Increasing single and multi-antibiotic resistance in Shigella species isolated from shigellosis patients in Sana'a, Yemen

OBJECTIVE: The epidemiology and antibiotic susceptibility of Shigella species changes over time. Updated susceptibility knowledge is necessary for appropriate empirical antibiotic treatment. Thus, this research aimed to study these changes in 2 time periods with an interval of 10 years.

METHODS: Two hundreds and three Shigella strains, isolated from stool samples of diarrheic patients at the Central Health Laboratory in Sana'a, Yemen in 2 time periods (1993 and 2003) with a 10-year interval, were examined for serotyping and drug resistance pattern. Resistance patterns of the strains to 12 commonly used antimicrobial agents and minimum inhibitory concentrations of the antibiotics were tested.

RESULTS: Shigella flexneri (60%) was found to be the most common isolate of the total Shigella species, followed by Shigella dysenteriae (28.6%) and Shigella boydii (11.3%). In Shigella flexneri strains, Shigella flexneri 3 (30.5%) was the most prevalent serotype, followed by Shigella flexneri 6 (17.2%), and Shigella flexneri 1 (12.3%). All strains were found equally susceptible to cefotaxime, ceftriaxone, ciprofloxacin, and gentamicin, but more than 80% of the strains of 2003 were resistant to tetracycline, co-trimoxazole, and 52% of the same strains were resistant to ampicillin. Resistance to chloramphenicol was found in 61%, cefuroxime in 56.2%, and cephradine, 52% of the strains. Overall, Shigella species showed statistically significant increase in resistance against tetracycline, cephradine, trimethoprim/sulfamethoxazole, nalidixic acid, and aztreonam (p<0.05) over the 10 years period. This indicates decreased efficacy of co-trimoxazole and nalidixic acid for the empirical treatment of shigellosis in Sana'a, Yemen. Almost 55.2% of the strains were resistant to 4 drugs.

CONCLUSION: This is one of the first studies reporting epidemiological pattern of Shigella species in Sana'a, Yemen with regard to serotypes and antibiotic resistance patterns. Based on these antibiotic resistance pattern findings, it is suggested that the commonly in use antibiotics including ampicillin, trimethoprim/sulfamethoxazole, tetracycline, and chloramphenicol should not be used for empirical treatment of shigellosis in Yemen.