jerusalem, Israel.Government Central Laboratories, Ministry of Health, Jerusalem, Israel.Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.Government Central Laboratories, Ministry of Health, Jerusalem, Israel.Government Central Laboratories, Ministry of Health, Jerusalem, Israel.Government Central Laboratories, Ministry of Health, Jerusalem, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31626667

Citation

Ezernitchi, Analía V., et al. "Azithromycin Non-susceptible Shigella Circulating in Israel, 2014-2016." PloS One, vol. 14, no. 10, 2019, pp. e0221458.
Ezernitchi AV, Sirotkin E, Danino D, et al. Azithromycin non-susceptible Shigella circulating in Israel, 2014-2016. PLoS ONE. 2019;14(10):e0221458.
Ezernitchi, A. V., Sirotkin, E., Danino, D., Agmon, V., Valinsky, L., & Rokney, A. (2019). Azithromycin non-susceptible Shigella circulating in Israel, 2014-2016. PloS One, 14(10), pp. e0221458. doi:10.1371/journal.pone.0221458.
Ezernitchi AV, et al. Azithromycin Non-susceptible Shigella Circulating in Israel, 2014-2016. PLoS ONE. 2019;14(10):e0221458. PubMed PMID: 31626667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Azithromycin non-susceptible Shigella circulating in Israel, 2014-2016. AU - Ezernitchi,Analía V, AU - Sirotkin,Elizabeta, AU - Danino,Dana, AU - Agmon,Vered, AU - Valinsky,Lea, AU - Rokney,Assaf, Y1 - 2019/10/18/ PY - 2019/01/08/received PY - 2019/08/07/accepted PY - 2019/10/19/entrez PY - 2019/10/19/pubmed PY - 2019/10/19/medline SP - e0221458 EP - e0221458 JF - PloS one JO - PLoS ONE VL - 14 IS - 10 N2 - Shigella species remains a major diarrhoeagenic agent, affecting mostly children, with global high incidence and high mortality rate specially in developing areas. Although azithromycin is recommended for treatment of shigellosis, there are currently no CLSI susceptibility breakpoints, accordingly no routine antimicrobial susceptibility test is performed in the clinical laboratory. The purpose of this study was to estimate the prevalence, resistance profile and molecular epidemiology of azithromycin non-susceptible Shigella strains in Israel during a three year period. Shigella isolates (n = 1,170) referred to the National Reference Center during 2014-2016, were included in this study. Serotyping was performed by slide agglutination. Resistance genes, mph(A) and erm(B), were identified by PCR and the phenotype profile was determined by broth microdilution (BMD). Genetic relatedness was assessed by wgMLST. Decreased susceptibility to azithromycin (DSA) phenotype and genotype were detected in various Shigella species and serotypes related to diverse genetic backgrounds and antimicrobial profiles: 6% (26/423) of Shigella flexneri and 2% (16/747) of Shigella sonnei displayed DSA (MIC16 mg/L). Correlation of this phenotype with the presence of mph(A) and erm(B) genes was confirmed. All DSA-strains displayed resistance to ≥3 different antimicrobial classes. Among DSA-strains, 14% were resistant to quinolones and 5% displayed resistance to ceftriaxone. Most of these strains (32/42) were isolated from children in the southern and central regions of Israel. Clonality and significant relatedness was confirmed by PFGE and wgMLST. The presence of macrolide resistance genes among the different species and lineages reflects the transmissible nature of these genes. The emergence of DSA-Shigella reinforces the necessity to establish clinical breakpoints that would warrant routine testing, reporting and surveillance for this drug of choice. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31626667/Azithromycin_non-susceptible_Shigella_circulating_in_Israel,_2014-2016 L2 - http://dx.plos.org/10.1371/journal.pone.0221458 DB - PRIME DP - Unbound Medicine ER -