High frequency of antimicrobial resistance and virulence gene in Shigella species isolated from pediatric patients in an Iranian Referral Hospital

Main Article Content

Setareh Mamishi
Babak Pourakbari
Mohammad Ghaffari Charati
Shima Mahmoudi
Mohammad Reza Abdolsalehi
Reihaneh Hosseinpour Sadeghi

Keywords

Shigella, children, antibiotics resistance, virulence factors

Abstract

Background: Shigella is a main cause of gastroenteritis and it is responsible for 5 to 10 % of diarrhea through the world. The aims of this study were to assess the antibiotic susceptibility pattern and the presence of 3 common virulence genes (sigA, virF, invE) of Shigella strains isolated from patients with gastroenteritis in Children's Medical Center Hospital, Tehran, Iran.


Methods: Over a period of 15 months, all Shigella species collected from the patients with gastroenteritis were entered to the study. Susceptibility testing of all isolates towards different antibiotics was performed using the disk diffusion method and the prevalence of virulence genes was detected by polymerase chain reaction (PCR) technology.


Results: Among a total of 183 Shigella strains, 128 Shigella sonnei (70%) and 55 S. flexneri (30%) were isolated. The resistance rate to the antibiotics in S. sonnei strains was higher than S. flexneri. The most sensitive antibiotics for S. flexneri strains were gentamicin (98%), amikacin (85%) and ciprofloxacin (82%), while high resistance rate to trimethoprim-sulfamethoxazole (96%), ampicillin (96%), nalidixic acid (64%) and cefotaxime (60%) was observed. The frequency of invE, virF and sigA gene in S. flexneri strains was 89 %, 93 % and 56 %, respectively; whereas they found in 93 %, 96 %, and 100 % of S. sonnei strains, respectively. SigA gene was identified significantly higher in the S. sonnei strains (100%). There was no significant difference between the presence of virF and invE genes among Shigella strains.


Conclusion: The high presence of sigA gene in S. sonnei strains plays an important role in its pathogenesis, and the high frequency of invE and virF genes showed that this classical pathway regulating the expression of Shigella virulence factor genes could play a key role in the pathogenesis of this bacterium.

