MMWR Morb Mortal Wkly Rep. 2014 Feb 14;63(6):132-3.
Bacteria of the genus Shigella cause approximately 500,000 illnesses each year in the United States. Diarrhea (sometimes bloody), fever, and stomach cramps typically start 1-2 days after exposure and usually resolve in 5-7 days. For patients with severe disease, bloody diarrhea, or compromised immune systems, antibiotic treatment is recommended, but resistance to traditional first-line antibiotics (e.g., ampicillin and trimethoprim-sulfamethoxazole) is common. For multidrugresistant cases, azithromycin, the most frequently prescribed antibiotic in the United States, is recommended for both children and adults. However, not all Shigellae are susceptible to azithromycin. Nonsusceptible isolates exist but are not usually identified because there are no clinical laboratory guidelines for azithromycin susceptibility testing. However, to monitor susceptibility of Shigellae in the United States, CDC's National Antimicrobial Resistance Monitoring System (NARMS) has, since 2011, routinely measured the azithromycin minimum inhibitory concentration (MIC) for every 20th Shigella isolate submitted from public health laboratories to CDC, as well as outbreak-associated isolates. All known U.S. Shigella isolates with decreased susceptibility to azithromycin (DSA-Shigella), and the illnesses caused by them, are described in this report.
在美国，每年大约有 50 万人感染志贺氏菌属细菌。腹泻（有时伴有血便）、发热和腹部绞痛通常在接触后 1-2 天开始，通常在 5-7 天内缓解。对于病情严重、有血便或免疫系统受损的患者，建议进行抗生素治疗，但对传统一线抗生素（如氨苄西林和复方磺胺甲噁唑）的耐药性很常见。对于多重耐药病例，美国最常开的抗生素阿奇霉素被推荐用于儿童和成人。然而，并非所有的志贺氏菌都对阿奇霉素敏感。存在非敏感性分离株，但通常不会被识别，因为没有临床实验室阿奇霉素药敏试验的指南。然而，为了监测美国志贺氏菌的药敏情况，自 2011 年以来，疾病预防控制中心的国家抗菌药物耐药性监测系统（NARMS）已经对从公共卫生实验室提交给疾病预防控制中心的每 20 份志贺氏菌分离株以及与暴发相关的分离株常规测量阿奇霉素的最低抑菌浓度（MIC）。本报告描述了所有已知对阿奇霉素有降低敏感性的美国志贺氏菌分离株（DSA-Shigella）及其引起的疾病。
