Infektionsmedizinisches Centrum Hamburg, ICH, Glockengiesserwall 1, 20095, Hamburg, Germany.
Infection. 2013 Oct;41(5):999-1003. doi: 10.1007/s15010-013-0501-4. Epub 2013 Jul 13.
There is increasing evidence that shigellosis is a predominantly sexually transmitted disease among men who have sex with men (MSM) and that infection with the human immunodeficiency virus (HIV) is a risk factor for shigellosis.
Retrospective analysis of antibiotic resistance profiles of Shigella species isolated from stool specimens of patients presenting with diarrhea from January 2010 to July 2012 in three German outpatient clinics specialized in HIV care.
Among 79 cases of Shigella sonnei, 56 occurred in HIV-infected MSM, while 23 were observed in HIV-negative MSM. High resistance rates (>90%) were found for doxycycline, tetracycline, aminoglycosides, all cephalosporins of first and second generations tested, and trimethoprim/sulfamethoxazole. In total, 54% of cases were resistant to ciprofloxacin. Compared to negative subjects, HIV-infected MSM had a significantly higher rate of quinolone resistance. For ciprofloxacin, the resistance rates were 66 versus 24%, respectively (p = 0.0016). Individual resistance patterns did not indicate that this was due to a limited outbreak. Rates of resistance to other antibiotics than quinolones showed no differences between HIV-infected and HIV-negative cases. No resistance was found for carbapenems or newer cephalosporins such as ceftriaxone.
The high rates of S. sonnei isolates resistant to quinolones and other traditional antibiotics are of concern. Innovative prevention efforts are urgently needed. The empirical use of quinolones in HIV-infected patients presenting with S. sonnei infection is no longer recommended.
越来越多的证据表明，志贺菌病主要是男男性行为者（MSM）中的性传播疾病，并且感染人类免疫缺陷病毒（HIV）是志贺菌病的一个危险因素。
对 2010 年 1 月至 2012 年 7 月期间在三家专门从事 HIV 护理的德国门诊诊所就诊的腹泻患者粪便标本中分离的志贺菌属物种的抗生素耐药谱进行回顾性分析。
在 79 例宋内志贺菌中，56 例发生在 HIV 感染的 MSM 中，23 例发生在 HIV 阴性的 MSM 中。发现多西环素、四环素、氨基糖苷类、所有测试的第一代和第二代头孢菌素以及甲氧苄啶/磺胺甲恶唑的耐药率均较高（>90%）。总共有 54%的病例对环丙沙星耐药。与阴性受试者相比，HIV 感染的 MSM 对喹诺酮类药物的耐药率明显更高。对于环丙沙星，耐药率分别为 66%和 24%（p = 0.0016）。个体耐药模式表明，这并非由于有限的爆发。除了喹诺酮类以外，其他抗生素的耐药率在 HIV 感染和 HIV 阴性病例之间没有差异。未发现对碳青霉烯类或头孢曲松等新型头孢菌素类药物的耐药性。
宋内志贺菌分离株对喹诺酮类和其他传统抗生素的高耐药率令人担忧。迫切需要采取创新的预防措施。对于感染宋内志贺菌的 HIV 感染患者，不再推荐经验性使用喹诺酮类药物。
