All issues > Volume 48(10); 2005

Original Article

Korean J Pediatr. 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 HT Lim¹, So Hee SH Lee¹, Jung Hwa JH Lee¹, Jeong Eun JE Kim¹, Kyo Sun KS Kim¹, Eun Ju EJ Jeong², Seung Hyun SH Lee², Chang Gyu CG Kang³, Seong Jin SJ 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

Correspondence Seong Jin SJ 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.

Keywords :Shigella sonnei , Extended-spectrum β-lactamase , Ciprofloxacin , Azithromycin