Journal of Gastrointestinal Infections

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VOLUME 4 , ISSUE 1 ( 2014 ) > List of Articles

ORIGINAL ARTICLE

Ciprofloxacin Resistant Shigella flexneri in India–A New Therapeutic Challenge

Prashant Sood, Neelam Taneja, Pooja Rao, Garima Sangar, Shivapriya

Keywords : Shigella flexneri, Ciprofloxacin resistance, India

Citation Information : Sood P, Taneja N, Rao P, Sangar G, S. Ciprofloxacin Resistant Shigella flexneri in India–A New Therapeutic Challenge. J Gastrointest Infect 2014; 4 (1):33-35.

DOI: 10.5005/jp-jogi-4-1-33

License: CC BY-SA 4.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background & Objective: Fluoroquinlones (FQ) have been highly effective drugs for treatment of shigellosis all over the world. Ciprofloxacin resistance in Shigella flexneri has emerged as a therapeutic challenge in our region. Here, we report clinical presentation of patients in whom S. flexneri was isolated from stool specimens as well as trends of ciprofloxacin susceptibility for the period 2000-2005. Material and Methods: Stool samples were cultured and shigella spp. were identified using standard methods Antibiotic susceptibility was performed in accordance with Clinical Laboratory Standards (CLSI). Minimum inhibitory concentration (MIC) studies were performed by using the agar dilution technique of CLSI and E test. Patients\' clinical details and response to therapy were noted. Plasmid profile of ciprofloxacin resistant strains was performed by the rapid alkaline lysis method. Conjugation experiments were done to determine whether quinolone resistance was transferable to E .coli J 53 Rif R. Results : From 995 stool samples submitted from 1st Jan 2005 to 31st Dec 2005, 53 shigellae were isolated. S. flexneri (31 isolates, 60.7%) was the predominant isolate, followed by S. dysenteriae (7), S .sonnei and S. boydii (6 each) and 3 (nonagglutinable). Isolates from 23 out of 28 patients (82%) with S. flexneri shigellosis showed ciprofloxacin resistance (MIC>4). Seven patients infected with S. flexneri did not show any response to either ciprofloxacin/ ofloxacin, but 3 patients responded to ceftriaxone & 4 patients respond to combination of amikacin & ciprofloxacin. Three patients showed a partial response, 2 relapsed after an initial response. Over a period of five years, a trend towards increasing MIC was noticed. Though the increase in MIC values appears gradual for MIC <4, a sharp peak is noticed for MIC>4 in 2005. Though plasmids of 2, 4 and 1.8 Kb were transferred to E coli, the E coli conjugants were susceptible to ciprofloxacin, thereby confirming that ciprofloxacin resistance was not plasmid mediated Interpretation & Conclusion: There is a great immediate need for an effective oral agent that can be safely used for treatment of children with shigellosis along with continued surveillance required at regional and national level.


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