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A Domestic Outbreak of Bacterial Dysentery Caused by Extended-Spectrum β-Lactamase(ESBL)-producing Shigella sonnei

Korean Journal of Pediatrics 2005;48(10):1107-1115.
Published online October 15, 2005.
A Domestic Outbreak of Bacterial Dysentery Caused by Extended-Spectrum β-Lactamase(ESBL)-producing Shigella sonnei
Hyun Taek Lim1, So Hee Lee1, Jung Hwa Lee1, Jeong Eun Kim1, Kyo Sun Kim1, Eun Ju Jeong2, Seung Hyun Lee2, Chang Gyu Kang3, Seong Jin Hong1
1Department of Pediatrics College of Medicine, Konkuk University, Chungju, Korea
2Department of Microbiology, College of Medicine, Konkuk University, Chungju, Korea
3Local Corporation Chungju Medical Center, Chungju, Korea
집단 발생한 Extended-spectrum β-lactamase(ESBL) 생산 Shigella sonnei 감염에 의한 세균성 이질에 관한 연구
임현택1, 이소희1, 이정화1, 김정은1, 김교순1, 정은주2, 이승현2, 강창규3, 홍성진1
1건국대학교 의과대학 소아과학교실
2건국대학교 의과대학 미생물학교실
3지방공사 충주의료원
Correspondence: 
Seong Jin Hong, Email: sjhong@kku.ac.kr
Abstract
Purpose
: An outbreak of ESBL-producing Shigella sonnei enteritis was unprecedented not only in Korea but throughout the world in the past. We intended to devise a management guideline for ESBL-producing shigellosis based on analysis of clinical manifestations and response to therapy.
Methods
: We analyzed 103 patients who were admitted to the hospital with acute GI symptoms and were shown positive result for S. sonnei on stool culture. We performed sensitivity test to the antibiotics and DNA sequencing of ESBL gene in the isolated S. sonnei colonies. In addition, we retrospectively analyzed their clinical characteristics, laboratory results, and clinical and microbiological responses to the antibiotics.
Results
: Among the clinical manifestations, fever was the most frequent(96.1%), followed by diarrhea(93.2%), abdominal pain(76.7%), headache(71.8%), vomiting(65.0%), and nausea(41.7%). The fever was sustained for average of 2.0 days and diarrhea for 3.9 days. Watery diarrhea was the most common(69%) followed by mucoid(26%), and bloody stool(5%). On peripheral blood smear, leukocytosis was noted in 53.4% of patients, and 78.6% of patients tested positive for serum CRP response. On stool direct smear, 11.7% of patients showed more than 50 WBCs/HPF, and 9.7% of patients between 5 to 20 WBCs/HPF. Stool occult blood was positive in 71% of patients. Production of CTX-M-14 type ESBL was reported for all S. sonnei strains isolated from this outbreak. Microbiological eradication rates to various antibiotics were as follows : 100%(9/9) to ciprofloxacin, 100% 5/5) to azithromycin, 6.9%(5/72) to cefdinir, 0%(0/8) to ceftriaxone, 12.5%(1/8) to ceftizoxime, 0%(0/ 8) to TMP/SMX, 42.9%(3/7) to ampicillin/sulbactam, 20%(1/5) to amoxicillin/clavulanic acid, and 68.8 %(11/16) to imipenem/cilastatin.
Conclusion
: It is presumed that azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric population, given its cost-effectiveness and safety. Although ciprofloxacin is another cost-effective agent, its use in pediatric population may be a bit too premature.
Key Words: Shigella sonnei , Extended-spectrum β-lactamase , Ciprofloxacin , Azithromycin


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