Public Health England reports cases of microbial resistant Shigella
PHE press statement
Public Health England (PHE) recently identified five cases of Shigella sonnei phage type 6 which show high levels of antimicrobial resistance – typically only seen before in Shigella infections associated with travel and therefore imported.
The Shigella sonnei isolated in these cases are clustered by whole genome sequencing suggesting they belong to an outbreak.
Four cases are adult men who have sex with men (MSM) from London with sample dates from 21 September to 27 October inclusive. The fifth case, from mid-November, is an adult man from outside London with a likely sexual exposure in London.
The isolates from these cases have genes conferring resistance to amoxicillin, ceftriaxone (first line treatment for HIV positive individuals with invasive shigellosis), trimethoprim, sulphonamides, tetracycline, including the extended-spectrum beta-lactamase (ESBL) resistance gene CTX-M-27 and macrolide resistance genes ermB/mph(A). These resistance genes are plasmid mediated and therefore readily transmissible. The isolates are phenotypically sensitive to quinolones, carbapenems, aminogylcosides and fosfomycin.
Our primary concerns are as follows: a) that this strain might spread rapidly among HIV positive MSM in high-risk sexual networks, including outside of London b) potential spread of resistance to other Shigella and other organisms c) the possibility of treatment failure for severe shigellosis disease in the immunocompromised.
PHE would therefore recommend that all GUM and HIV doctors:
- Provide written advice to all MSM attending their services (especially HIV positive patients) on how to prevent infection with Shigella. Materials are available on the PHE website here:
- Obtain appropriate and timely stool samples for patients presenting with acute diarrhoea, abdominal pain and fever.
- Provide advice to patients with Shigella on how to prevent onward transmission.
- Discuss the need for antibiotic management of severe disease (fever, bloody diarrhoea or signs of sepsis) with their microbiologist.
- Notify cases to their local Health Protection Team.
- Record any Shigella diagnosis in England using the appropriate SHHAPT code (SG1, SG2 or SG3) in the patient’s medical record, so that it can be reported in GUMCAD. See SHHAPT code look-up here: