Persistent Transmission of Shigellosis in England Is Associated with a Recently Emerged Multidrug-Resistant Strain of Shigella sonnei
Persistent Transmission of Shigellosis in England Is Associated with a Recently Emerged Multidrug-Resistant Strain of Shigella sonnei
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DOI：
10.1128/jcm.01692-19
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发表时间：
2020-04-01
影响因子：
9.4
通讯作者：
Dallman, Timothy J.
中科院分区：
文献类型：
--
作者：
Bardsley, Megan;Jenkins, Claire;Dallman, Timothy J.
全基因组测序增强了监测并促进了对英国志贺氏菌传播的详细监测。我们对 2015 年至 2018 年间转交英国公共卫生部的所有志贺氏菌病病例中的分离株进行了流行病学和系统发育分析，以探讨志贺氏菌的最新菌株特征和传播动态。在此期间发现的 4,950 例志贺氏菌病确诊病例中，分离株比例最高的是宋内志贺氏菌（54.4%），其次是弗氏志贺氏菌（39.2%）、博伊迪志贺氏菌（4.1%）和痢疾志贺氏菌（2.2%）。大多数病例是成年人（82.9%）和男性（59.5%），34.9%的病例报告最近曾到过英国境外旅行。在整个研究期间，福氏链球菌和宋内链球菌感染的诊断最常见于近期没有出国旅行史的男性。该物种的流行率并非一成不变，2015年至2016年间，男性福氏链球菌感染病例数有所减少，而宋内链球菌感染病例数自2017年起有所增加。系统发育分析显示，宋内链球菌感染的近期增加归因于中亚亚系中出现的一个新分支，该分支对环丙沙星和阿奇霉素表现出耐药性。尽管物种流行率发生了变化，但英格兰志贺氏菌感染的诊断在没有报告旅行史的成年男性中仍然最常见，这与男男性行为者之间的性传播一致。除了质粒介导的阿奇霉素耐药性之外，宋内链球菌环丙沙星耐药率增加的趋势在多重耐药胃肠道病原体的传播和治疗失败的风险方面具有重大的公共卫生问题。
Whole-genome sequencing has enhanced surveillance and facilitated detailed monitoring of the transmission of Shigella species in England. We undertook an epidemiological and phylogenetic analysis of isolates from all cases of shigellosis referred to Public Health England between 2015 and 2018 to explore recent strain characteristics and the transmission dynamics of Shigella species. Of the 4,950 confirmed cases of shigellosis identified during this period, the highest proportion of isolates was Shigella sonnei (54.4%), followed by S. flexneri (39.2%), S. boydii (4.1%), and S. dysenteriae (2.2%). Most cases were adults (82.9%) and male (59.5%), and 34.9% cases reported recent travel outside the United Kingdom. Throughout the study period, diagnoses of S. flexneri and S. sonnei infections were most common in men with no history of recent travel abroad. The species prevalence was not static, with cases of S. flexneri infection in men decreasing between 2015 and 2016 and the number of cases of S. sonnei infection increasing from 2017. Phylogenetic analysis showed this recent increase in S. sonnei infections was attributed to a novel clade that emerged from a Central Asia sublineage exhibiting resistance to ciprofloxacin and azithromycin. Despite changes in species prevalence, diagnoses of Shigella infections in England are persistently most common in adult males without a reported travel history, consistent with sexual transmission among men who have sex with men. The trend toward increasing rates of ciprofloxacin resistance in S. sonnei, in addition to plasmid-mediated azithromycin resistance, is of significant public health concern with respect to the transmission of multidrug-resistant gastrointestinal pathogens and the risk of treatment failures.