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Childhood shigellosis in Saudi Arabia
A F Kagalwalla1, S N Khan, Y A Kagalwalla
1Department of Pediatrics, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Insights
Shigellosis in children is often caused by Shigella flexneri and Shigella sonnei. Antimicrobial resistance is high, and treatment with ineffective antibiotics increases shigellosis morbidity and mortality.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Shigellosis is a significant cause of childhood diarrhea worldwide.
- Understanding local epidemiology and antimicrobial resistance patterns is crucial for effective treatment.
Purpose of the Study:
- To evaluate the clinical characteristics and antimicrobial susceptibility patterns of shigellosis in children.
- To assess the impact of antimicrobial resistance on patient outcomes.
Main Methods:
- Retrospective analysis of 234 pediatric shigellosis cases over 6 years.
- Identification of Shigella species and antimicrobial susceptibility testing.
- Comparison of outcomes based on initial antibiotic treatment efficacy.
Main Results:
- Shigella flexneri (44%) and Shigella sonnei (43%) were the predominant isolates.
- High resistance rates observed: ampicillin (54%), trimethoprim-sulfamethoxazole (72%), tetracycline (77%).
- Eighty percent of isolates were resistant to two or more agents.
- Higher morbidity and mortality in children treated with resistant antimicrobials.
Conclusions:
- Pediatric shigellosis cases show high rates of multidrug resistance.
- Appropriate antimicrobial selection is critical to improve outcomes and reduce complications in children with shigellosis.
Abstract:
In this study 234 children with shigellosis were evaluated during a 6-year period. The ages ranged from 2 days to 13 years (mean, 3.4 years). Sixty percent of the children were in the 1- to 4-year age group. One hundred four children were hospitalized and 130 were outpatients. Most cases of shigellosis presented during the months of April-May and September-November. Shigella flexneri accounted for 44% and Shigella sonnei for 43% of the isolates. Susceptibility testing showed that 54% were resistant to ampicillin, 72% to trimethoprim-sulfamethoxazole and 77% to tetracycline. Eighty percent were resistant to two or more antimicrobial agents. Morbidity and mortality was higher in children who were initially treated with antimicrobials to which the organism was resistant than in those treated with antimicrobial agent to which the organism was susceptible.