RESUMO
BACKGROUND: Several countries have recently reported the detection of ESBL-producing Shigella sonnei associated with transmission among MSM. In a previous study by our group, 2.8% of Shigella spp. obtained from MSM in Barcelona between 2015 and 2019 were ESBL producers. OBJECTIVES: To describe and characterize the emerging ESBL-producing Shigella spp. associated with sexual transmission among MSM detected from 2020 to 2021 in Barcelona, elucidating their connectivity with contemporaneous ESBL-producing Shigella spp. from other countries. RESULTS: From 2020 to 2021, we identified that among MSM, 68% of S. sonnei were XDR harbouring blaCTX-M-27 and 14% of Shigella flexneri were MDR harbouring blaCTX-M-27. WGS analysis showed that the ESBL-producing S. sonnei were part of a monophyletic cluster, which included isolates responsible for the prolonged outbreak occurring in the UK. Our data also reveal the first emergence and clonal dissemination of ESBL-producing and fluoroquinolone-resistant S. flexneri 2a among MSM. CONCLUSIONS: We report an increasing trend of antimicrobial resistance in Shigella spp. among MSM in Barcelona since 2021, mainly as a consequence of the dissemination of XDR ESBL-producing S. sonnei, previously reported in the UK. These results highlight the importance of international collaborative surveillance of MDR/XDR S. sonnei and S. flexneri for rapid identification of their emergence and the prevention of the transmission of these pathogens.
Assuntos
Disenteria Bacilar , Minorias Sexuais e de Gênero , Shigella , Masculino , Humanos , Shigella flexneri , Shigella sonnei , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/tratamento farmacológico , Homossexualidade Masculina , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Surtos de DoençasRESUMO
BACKGROUND: In high-income countries, shigellosis is mainly found in travellers to high-risk regions or in men who have sex with men (MSM). This study investigated the genomic characteristics and the features of antimicrobial resistance of MSM-associated Shigella flexneri and Shigella sonnei circulating in Barcelona, Spain, elucidating their connectivity with contemporaneous Shigella spp. from other countries. METHODS: Antimicrobial susceptibility, whole-genome sequencing, genomic characterization and phylogenetic analysis were performed in MSM-associated Shigella spp. recovered from 2015 to 2019. Reference genomes of MSM-associated Shigella spp. were included for contextualization and to determine their connection with international outbreaks. RESULTS: In total, 44 S. flexneri and 26 S. sonnei were identified among MSM. Overall, 80% showed resistance to azithromycin, 65.7% showed resistance to trimethoprim-sulphamethoxazole and 32.8% showed resistance to ciprofloxacin; 27.1% were resistant to all three antimicrobials. mphA and/or ermB, and qnrS and mutations in the quinolone resistance determining regions were found in the azithromycin- and ciprofloxacin-resistant isolates, respectively. Additionally, two isolates carried blaCTX-M-27. Single-nucleotide-polymorphism-based analysis revealed that the isolates were organized into different lineages, most of which were closely related to dominant MSM-associated lineages described previously in the UK and Australia. CONCLUSIONS: This study investigated the circulation of lineages of S. flexneri and S. sonnei among MSM in Spain that were mainly resistant to first-/second-line oral treatments, and closely related to dominant MSM-associated lineages described previously in the UK and Australia. These data reinforce the urgent need for the implementation of public health measures focusing on the early detection and prevention of transmission of this emerging pathogen, which is contributing to the antimicrobial resistance crisis in sexually transmitted infections.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Ciprofloxacina/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Disenteria Bacilar/tratamento farmacológico , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Shigella/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Azitromicina/farmacologia , Ciprofloxacina/farmacologia , Suscetibilidade a Doenças , Variação Genética , Genoma , Geografia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Shigella/genética , Espanha , Sequenciamento Completo do GenomaRESUMO
Se presenta un caso clínico de un varón con una úlcera anal y adenopatía inguinal, procediéndose a la discusión del diagnostico diferencial ante imposibilidad inicial de realizar serologías urgentes en circunstancias reales debido a la hora y el día. La evolución de la misma ilustra la interacción que hay entre el VIH y sífilis, además de manifestar la necesidad de realizar el cribado de otras infecciones de transmisión sexual (AU)
We report a case of a man with an anal ulcer and an inguinal adenopathy, proceeding to the discussion of differential diagnosis due to initial inability to perform urgent serology because of the circumstances of the time and day we visited the patient. The case illustrates the interaction between HIV and syphilis, and in addition expreses the need for screening for other sexually transmitted infections (AU)