Downloads

Download data is not yet available.
Abstract 54 | PDF Downloads 26

References

1. Medeiros PHQS, Lima AÂM, Guedes MM, Havt A, Bona MD, Rey LC, et al. Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil. Diagnostic Microbiology and Infectious Disease. 2018;90(3):198-205.
2. The HC, Thanh DP, Holt KE, Thomson NR, Baker S. The genomic signatures of Shigella evolution, adaptation and geographical spread. Nature Reviews Microbiology. 2016;14(4):235.
3. Bardhan P, Faruque A, Naheed A, Sack DA. Decreasing shigellosis-related deaths without Shigella spp.–specific interventions, Asia. Emerging infectious diseases. 2010;16(11):1718.
4. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2012;380(9859):2095-128.
5. Jain PA, Kulkarni R, Dutta S, Ganavali AS, Kalabhavi AS, Shetty PC, et al. Prevalence and antimicrobial profile of Shigella isolates in a tertiary care hospital of North Karnataka: A 12-year study. Indian Journal of Medical Microbiology. 2020;38(1):101.
6. SH EZ, Fahimi H, Fardsanei F, MM SD. Antimicrobial Resistance and Presence of Cass 1 Integrons Among Different Serotypes of Salmonella spp. Recovered From Children With Diarrhea In Tehran, Iran. Infectious Disorders Drug Targets. 2019.
7. Cruz CBNd, Souza MCSd, Serra PT, Santos I, Balieiro A, Pieri FA, et al. Virulence factors associated with pediatric shigellosis in Brazilian Amazon. BioMed research international. 2014;2014.
8. Nüesch-Inderbinen M, Heini N, Zurfluh K, Althaus D, Hächler H, Stephan R. Shigella antimicrobial drug resistance mechanisms, 2004–2014. Emerging infectious diseases. 2016;22(6):1083.
9. Sethuvel DPM, Anandan S, Michael JS, Murugan D, Neeravi A, Verghese VP, et al. Virulence gene profiles of Shigella species isolated from stool specimens in India: its association with clinical manifestation and antimicrobial resistance. Pathog Glob Health. 2019;113(4):173-9.
10. Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiology and molecular biology reviews. 2010;74(3):417-33.
11. Farsiani H, Sasan MS. High rate of resistance to ceftriaxone and azithromycin among Shigella spp. isolates at three children's referral hospitals in Northeast Iran. Journal of Infection and Chemotherapy. 2020.
12. Bastos FC, Loureiro ECB. Antimicrobial Resistance of Shigella spp. isolated in the State of Pará, Brazil. Revista da Sociedade Brasileira de Medicina Tropical. 2011;44(5):607-10.
13. Gonzales JC, Seribelli AA, Gomes CN, dos Prazeres Rodrigues D, Campioni F, Passaglia J, et al. A high number of multidrug-resistant and predominant genetically related cluster of Shigella flexneri strains isolated over 34 years in Brazil. Brazilian Journal of Microbiology. 2020:1-9.
14. Mahon CR, Lehman DC, Manuselis G. Textbook of diagnostic microbiology-E-Book: Elsevier Health Sciences; 2018.
15. .
16. Nave HH, Mansouri S, Emaneini M, Moradi M. Distribution of genes encoding virulence factors and molecular analysis of Shigella spp. isolated from patients with diarrhea in Kerman, Iran. Microbial pathogenesis. 2016;92:68-71.
17. Ahmed AM, Furuta K, Shimomura K, Kasama Y, Shimamoto T. Genetic characterization of multidrug resistance in Shigella spp. from Japan. Journal of medical microbiology. 2006;55(12):1685-91.
18. Shakoor S, Zaidi AK, Hasan R. Tropical bacterial gastrointestinal infections. Infectious Disease Clinics. 2012;26(2):437-53.
19. Malau E, Ford R, Valcanis M, Jennison AV, Mosse J, Bean D, et al. Antimicrobial sensitivity trends and virulence genes in Shigella spp. from the Oceania region. Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases. 2018 Oct;64:52-6.
20. Taneja N, Mewara A. Shigellosis: epidemiology in India. The Indian journal of medical research. 2016;143(5):565.
21. Fan W, Qian H, Shang W, Ying C, Zhang X, Cheng S, et al. Low distribution of genes encoding virulence factors in Shigella flexneri serotypes 1b clinical isolates from eastern Chinese populations. Gut Pathogens. 2017;9(1):76.
22. Mahmoudi S, Pourakbari B, Moradzadeh M, Eshaghi H, Ramezani A, Haghi Ashtiani MT, et al. Prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital. Microb Pathog. 2017 Aug;109:45-8.
23. Sousa MÂB, Mendes EN, Collares GB, Péret-Filho LA, Penna FJ, Magalhães PP. Shigella in Brazilian children with acute diarrhoea: prevalence, antimicrobial resistance and virulence genes. Memórias do Instituto Oswaldo Cruz. 2013;108(1):30-5.
24. Orrett FA. Prevalence of Shigella serogroups and their antimicrobial resistance patterns in southern Trinidad. Journal of health, population, and nutrition. 2008;26(4):456.
25. Qu F, Bao C, Chen S, Cui E, Guo T, Wang H, et al. Genotypes and antimicrobial profiles of Shigella sonnei isolates from diarrheal patients circulating in Beijing between 2002 and 2007. Diagnostic microbiology and infectious disease. 2012;74(2):166-70.
26. MoezArdalan K, Zali MR, Dallal MMS, Hemami MR, Salmanzadeh-Ahrabi S. Prevalence and pattern of antimicrobial resistance of Shigella species among patients with acute diarrhoea in Karaj, Tehran, Iran. Journal of Health, Population and Nutrition. 2003:96-102.
27. Pourakbari B, Mamishi S, Mashoori N, Mahboobi N, Ashtiani MH, Afsharpaiman S, et al. Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases. 2010 Mar-Apr;14(2):153-7.
28. Mamishi S, Mashoori N, Mahboobi N, Pour Akbari B. Increasing resistance to nalidixic acid in Shigella subgroups in a comparative study between 2001-2003 and 2004-2006. Singapore medical journal. 2009 Aug;50(8):791-3.
29. BARARI SKR, AHMADPOUR KM. Prevalence of Shigella species and their antimicrobial resistance patterns at Amirkola Children's Hospital, North of Iran. 2007.
30. Jomezadeh N, Babamoradi S, Kalantar E, Javaherizadeh H. Isolation and antibiotic susceptibility of Shigella species from stool samples among hospitalized children in Abadan, Iran. Gastroenterology and hepatology from bed to bench. 2014;7(4):218.
31. Mamishi S, Arab ZY, Mahmoudi S, Moradzadeh M, Taghi MHA, Pourakbari B. Antimicrobial-resistance pattern of Shigella species in children: a six-year study in an Iranian referral Hospital. Ann Ig Med Preventiva Comunita. 2019;31(4):356-64.
32. Aggarwal P, Uppal B, Ghosh R, Prakash SK, Chakravarti A, Rajeshwari K. True prevalence of shigellosis in Indian children with acute gastroenteritis: have we been missing the diagnosis? Journal of research in health sciences. 2016;16(1):11.
33. Asrat D. Shigella and Salmonella serogroups and their antibiotic susceptibility patterns in Ethiopia. EMHJ-Eastern Mediterranean Health Journal, 14 (4), 760-767, 2008. 2008.
34. Coster TS, Hoge CW, VanDeVerg LL, Hartman AB, Oaks EV, Venkatesan MM, et al. Vaccination against shigellosis with attenuated Shigella flexneri 2a strain SC602. Infection and immunity. 1999;67(7):3437-43.
35. Sansonetti PJ. Rupture, invasion and inflammatory destruction of the intestinal barrier by Shigella, making sense of prokaryote–eukaryote cross-talks. FEMS Microbiology Reviews. 2001;25(1):3-14.
36. Gu B, Fan W, Qin T, Kong X, Dong C, Tan Z, et al. Existence of virulence genes in clinical Shigella sonnei isolates from Jiangsu Province of China: a multicenter study. Annals of translational medicine. 2019 Jul;7(14):305.

Most read articles by the same author(s)