ECDC reported an increase in XDR S. sonnei infections in 10 European countries

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The European Centre for Disease Prevention and Control (ECDC) recently reported an increase in the number of XDR S. sonnei infections in 10 European countries.

This is a concerning development, as XDR (extensively drug-resistant) S. sonnei is a strain of bacteria that is resistant to many of the antibiotics commonly used to treat infections. In this article, we will discuss what XDR S. sonnei is, why it is a cause for concern, and what can be done to address this growing problem.

Firstly, it is important to understand what S. sonnei is. S. sonnei is a species of bacteria that can cause illness in humans, typically resulting in symptoms such as diarrhea, abdominal pain, and fever. It is one of several species of Shigella bacteria, which are collectively known as shigellosis. Shigellosis is a common cause of foodborne illness and is most often transmitted through contaminated food or water.

Now, what is XDR S. sonnei?

S. sonnei infections are caused by the bacterium Shigella sonnei, which is one of the four species of Shigella bacteria that can cause shigellosis in humans. Shigellosis is a type of foodborne illness that is usually transmitted through contaminated food or water.

S. sonnei infections typically cause symptoms such as diarrhea, abdominal pain, fever, and sometimes vomiting. The diarrhea may be watery or bloody, and can be accompanied by mucus. In some cases, individuals may experience cramps or tenesmus, which is a feeling of incomplete defecation.

The symptoms of S. sonnei infections usually appear within 1-3 days after exposure to the bacteria, and can last for up to a week. While most people will recover from the infection without complications, some individuals may develop more serious symptoms such as dehydration, seizures, or hemolytic uremic syndrome (HUS).

HUS is a rare but serious complication of shigellosis that can occur in children under the age of 5, the elderly, or individuals with weakened immune systems. HUS can cause kidney failure, anemia, and low platelet count, and requires immediate medical attention.

S. sonnei infections are typically diagnosed through laboratory testing of a stool sample. Treatment for S. sonnei infections usually involves hydration and rest, as well as antibiotics in some cases. However, as mentioned earlier, the rise of XDR S. sonnei infections has made treating these infections much more difficult.

Preventing S. sonnei infections involves practicing good hygiene, such as washing hands regularly with soap and water, particularly after using the bathroom or changing a diaper, and before preparing or eating food. It is also important to ensure that food is cooked properly and stored at safe temperatures to prevent contamination.

Overall, S. sonnei infections can cause significant discomfort and complications in some individuals, particularly if they develop into XDR S. sonnei infections. Practicing good hygiene and food safety measures can help to prevent these infections, while ongoing research and development of new treatments are critical to addressing the problem of antibiotic-resistant bacterial infections.

In addition to good hygiene practices, there are other preventive measures that can help to reduce the risk of S. sonnei infections. For example, individuals who work in food handling or healthcare settings should take extra precautions to prevent the spread of infection. This may include wearing gloves and other protective equipment, regularly disinfecting surfaces, and avoiding food or drink that may be contaminated.

People who have been diagnosed with S. sonnei infections should take steps to prevent the spread of the bacteria to others. This may include staying home from work or school until the infection has cleared, avoiding close contact with others, and practicing good hygiene.

It is also important to note that S. sonnei infections are more common in certain populations, such as travelers to developing countries and individuals living in crowded or unsanitary conditions. These groups may need to take extra precautions to prevent infection.

The recent increase in XDR S. sonnei infections in Europe is a cause for concern for several reasons. Firstly, the spread of antibiotic-resistant bacteria is a growing problem worldwide, with serious implications for public health. As more and more bacteria become resistant to antibiotics, it becomes more difficult to treat infections, which can result in longer hospital stays, higher healthcare costs, and in some cases, increased mortality rates.

  • In 2019, 8,848 confirmed cases of shigellosis were reported by 30 countries in the European Union (including the UK) and the European Economic Area. 59.4% of these cases were due to S. sonnei.
  • Many multidrug-resistant (MDR) strains of S. sonnei have been identified in recent years. These strains were originally linked to travel to Asia or specific communities or networks, such as gay, bisexual, and other men who have sex with men (GBMSM).
  • Prior to 2022, S. sonnei isolates that were simultaneously resistant to the three recommended antimicrobial drugs (CIP, 3GCs, and AZM) were reported only exceptionally, and were often linked to Southeast Asia.
  • A study in high-income countries found that only 0.8% of S. sonnei genomic sequences obtained between 2016 and 2019 were inferred to be XDR. However, no phenotypic antimicrobial susceptibility data were provided to confirm the XDR phenotype.
  • In 2022, the UKHSA and the ECDC reported an increase in XDR S. sonnei infections in 10 European countries, with France and the UK being the most severely affected.

