Co-circulation of Multidrug-resistant Shigella Among Men Who Have Sex With Men in Australia
Co-circulation of Multidrug-resistant Shigella Among Men Who Have Sex With Men in Australia
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DOI：
10.1093/cid/ciz005
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发表时间：
2019-11-01
影响因子：
11.8
通讯作者：
Williamson, Deborah A.
中科院分区：
文献类型：
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作者：
Ingle, Danielle J.;Easton, Marion;Williamson, Deborah A.
背景。在澳大利亚城市，志贺氏菌病的负担要么发生在从志贺氏菌病流行地区返回的旅行者身上，要么发生在男男性行为者（MSM）身上。在这里，我们将基因组数据与性接触和旅行的综合流行病学数据结合起来，描述多重耐药志贺氏菌谱系的传播。2016年1月1日至2018年3月31日，对澳大利亚维多利亚州所有培养的志贺氏菌分离株进行了人群水平研究。在微生物诊断单位公共卫生实验室对545株志贺氏菌分离株进行了抗菌药敏试验、全基因组测序和生物信息学分析。通过加强监测表格或访谈收集旅行和性接触的风险因素数据。耐药率较高，对环丙沙星和阿奇霉素的耐药率分别为17.6%（95/541）和50.6%（274/541）。在抗菌素耐药性、系统发育和流行病学之间有很强的联系。具体来说，确定了2个主要的msm相关谱系：志贺氏杆菌谱系（n = 159）和福氏志贺氏杆菌2a谱系（n = 105）。值得关注的是，147/159 (92.4%)sonnei msm相关谱系中的分离株携带与推荐口服抗菌药（即阿奇霉素、甲氧苄啶-磺胺甲恶唑和环丙沙星）易感性降低相关的突变。长读序列显示多重耐药质粒在志贺氏菌物种和谱系中全球传播，但主要与MSM分离有关。我们的当代数据强调了耐药志贺氏菌在澳大利亚和全球持续构成的公共卫生威胁。需要采取紧急多学科公共卫生措施，以阻断传播和预防感染。
Background. In urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages.Methods. A population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews.Results. Rates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigellasonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates.Conclusions. Our contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection.