ArticlePLoS medicine2016
South Asia as a Reservoir for the Global Spread of Ciprofloxacin-Resistant Shigella sonnei: A Cross-Sectional Study.
Article in PLoS medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 3 of them syntheses that pooled it.
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Who cites it
67 citing papers in PubMed, 3 syntheses or guidelines pooled it, 115 citations in OpenAlex.
- Antimicrobial resistance in community-acquired enteric pathogens among children aged ≤ 10-years in low-and middle-income countries: a systematic review and meta-analysis.Frontiers in microbiology · 2025Pooled it
- Prevalence of Shigella species and antimicrobial resistance patterns in Africa: systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- The increasing antimicrobial resistance ofPathogens and global health · 2023Pooled it
- A Double-blind, Randomized, Placebo-controlled Trial of Lactobacillus acidophilus for the Treatment of Acute Watery Diarrhea in Vietnamese Children.The Pediatric infectious disease journal · 2018Trial
- Review
- Surveillance of enteropathogenicJournal of medical microbiology · 2026Article
- Fluoroquinolone resistance-associated determinants in ciprofloxacin-susceptibleFrontiers in microbiology · 2026Article
- A public resource of 15 genomically characterized representative strains ofMicrobial genomics · 2026Article
- The natural history of the emergence of sexually transmissible shigellosis.Microbial genomics · 2026Review
- Article
- Epidemiological Characteristics, Antibiotic Resistance Patterns and Genomic Analysis ofAntibiotics (Basel, Switzerland) · 2025Article
- Enhanced virulence and stress tolerance are signatures of epidemiologically successful Shigella sonnei.Nature communications · 2025Article
- Epidemiologic and Genomic Investigation of Sexually Transmitted Shigella sonnei, England.Emerging infectious diseases · 2025Article
- Article
- Microbiological Methods Used in the Enterics for Global HealthOpen forum infectious diseases · 2024Article
- Oral immunization withmSphere · 2024Article
- The re-emergence of sexually transmissible multidrug resistantnpj antimicrobials and resistance · 2024Article
- The genomic epidemiology of shigellosis in South Africa.Nature communications · 2023Article
- Article
- Concordance between Genotypic and Phenotypic Drug-Resistant Profiles ofMicrobiology spectrum · 2023Article
7 more citing papers are in PubMed but not listed here.
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Authors and funding
22 authors at 8 institutions in 7 countries.
Funding
Abstract
backgroundAntimicrobial resistance is a major issue in the Shigellae, particularly as a specific multidrug-resistant (MDR) lineage of Shigella sonnei (lineage III) is becoming globally dominant. Ciprofloxacin is a recommended treatment for Shigella infections. However, ciprofloxacin-resistant S. sonnei are being increasingly isolated in Asia and sporadically reported on other continents. We hypothesized that Asia is a primary hub for the recent international spread of ciprofloxacin-resistant S. sonnei. METHODS AND
findingsWe performed whole-genome sequencing on a collection of 60 contemporaneous ciprofloxacin-resistant S. sonnei isolated in four countries within Asia (Vietnam, n = 11; Bhutan, n = 12; Thailand, n = 1; Cambodia, n = 1) and two outside of Asia (Australia, n = 19; Ireland, n = 16). We reconstructed the recent evolutionary history of these organisms and combined these data with their geographical location of isolation. Placing these sequences into a global phylogeny, we found that all ciprofloxacin-resistant S. sonnei formed a single clade within a Central Asian expansion of lineage III. Furthermore, our data show that resistance to ciprofloxacin within S. sonnei may be globally attributed to a single clonal emergence event, encompassing sequential gyrA-S83L, parC-S80I, and gyrA-D87G mutations. Geographical data predict that South Asia is the likely primary source of these organisms, which are being regularly exported across Asia and intercontinentally into Australia, the United States and Europe. Our analysis was limited by the number of S. sonnei sequences available from diverse geographical areas and time periods, and we cannot discount the potential existence of other unsampled reservoir populations of antimicrobial-resistant S. sonnei.
conclusionsThis study suggests that a single clone, which is widespread in South Asia, is likely driving the current intercontinental surge of ciprofloxacin-resistant S. sonnei and is capable of establishing endemic transmission in new locations. Despite being limited in geographical scope, our work has major implications for understanding the international transfer of antimicrobial-resistant pathogens, with S. sonnei acting as a tractable model for studying how antimicrobial-resistant Gram-negative bacteria spread globally.
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