Drug-resistant shigella - how worried should you be?

Recent news stories have brought to our attention a report from the CDC that multiple strains of the diarrhea-causing bacteria Shigella have acquired resistance to the antibiotics most often used to treat the illness. The first case of extensively drug-resistant Shigella was discovered in the United States in 2016; by 2022, the strains accounted for 5 percent of Shigella infections. The drug-resistant bacteria have been found in 29 states so far. Even though shigellosis is commoner in children than adults, the resistant strain has been seen most often in adults, and is particularly common in men who have sex with men, the homeless and those with immune deficiency.

Is this important? Should you care?

Shigella is a bacterium that infects the wall of the intestine and causes nasty diarrhea, usually bloody, as well as nausea, cramps and fever. While mild cases exist and may improve without treatment, antibiotics are usually needed, as well as fluid replacement – by mouth if possible or by intravenous if you are very sick.

How do bacteria become resistant to antibiotics? Some bacteria randomly mutate to become resistant to one or more antibiotics. If exposed to antibiotics, the sensitive bacteria are killed off while the resistant ones thrive. We also know that antibiotic-resistant bacteria can share their resistance genes with other bacteria.

We live in an antibiotic-obsessed culture. People who go to their doctor with a cough and fever expect to get a prescription for antibiotics, whether they believe their illness be a sinus infection, bronchitis or pharyngitis. In the time-stressed doctor’s office, many doctors realize it is easier and faster to write a prescription than to explain why the illness is probably viral and will not get better any faster with an antibiotic.

In hospitals, patients are sicker, antibiotics are frequently given, and bacteria are readily transmitted from one patient to another, including resistant ones. These “super-bugs” are responsible for many hospital deaths.

If that is not bad enough, antibiotics are widely and often unnecessarily given to farm animals, in most cases to compensate for unhealthy conditions in which the animals are raised.

What can you do?

First, if your doctor tells you that an antibiotic is not needed, accept this. Most respiratory infections will do as well or better without one. Second, if you have any intestinal infection, be scrupulous with hand washing after using the toilet – the person you save from getting ill may be family or friend.

If you are unlucky enough to be hospitalized, do not be afraid or embarrassed to ask your doctors and nurses if they have washed their hands before they examine you. Finally, make your preference known at the grocery – try to purchase meat labelled as antibiotic-free, so that hopefully this practice will lessen.

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