P0285 - From Contagion to Containment: Tackling Multidrug-Resistant Shigella in MSM Community

Award: Presidential Poster Award

Abdullah Hafeez, MD¹, Dhruvi Sanikommu, MD², Glenn Fort, MD^2
1Landmark Medical Center, Cumberland, RI; ²Landmark Medical Center, Woonsocket, RI

Introduction: The emergence and spread of multidrug-resistant (MDR) or extensively drug-resistant (XDR) infections in the US is a significant public health concern. Among these infections, there has been a rise in cases of Shigellosis among gay, bisexual, and men who have sex with men (MSM). This report describes a case of a young male with multidrug-resistant Shigella and Enteroinvsive E. coli (EIEC).

Case Description/Methods: A 38 year old Asian male presented with a history of nausea, diarrhea, fever, and chills for two days. His stools were watery, non-bloody, and non-mucoid. He reported having a sexual encounter with another man four days prior during his trip to Ohio. On presentation, he was hemodynamically stable. Laboratory results were significant for leukocytosis, elevated inflammatory markers, mild hyperbilirubinemia (1.6 mg/dL) and acute kidney injury (creatinine 1.75 mg/dL). A CT scan of the abdomen and pelvis with IV contrast revealed right sided colitis. GI pathogen panel was positive for Shigella flexneri (Group B) and EIEC. He was treated with supportive care and broad-spectrum IV antibiotic meropenem for presumed sepsis. However, he continued to have diarrhea. Susceptibility testing of the GI PCR panel showed a multidrug resistance to ampicillin, ciprofloxacin and levofloxacin. It was sensitive only to trimethoprim-sulfamethoxazole and ceftriaxone. The patient had a complete resolution of symptoms once the antibiotic was switched according to sensitivities.

Discussion: Shigella is highly infectious and typically spreads via fecal-oral route. Outbreaks of shigellosis among MSM have been previously reported, mainly in the UK and Europe. Incubation period is 1 to 7 days and our patient’s sexual transmission occurred within this timeframe. Recent data from the US indicate a concerning rise in multidrug-resistant Shigella infections among these populations. These strains are highly resistant to common antibiotic classes, including macrolides, cephalosporins, and fluoroquinolones. It is crucial to increase awareness of adequate measures such as good hand hygiene practices during and after sexual intercourse, especially in the MSM community, to prevent and minimize the risk of transmission. Public health authorities and clinicians must be vigilant in reporting such cases.


Disclosures:


Abdullah Hafeez, MD¹, Dhruvi Sanikommu, MD², Glenn Fort, MD². P0285 - From Contagion to Containment: Tackling Multidrug-Resistant Shigella in MSM Community, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.