It is clear that the rise of XDR S. sonnei infections in Europe is a serious concern, and highlights the need for continued surveillance, research, and development of effective strategies to prevent the spread of antibiotic-resistant bacteria.

In the case of XDR S. sonnei, the situation is particularly concerning because it is already a strain of bacteria that is resistant to many antibiotics. If the number of XDR S. sonnei infections continues to rise, it could become even more difficult to treat this type of infection in the future.

S. sonnei infections can exhibit various types of antibiotic resistance. Some of the most common types of antibiotic resistance seen in S. sonnei infections include:

  • Resistance to ampicillin: Ampicillin is a common antibiotic used to treat bacterial infections. However, some strains of S. sonnei have developed resistance to this drug.
  • Resistance to trimethoprim-sulfamethoxazole: This combination antibiotic is commonly used to treat urinary tract infections and other bacterial infections. However, some S. sonnei strains have developed resistance to this drug.
  • Resistance to ciprofloxacin: Ciprofloxacin is a fluoroquinolone antibiotic that is often used to treat bacterial infections. However, some strains of S. sonnei have developed resistance to this drug.
  • Resistance to extended-spectrum cephalosporins: This class of antibiotics includes drugs such as ceftriaxone and cefotaxime. Some strains of S. sonnei have developed resistance to these drugs, which can make infections more difficult to treat.
  • Extensively drug-resistant (XDR) S. sonnei: XDR strains of S. sonnei are resistant to multiple antibiotics, including ciprofloxacin, extended-spectrum cephalosporins, and azithromycin. These strains can be extremely difficult to treat and are a growing public health concern.
  • Resistance to azithromycin: Azithromycin is a commonly used macrolide antibiotic that is often used to treat respiratory tract infections and sexually transmitted infections. Some strains of S. sonnei have developed resistance to this drug.
  • Resistance to multiple antibiotics: Some strains of S. sonnei have developed resistance to multiple antibiotics, making infections difficult to treat. These strains can be classified as multidrug-resistant (MDR) or extensively drug-resistant (XDR), depending on the number and types of antibiotics they are resistant to.

So, what can be done to address this problem?

The ECDC has recommended several measures to help control the spread of XDR S. sonnei. These include improved surveillance and monitoring of the bacteria, as well as increased efforts to prevent the transmission of shigellosis in general.

In addition, the ECDC has emphasized the importance of reducing the unnecessary use of antibiotics, both in human medicine and in agriculture. Overuse and misuse of antibiotics can contribute to the development of antibiotic-resistant bacteria, so reducing the amount of antibiotics used overall can help to slow the spread of these types of infections.

Finally, the development of new antibiotics and alternative treatments for bacterial infections is also a critical area of research that could help to address the problem of XDR S. sonnei and other antibiotic-resistant bacteria.

There is currently limited data on the potential interaction between COVID-19 and S. sonnei infections. However, based on the available information, the following are possible ways in which COVID-19 could interact with S. sonnei infections:

  • Weakened Immune System: COVID-19 is known to weaken the immune system, which could potentially increase the risk of developing secondary bacterial infections such as S. sonnei.
  • Underlying Health Conditions: Individuals with underlying health conditions such as diabetes or chronic kidney disease may be at higher risk of complications from both COVID-19 and S. sonnei infections.
  • Increased Severity of S. sonnei: COVID-19 could potentially worsen the severity of S. sonnei infections, particularly in individuals who are already immunocompromised.
  • Delayed Diagnosis: COVID-19 could potentially delay the diagnosis of S. sonnei infections due to similar symptoms such as fever and gastrointestinal symptoms.
  • Antibiotic Resistance: COVID-19 could potentially exacerbate the problem of antibiotic resistance in S. sonnei infections, as the overuse of antibiotics in COVID-19 treatment could contribute to the development of antibiotic-resistant strains of bacteria.
  • Nosocomial Infections: COVID-19 could potentially increase the risk of nosocomial S. sonnei infections, particularly in healthcare settings where there is a high risk of transmission of both COVID-19 and S. sonnei.
  • Diagnostic Challenges: The diagnosis of S. sonnei infections may be challenging during the COVID-19 pandemic due to limited laboratory resources and the need to prioritize COVID-19 testing.
  • Co-infections: Individuals with COVID-19 may be more susceptible to co-infections with other bacterial or viral pathogens, including S. sonnei.
  • Complications: Individuals with COVID-19 who develop S. sonnei infections may be at higher risk of developing complications such as dehydration, kidney failure, and sepsis.

In conclusion, the recent increase in XDR S. sonnei infections in Europe is a concerning development that highlights the need for increased efforts to control the spread of antibiotic-resistant bacteria. By improving surveillance, reducing unnecessary antibiotic use, and developing new treatments, we can work to address this growing problem and protect public health.

reference link : https://www.nature.com/articles/s41467-023-36222-8

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