Shigellosis Caused by CTX-M Type ESBL Producing in Two Siblings of Rural Nepal: First Case Report from the Country.

Shigellosis is an acute infectious disease characterized as severe bloody diarrhea (dysentery) and is accountable for a significant burden of morbidity and mortality especially in children under the age of 5 years. Antimicrobial therapy is required in the cases of severe dysentery associated with . However, emergence of multidrug resistant (MDR) strains of spp. over the last two decades has restricted the use of common therapeutic antimicrobials. In MDR strains, the third-generation cephalosporins have been used for the treatment, but, unfortunately, emerging reports of enzyme mediated -lactam resistance among isolates from various parts of the world have greatly compromised the therapy of pediatric dysentery. In Nepal, drug resistant strains of spp. have been reported, but MDR and extended spectrum -lactamase (ESBL) producing strains were previously unknown. Here, we report two isolates harboring ESBL genotype-CTX-M associated with acute dysentery in two siblings which were presented and treated in a tertiary care teaching hospital of Kathmandu, Nepal.