ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Azithromycin and Ciprofloxacin Treatment Outcomes During an Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community-Vermont, 2018.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed, 12 citations in OpenAlex.
- Azithromycin in crisis: antimicrobial resistance, diagnostics gaps, and vaccine-linked stewardship for enteric infections in low- and middle-income countries.IJID regions · 2026Review
- Genomic and socioeconomic drivers of antimicrobial resistance forecast to 2050.Cell genomics · 2026Article
- From Diarrhea to Bacteremia: Extended-Spectrum Beta-Lactamase (ESBL)-Producing Shigella in a Rare Clinical Scenario.Cureus · 2025Article
- Article
- Ciprofloxacin is a novel anti-ferroptotic antibiotic.Heliyon · 2024Article
- Frequency of bystander exposure to antibiotics for enteropathogenic bacteria among young children in low-resource settings.Proceedings of the National Academy of Sciences of the United States of America · 2022Article
- Clinical and Genomic Investigation of an International Ceftriaxone- and Azithromycin-Resistant Shigella sonnei Cluster among Men Who Have Sex with Men, Montréal, Canada 2017-2019.Microbiology spectrum · 2022Article
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13 authors at 2 institutions in 1 country.
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Abstract
backgroundIn 2018, the Centers for Disease Control and Prevention and the Vermont Department of Health investigated an outbreak of multidrug-resistant Shigella sonnei infections in a retirement community that offered a continuum of care from independent living through skilled nursing care. The investigation identified 24 culture-confirmed cases. Isolates were resistant to trimethoprim-sulfamethoxazole, ampicillin, and ceftriaxone, and had decreased susceptibility to azithromycin and ciprofloxacin.
methodsTo evaluate clinical and microbiologic response, we reviewed inpatient and outpatient medical records for treatment outcomes among the 24 patients with culture-confirmed S. sonnei infection. We defined clinical failure as diarrhea (≥3 loose stools per day) for ≥1 day after treatment finished, and microbiologic failure as a stool culture that yielded S. sonnei after treatment finished. We used broth microdilution to perform antimicrobial susceptibility testing, and whole genome sequencing to identify resistance mechanisms.
resultsIsolates contained macrolide resistance genes mph(A) and erm(B) and had azithromycin minimum inhibitory concentrations above the Clinical and Laboratory Standards Institute epidemiological cutoff value of ≤16 µg/mL. Among 24 patients with culture-confirmed Shigella infection, 4 were treated with azithromycin; all had clinical treatment failure and 2 also had microbiologic treatment failure. Isolates were susceptible to ciprofloxacin but contained a gyrA mutation; 2 patients failed treatment with ciprofloxacin.
conclusionsThese azithromycin treatment failures demonstrate the importance of clinical breakpoints to aid clinicians in identifying alternative treatment options for resistant strains. Additionally, these treatment failures highlight a need for comprehensive susceptibility testing and systematic outcome studies, particularly given the emergence of multidrug-resistant Shigella among an expanding range of patient populations.
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