Journal
EPIDEMIOLOGY AND INFECTION
Volume 139, Issue 3, Pages 446-452Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0950268810001093
Keywords
Antimicrobial resistance; Bangladesh; diarrhoea; severe malnutrition; Shigella
Funding
- ICDDR,B
- Government of the People's Republic of Bangladesh through IHP-HNPRP
- Erasmus Mundus programme
- Australian Agency for International Development (AusAID)
- Government of the People's Republic of Bangladesh
- Canadian International Development Agency (CIDA)
- Embassy of the Kingdom of the Netherlands (EKN)
- Swedish International Development Cooperation Agency (Sida)
- Swiss Agency for Development and Cooperation (SDC)
- Department for International Development, UK (DFID)
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we studied changes in species distribution and antimicrobial resistance patterns of Shigella during 1980-2008, using the Diarrhoeal Diseases Surveillance system of Dhaka Hospital of ICDDR,B. In hospitalized patients Shigella prevalence decreased steadily from 8-12% in the 1980s to 3% in 2008. Endemic S. flexneri was the most commonly isolated species (54%). Epidemic S. dysenteriae type 1 had two peaks in 1984 and 1993, but was not found after 2000, except for one case in 2004. The therapeutic options are now limited: in 2008 a total of 33% of S. flexneri were resistant to ciprofloxacin and 57% to mecillinam. In the <5 years age group, severely underweight, wasted and stunted children were more at risk of shigellosis compared to well-nourished children (P<0.001). Although hospitalization for Shigella diarrhoea is decreasing, the high levels of antimicrobial resistance and increased susceptibility of malnourished children continue to pose an ongoing risk.
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