Fluoroquinolones-resistant Shigella species in Iranian children: a meta-analysis

Shigella is one of the most common causes of childhood dysentery along with high rate of morbidity and mortality in both developing and developed countries. According to the World Health Organization (WHO) reports, the prevalence of fluoroquinolones-resistant Shigella species is increasing worldwide which can cause treatment failure of Shigella infections. Since there has not been any comprehensive information on drug-resistant Shigella species in Iran, we conducted the following meta-analysis to raise awareness.

We conducted a literature search on antibiotic resistance of Shigella species to collect published studies in Iran using national and international databases. Literature search was performed by up to Jan 30, 2019 and eligible studies were included in the meta-analysis by predefined criteria.

Antimicrobial susceptibility testing using disk diffusion technique was the only used method in all included studies. Antibiotic resistance characteristics of Shigella species against WHO recommended therapeutic regimens were as follows: S. dysenteriae 7%, S. flexneri 3.8%, S. boydii 6.9% and S. sonnei 2.6% to ciprofloxacin, S. dysenteriae 27.9%, S. flexneri 19.3%, S. boydii 15.7% and S. sonnei 9.5% to ceftriaxone and also S. dysenteriae 91.7%, S. flexneri 20.7%, S. boydii 46.7% and S. sonnei 32.3% to azithromycin. Resistance to pivmecillinam has not been investigated in Iran.

Our findings revealed that ciprofloxacin can still be used as the first-line antibiotic for Shigella infections in Iranian children. However, it seems that second-line antibiotics i.e., ceftriaxone and azithromycin are not good choices for treatment and thus not recommended.