Background: The epidemiology and antibiotic susceptibility of Shigella species changes over time. Updated susceptibility knowledge is necessary for appropriate empirical antibiotic treatment.
Methods: In this study the clinical characteristics and the antibiotic susceptibility test results of Shigella species isolated from patients admitted to Hacettepe University Ihsan Dogramac Children's Hospital Diarrheal Diseases Training and Treatment Unit between 1995-2002 (n = 218) were evaluated. The results were compared with the results of 1987-1994 from the same center (n = 618).
Results: The predominant species was S. sonnei in both periods with increasing prevalence in the later period (64% and 71.5% respectively, P < 0.05). Although the prevalence of bloody diarrhea among Shigella cases did not change between periods, the prevalence of mild to moderate dehydration (11% and 20.6%) increased. Approximately 40% of cases were prescribed antibiotics on the suspicion of shigellosis. When the two periods were compared, Shigella resistance to trimethoprim/sulfamethoxazole increased from 39% to 70% (P < 0.0001), whereas resistance to ampicillin decreased from 41% to 23% (P < 0.0001). However, the resistance of S. flexneri to ampicillin was found to be quite high (72.9%) between 1995-2002. No Shigella species resistant to ciprofloxacin was detected. Multi-drug resistance was present in 52 (24%) of the cases, of which 10 were S. sonnei (6.3%) and 42 S. flexneri (26.4%) (P < 0.0001).
Conclusion: The need to treat all Shigella cases in areas where S. sonnei is predominant should be reevaluated, as should the appropriate empirical antibiotic.