Albert M John, Purohit Prashant, Poirel Laurent, Carter Glen, Bulach Dieter
Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
Department of Medical Microbiology, Al-Sabah Hospital, Shuwaikh, Kuwait.
Gut Pathog. 2021 Mar 20;13(1):18. doi: 10.1186/s13099-021-00413-9.
Infections caused by multidrug-resistant shigellae resistant to broad-spectrum cephalosporins are becoming more prevalent in the Middle East. We report a case of severe diarrhea due to a multiresistant Shigella flexneri 1 strain carrying four different ß-lactamase genes.
A one-year-old Syrian infant presented with severe acute diarrhea, vomiting and dehydration. She did not respond to empirical treatment with amoxicillin-clavulanic acid followed by cefotaxime. Later, stool culture revealed S. flexneri 1 resistant to both these drugs. The patient was successfully treated with meropenem to which S. flexneri 1 was susceptible. The isolate was resistant to eight classes of antibiotics, and the whole genome sequence (WGS) identified four ß-lactamase genes (bla, bla, bla, and bla) along with genes mediating resistance to seven other antibiotic classes. The WGS also identified several virulence genes including senA that encodes ShET-2 which induces watery diarrhea. Phylogenetically, the isolate was closely related to isolates from South Asia.
This report highlights the emergence of extremely resistant Shigella that has acquired multiple resistance genes to cephalosporins rendering these drugs ineffective.
对广谱头孢菌素耐药的多重耐药志贺菌引起的感染在中东地区正变得越来越普遍。我们报告一例由携带四种不同β-内酰胺酶基因的多重耐药福氏志贺菌1型菌株引起的严重腹泻病例。
一名1岁叙利亚婴儿出现严重急性腹泻、呕吐和脱水。她对阿莫西林-克拉维酸经验性治疗以及随后的头孢噻肟治疗均无反应。后来，粪便培养显示福氏志贺菌1型对这两种药物均耐药。该患者用美罗培南成功治疗，福氏志贺菌1型对美罗培南敏感。该分离株对八类抗生素耐药，全基因组测序（WGS）鉴定出四个β-内酰胺酶基因（bla、bla、bla和bla）以及介导对其他七类抗生素耐药的基因。WGS还鉴定出几个毒力基因，包括编码诱导水样腹泻的ShET-2的senA。从系统发育来看，该分离株与来自南亚的分离株密切相关。
本报告强调了出现了具有极强耐药性的志贺菌，其获得了多个对头孢菌素的耐药基因，使这些药物失效。
