Antibiotic resistance pattern in Shigella species isolated from children with acute diarrhea in Tabriz city, Iran

Background and aim: Shigella is one of the leading causes of acute diarrhea in children worldwide. Antibiotic resistance in this bacterium has increased due to the indiscriminate use of common antibiotics. Therefore, the aim of this study was to investigate the prevalence and pattern of antibiotic resistance in Shigella species isolated from children with acute diarrhea in Tabriz hospitals. Materials and methods: In this descriptive cross-sectional study, 321 samples suspected of Shigella were collected from children's diarrhea stool samples and identified using standard microbiological and biochemical tests. Antibiotic resistance was also determined using disk diffusion by the Kirby-Bauer method. Results: A total of 84 samples were positive for Shigella. Among them, S. flexneri species with 83.3% had the highest frequency and S. boydii with 13.1%, S. sonnei with 2.4% and S. dysanteriae with 1.2% had the lowest frequency. The highest resistance was related to the antibiotics cotrimoxazole (92.85%), tetracycline and ampicillin (67.86%) and the lowest resistance was related to imipenem antibiotics (2.38%) and ceftizoxime (9.52%). Conclusion: The present study showed that Shigella flexneri is the predominant species isolated from children with Shigellosis in hospitals in Tabriz city. Our results also indicate an increase in resistance to common antibiotics. Therefore, it is recommended that antimicrobial susceptibility testing be performed in the study area prior to antibiotic administration.

Keywords:

