CDC Warns of Rising Drug-Resistant Shigella Threat in U.S.

CDC reports U.S. cases of extensively drug-resistant Shigella rose to 8.5% in 2023.

The CDC's latest report spotlights an alarming rise in extensively drug-resistant (XDR) Shigella cases in the United States. Among 16,788 Shigella isolates analyzed from 2011 to 2023, 3% were found to be XDR, with the annual proportion climbing to 8.5% last year.

• XDR Shigella resists all five key antibiotics typically used for treatment: ampicillin, azithromycin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole.
• There are currently no FDA-approved oral antibiotics for these infections, which “makes treatment options for XDR Shigella extremely limited,” said Dr. Robert Glatter, attending emergency physician at Lenox Hill Hospital.
• The median patient age is 41, and 86.2% of XDR shigellosis patients are men.
• Transmission is largely domestic: 76.2% of patients reported no recent domestic travel and 82.4% had no international travel, indicating homegrown spread.

Shigella is highly infectious—illness can occur after exposure to as few as 10 bacteria. It spreads via fecal-oral routes, including sexual contact and contaminated food or water.

Data show that nearly 38% of XDR shigellosis patients required hospitalization. Additionally, 46.6% of patients with available HIV status were co-infected with HIV.

For legal professionals, the rapid emergence of XDR Shigella signals heightened compliance responsibilities in healthcare settings and may trigger new infection control protocols, reporting standards, and potential legal exposure if mitigation is inadequate.

“Antibiotic resistance is a global issue because antibiotics are overused and used inappropriately around the world,” said Dr. William Schaffner, professor of preventive medicine at Vanderbilt University.