Extensively Drug-Resistant (XDR) Shigella Infections

CDC has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections reported through national surveillance. CDC defines XDR Shigella bacteria as strains that are resistant to all commonly recommended empiric and alternative antibiotics — azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin. XDR Shigella infections have been identified in Maryland.

The clinician letter (download PDF), distributed last week to Maryland healthcare providers, contains several recommendations to providers, including:

  1. Diagnostic recommendations, especially for patients at higher risk for Shigella infection
  2. Clinical management and antibiotic treatment information
  3. Patient counseling
  4. Maryland Reporting requirements for shigellosis, and laboratory submission requirements.

As a reminder, all Shigella infections in Maryland should be promptly investigated using the Gastroenteritis Case Report form at https://health.maryland.gov/phpa/IDEHASharedDocuments/Gastroenteritis%20Case%20Report%20form%202023_fillable.pdf

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