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Journal of Clinical Microbiology, June 2005, p. 2608-2612, Vol. 43, No. 6
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.6.2608-2612.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Outbreak of Dysentery Associated with Ceftriaxone-Resistant Shigella sonnei: First Report of Plasmid-Mediated CMY-2-Type AmpC ß-Lactamase Resistance in S. sonnei

I-Fei Huang,1,3 Cheng-Hsun Chiu,2 Mei-Hui Wang,2 Chan-Yao Wu,4 Kai-Sheng Hsieh,1 and Christine C. Chiou1,3*

Department of Pediatrics, Veterans General Hospital—Kaohsiung, Kaohsiung, Taiwan,1 Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan,2 National Yang-Ming University, Taipei, Taiwan,3 Department of Pediatrics, E-DA Hospital/I-Shou University, Kaohsiung County, Taiwan4

Received 21 September 2004/ Returned for modification 23 November 2004/ Accepted 20 January 2005

We document the first report of plasmid-encoded CMY-2-type AmpC ß-lactamase identified among Shigella sonnei isolates resistant to ceftriaxone and obtained after an outbreak of bacillary dysentery in Taiwan. One hundred eighty-two children in two elementary schools in Yu-Li, Taiwan, where an outbreak occurred after a typhoon hit this area in 2001, were enrolled in this study. Clinical and epidemiologic data on the infected children were collected. Pulsed-field gel electrophoresis (PFGE) was performed on the isolates to determine the genetic relatedness of outbreak strains. Plasmid analysis and PCR were performed to identify ß-lactamase genes responsible for ceftriaxone resistance. Forty-seven children from the two elementary schools were culture positive for S. sonnei in this outbreak. Twenty-three children were asymptomatic. Of the total isolates 55.3% were resistant to ampicillin. One hundred percent of the isolates obtained from children in school A were initially susceptible to both ampicillin and ceftriaxone. Of isolates obtained from school B 96.2% were nonsusceptible to ceftriaxone. However, two isolates from school A developed resistance to ampicillin during the course of treatment. All 18 available isolates showed closely related PFGE patterns (4, 4a, 4b, and 4c). CMY-2-type AmpC ß-lactamase was responsible for ceftriaxone resistance in ceftriaxone-nonsusceptible isolates; Southern blot hybridization confirmed that such a resistance gene was located on the plasmid. This is the first report of plasmid-mediated CMY-2-type AmpC ß-lactamase in S. sonnei. Ampicillin-resistant isolates can develop during the course of antibiotic treatment.

* Corresponding author. Mailing address: Department of Pediatrics, Veterans General Hospital—Kaohsiung, 386, Ta-Chung 1st Road, Kaohsiung, Taiwan. Phone: 886-7-3468203. Fax: 886-7-3468207. E-mail: chenchia{at}yahoo.com.

Journal of Clinical Microbiology, June 2005, p. 2608-2612, Vol. 43, No. 6
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.6.2608-2612.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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