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CORRESPONDENCE
Year : 2004  |  Volume : 22  |  Issue : 3  |  Page : 199-200
 

Changing resistance pattern of shigella isolates in a Delhi hospital: An alarming trend


Department of Microbiology, Maulana Azad Medical College and Associated LN Hospital, New Delhi - 110 002, India

Date of Submission21-Oct-2003
Date of Acceptance07-Jan-2004

Correspondence Address:
Department of Microbiology, Maulana Azad Medical College and Associated LN Hospital, New Delhi - 110 002, India



How to cite this article:
Uppal B, Arora V M. Changing resistance pattern of shigella isolates in a Delhi hospital: An alarming trend. Indian J Med Microbiol 2004;22:199-200


How to cite this URL:
Uppal B, Arora V M. Changing resistance pattern of shigella isolates in a Delhi hospital: An alarming trend. Indian J Med Microbiol [serial online] 2004 [cited 2020 Jul 12];22:199-200. Available from: http://www.ijmm.org/text.asp?2004/22/3/199/11223


Dear Editor,
Shigellosis is a major cause of morbidity and mortality among children in the developing countries but effective antimicrobial therapy reduces both its duration and severity. Emergence of resistance to ampicillin and trimethoprim-sulphamethoxazole (TMP-SMX) in the 1980s led to the use of nalidixic acid (NA) as the first line drug for shigellosis. However, increasing number of clinical Shigella isolates are showing resistance to NA and other quinolones leading to a therapeutic problem.[1],[2]
We evaluated the distribution and resistance pattern of Shigella species isolated from children of less than 12 years age and admitted in diarrhoea ward of LN Hospital from 1st January to 31st December 2002. From a total of 986 stool samples 56(5.67%) shigellae were identified by culture and subsequent serotyping. Sensitivity of Shigella serotypes to twelve antimicrobial agents was tested by Kirby Bauer[3] method using: ampicillin (10mg), TMP-SMX (25 mg), tetracycline (30 mg), NA (30 mg), chloramphenicol (30 mg), furazolidone (100 mg), ciprofloxacin (5 mg), norfloxacin (10 mg), ofloxacin (2 mg), gentamicin (10 mg), ceftriaxone (30 mg) and azithromycin (30 mg).
S. flexneri was isolated from 44 (78.57%) cases,  S.dysenteriae   type1 - 8 (14.28%) and  S.sonnei   - 4 (7.14%). Peak isolation was seen in the months of July-September. All S.dysenteriae type1 were resistant to NA. The resistance to ciprofloxacin, norfloxacin and ofloxacin was 62.5%, 75% and 25% respectively. Resistance to five or more antibiotics was seen in all S.dysenteriae type 1 strains [Table - 1]. Twenty (45.45%) of S. flexneri strains showed resistance to NA. None of the S. sonnei strains showed resistance to NA.
100% resistance of S.dysenteriae type 1 to NA was similar to other studies.[4] In addition, these isoaltes were resistant to fluoroquinolones. Cross-resistance due to decreased membrane permeability is well documented among chloramphenicol, trimethoprim, quinolones and tetracycline but not macrolides.[5] Hence a common plasmid mediated horizontal spread of multidrug resistance in S.dysenteriae type1 could be a cause of this finding and probably that is why no resistance to azithromycin was seen.
45.45% of  S.flexneri   showed resistance to NA, in contrast to Niyogi et al reporting 9% resistance to NA.[1] Surprisingly, resistance to furazolidone was not seen in our study in comparison to other Indian studies reporting 91-100% resistance.[1],[4] This could be attributed to possible regional variation in bacterial strains.
In conclusion, this study emphasizes the need for routine antimicrobial susceptibility testing for all Shigella strains. Unrestricted use of antimicrobials in dysentery/gastroenteritis has led to emergence of multidrug resistant Shigella strains. Alternative drugs like azithromycin, pivmecillin and ceftriaxone should further be evaluated for treatment of shigellosis. 

 ~ References Top

1.Niyogi SK, Dutta P, Mitra U. Trends in antimicrobial resistance of Shigella species isolates from children with acute diarrhoea. Indian Pediatr 2000;37(3): 339-341.  Back to cited text no. 1    
2.Jesudason MV. Shigella isolation in Vellore, south India (1997-2001). Indian J Med Res 2002;115:11-13.  Back to cited text no. 2    
3.Bauer AW, Kirby WMM, Sherris JC, Tucker M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45(4): 493-496.  Back to cited text no. 3    
4.Chunder N, Bhattacharya SK, Biswas D, Niyogi SK, Kumar R. Isolation of a fluoroquinolone resistant Shigella dysentriae 1 strain from Calcutta. Indian J Med Res 1997;106:494-496.  Back to cited text no. 4    
5.Hooper DC. New uses for new and old quinolones and the challenge of resistance. Clin Infec Dis 2000; 30(2):243-254.  Back to cited text no. 5    
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2004 - Indian Journal of Medical Microbiology
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