Antimicrobial resistance pattern of Shigella species isolated from human stool in Asia: A systematic review

Abstract: Background: Shigella species are Gram-negative bacteria responsible for bacillary dysentery, particularly affecting children in low-income countries. The species are highly infectious and are primarily transmitted through contaminated food and water. Treatment typically involves antibiotics, but the rise of multidrug-resistant (MDR) Shigella strains has made management challenging. Methods: A comprehensive literature search was performed using PubMed and Google Scholar to identify studies on the prevalence of Shigella species and its antimicrobial resistance in Asia from 2000 to 2022. Results: The prevalence of Shigella varied widely, ranging from 1.31% to 40.34% in analysis of 25 studies. Among the four Shigella species, S. flexneri emerged as the most prevalent, accounting for 51.38% of isolates (n=6062/11797). S. boydii was the least encountered species, constituting only 1.5% of cases. Ampicillin resistance was high with rates exceeding 80% in eight studies. Tetracycline resistance exceeded 80% in nine out of 15 studies. Cotrimoxazole resistance was also very high with 15 studies showing rates over 80%. Chloramphenicol resistance was less common, with eight of 11 studies showing over 50% susceptibility. Gentamycin resistance was low, with 11 of 12 studies showing over 50% susceptibility. Ciprofloxacin low resistance with 100% susceptibility in five studies. Ceftriaxone resistance was also minimal. Conclusions: This systematic review highlights high burden of Shigella infection in Asia and significant drug resistance to tetracycline, ampicillin, nalidixic acid, and cotrimoxazole. Urgent actions include proper antibiotic use, and conducting clinical trials to develop effective management guidelines for Shigella infections is to be considered. KEYWORDS Shigella, human stool, antimicrobial resistance, asia