Prevalence, Shigella Diarrhea, Drug Resistance,

PDF

___

Abbasi P, Kargar M, Doosti A, Mardaneh J, Ghorbani-Dalini S, Dehyadegari MA. Characterization of Shiga-toxin producing E.coli (STEC) and enteropathogenic E.coli (EPEC) using multiplex Real-Time PCR assays for stx1, stx2, eaeA. Iran J Microbiol 2014; 6: 169-74.
Niyogi SK. Shigellosis. J Microbiol 2005; 43: 133-43.
Anvarinejad M, Pouladfar GR, Pourabbas B, et al. Detection of Salmonella spp. with the BACTEC 9240 Automated Blood Culture System in 2008 - 2014 in Southern Iran (Shiraz): Biogrouping, MIC, and Antimicrobial Susceptibility Profiles of Isolates. Jundishapur J Microbiol 2016; 9: e26505.
Kotloff KL, Winickoff JP, Ivanoff B, et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ 1999; 77: 651-66.
Ke X, Gu B, Pan S, Tong M. Epidemiology and molecular mechanism of integron-mediated antibiotic resistance in Shigella. Arch Microbiol 2011; 193: 767-774.
Ahs JW, Tao W, Löfgren J, Forsberg BC. Diarrheal diseases in low-and middle-income countries: incidence, prevention and management. Open Infect Dis J 2010; 4: 113-24
Schroeder GN, Hilbi H. Molecular pathogenesis of Shigella spp. controlling host cell signaling, invasion, and death by type III secretion. Clin Microbiol Rev 2008; 21: 134-56.
Ahmed AM, Furuta K, Shimomura K, Kasama Y, Shimamoto T. Genetic characterization of multidrug resistance in Shigella spp. from Japan. J Med Microbiol 2006; 55: 1685-91.
Ahmed AM, Shimamoto T. Molecular characterization of multidrug-resistant Shigella spp. of food origin. Int J Food Microbiol 2015; 194: 78-82.
Dutta S, Chatterjee A, Dutta P, et al. Sensitivity and performance characteristics of a direct PCR with stool samples in comparison to conventional techniques for diagnosis of Shigella and enteroinvasive Escherichia coli infection in children with acute diarrhoea in Calcutta, India. J Med Microbiol 2001; 50: 667-74.
Clinical, Institute LS. Performance standards for antimicrobial susceptibility testing. Clinical and Laboratory Standards Institute Wayne, PA; 2017.
Ashida H, Ogawa M, Mimuro H, Sasakawa C. Shigella infection of intestinal epithelium and circumvention of the host innate defense system. Curr Top Microbiol Immunol 2009; 337: 231-55.
Keren DF, McDonald RA, Wassef JS, Armstrong LR, Brown JE. The enteric immune response to Shigella antigens. Curr Top Microbiol Immunol 1989; 146: 213-23.
Alavi YM, Zamnzad DB. [Clinical and bacteriological survey of invasive diarrhea, Kashani hospital, Shahrekord, 1597], J. Shahrekord Univ Med Sci 2002; 4: 58-62.
Khorshidi A, Akbari H, Salalehi A. Shigellosis frequency, serotyping & antibiotical resistance pattern in Kashan, Iran (2000-2001). Feyz J 2006; 10: 65-70.
Abbasi E, Abtahi H, van Belkum A, Ghaznavi-Rad E. Multidrug-resistant Shigella infection in pediatric patients with diarrhea from central Iran. Infect Drug Resist 2019; 12: 1535-44.
Hosseini Nave H, Mansouri S, Emaneini M, Moradi M. Distribution of genes encoding virulence factors and molecular analysis of Shigella spp. isolated from patients with diarrhea in Kerman, Iran. Microb Pathog 2016; 92: 68-71.
Kahsay AG, Teklemariam Z. Prevalence of Shigella among diarrheic children under-5 years of age attending at Mekelle health center, north Ethiopia. BMC Res Notes 2015; 8: 788.
Tajaddini S, Kajbaf M. The survey of antibiotical resistance of entropathogenic E. coli & Shigella in infants with diarrhea. Uremia UMS J 1997; 8: 177-84.
Moosavian M, Ghaderiyan GH, Shahin M, Navidifar T. First investigation of the presence of SPATE genes in Shigella species isolated from children with diarrhea infection in Ahvaz, southwest Iran. Infect Drug Resist 2019; 12: 795-804.
Nikfar R, Shamsizadeh A, Darbor M, Khaghani S, Moghaddam M. A Study of prevalence of Shigella species and antimicrobial resistance patterns in paediatric medical center, Ahvaz, Iran. Iran J Microbiol 2017; 9: 277-83.
Karimi-Yazdi M, Ghalavand Z, Shabani M, et al. High rates of antimicrobial resistance and virulence gene distribution Among Shigella spp. Isolated from Pediatric Patients in Tehran, Iran. Infect Drug Resist 2020; 13: 485-92.
Taneja N, Mewara A. Shigellosis: Epidemiology in India. Indian J Med Res 2016; 143: 565-76.
Dolatshahi Z, Amini K. Survey of tetracycline resistance genes in Shigella sonnei isolated from acute pediatric with bacterial diarrhea using Multiplex PCR method and their antibiotic resistance patterns. Zanko J Med Sci 2016; 17: 35-44.
Nikfar R, Shamsizadeh A, Darbor M, Khaghani S, Moghaddam M. A Study of prevalence of Shigella species and antimicrobial resistance patterns in paediatric medical center, Ahvaz, Iran. Iran J Microbiol 2017; 9: 277-83.
Pourakbari B, Mamishi S, Mashoori N, et al. Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006. Braz J Infect Dis 2010; 14: 153-7.
Ashkenazi S, Levy I, Kazaronovski V, Samra Z. Growing antimicrobial resistance of Shigella isolates. J Antimicrob Chemother 2003; 51: 427-9.
Akçali A, Levent B, Akbaş E, Esen B. Türkiye'nin bazi illerinde izole edilen Shigella sonnei suşlarinin antimikrobiyal direnç ve "pulsed field" jel elektroforezi yöntemleri ile tiplendirilmesi [Typing of Shigella sonnei strains isolated in some provinces of Turkey using antimicrobial resistance and pulsed field gel electrophoresis methods]. Mikrobiyol Bul 2008; 42: 563-72.
Zamanlou S, Ahangarzadeh Rezaee M, Aghazadeh M, Ghotaslou R, Babaie F, Khalili Y. Characterization of integrons, extended-spectrum β-lactamases, AmpC cephalosporinase, quinolone resistance, and molecular typing of Shigella spp. from Iran. Infect Dis (Lond) 2018; 50: 616-24.
Aggarwal P, Uppal B, Ghosh R, et al. Multi drug resistance and Extended Spectrum Beta Lactamases in clinical isolates of Shigella: A study from New Delhi, India. Travel Med Infect Dis 2016; 14: 407-13.
Ranjbar R, Behnood V, Memariani H, Najafi A, Moghbeli M, Mammina C. Molecular characterisation of quinolone-resistant Shigella strains isolated in Tehran, Iran. J Glob Antimicrob Resist 2016; 5: 26-30.