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On October 20, 2010, the South Carolina Department of Health and Environmental Control and CDC began investigating a cluster of three diarrheal illnesses caused by multidrug-resistant Shigella flexneri 2a. The index case occurred in a girl aged 2 years who experienced the onset of diarrhea on September 25 and was hospitalized the next day because of a seizure and fever. On September 30, her brother, aged 6 years, was hospitalized with vomiting, bloody diarrhea, and hyponatremia. Three days later, her father was hospitalized with vomiting, bloody diarrhea, and hyponatremia.
S. flexneri 2a was isolated from all three patients and tested for antimicrobial susceptibility using semi-automated broth microdilution panels. Interpretations of susceptible, intermediate, or resistant were based on the most recently approved standards published by the Clinical and Laboratory Standards Institute.1 The isolates were found susceptible to imipenem, had intermediate susceptibility or were resistant to ceftazidime and cefepime, and were resistant to ampicillin, aztreonam, cefotaxime, ceftriaxone, chloramphenicol, ciprofloxacin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim/sulfamethoxazole. Azithromycin inhibited the isolates at a minimum concentration of 2 or 4 μg/mL, which is similar to the azithromycin minimum inhibitory concentrations among Shigellae in the United States during 2005-2007 (no breakpoint for Shigella susceptibility to azithromycin has been established).2
Emergence of Shigella flexneri 2a Resistant to Ceftriaxone and Ciprofloxacin—South Carolina, October 2010. JAMA. 2011;305(8):776. doi:
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