Outbreak of multi-drug-resistant (MDR) Shigella flexneri in northern Australia due to an endemic regional clone acquirin
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ORIGINAL ARTICLE
Outbreak of multi-drug-resistant (MDR) Shigella flexneri in northern Australia due to an endemic regional clone acquiring an IncFII plasmid Christine J. D. Guglielmino 1 & Asha Kakkanat 1 & Brian M. Forde 2 & Sally Rubenach 3 & Lea Merone 4 & Russell Stafford 5 & Rikki M. A. Graham 1 & Scott A. Beatson 2 & Amy V. Jennison 1 Received: 8 July 2020 / Accepted: 27 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Epidemiological surveillance of Shigella spp. in Australia is conducted to inform public health response. Multi-drug resistance has recently emerged as a contributing factor to sustained local transmission of Shigella spp. All data were collected as part of routine public health surveillance, and strains were whole-genome sequenced for further molecular characterisation. 108 patients with an endemic regional Shigella flexneri strain were identified between 2016 and 2019. The S. flexneri phylogroup 3 strain endemic to northern Australia acquired a multi-drug resistance conferring blaDHA plasmid, which has an IncFII plasmid backbone with virulence and resistance elements typically found in IncR plasmids. This is the first report of multi-drug resistance in Shigella sp. in Australia that is not associated with men who have sex with men. This strain caused an outbreak of multi-drugresistant S. flexneri in northern Australia that disproportionality affects Aboriginal and Torres Strait Islander children. Community controlled public health action is recommended. Keywords Shigella . Australia . Public health surveillance . Vulnerable populations . Plasmids . Recombination, genetic
Introduction Shigellosis in Australia is generally understood to occur as sporadic cases among returning travellers or amongst men who have sex with men (MSM) as locally acquired, sexually Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-04029-w) contains supplementary material, which is available to authorized users. * Christine J. D. Guglielmino [email protected] 1
Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Australia
2
School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia
3
Tropical Public Health Services, Queensland Health, Cairns, Australia
4
Rural and Remote Clinical Support Unit, Apunipima Cape York Health Council, Cairns, Australia
5
Communicable Diseases Unit, Queensland Health, Brisbane, Australia
transmitted infections [1]. However, in northern Queensland and the Northern Territory, locally acquired strains of both Shigella sonnei and S. flexneri are persistently transmitted within other population groups [2]. These endemic strains have previously been mostly susceptible to commonly used antimicrobial agents including ampicillin, ciprofloxacin and co-trimoxazole [3]. In 2019, both Australia and Queensland had a shigellosis notification rate of 12 per 100,000 head of population, while in contrast, the Northern
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