A serious and increasingly untreatable diarrheal illness is spreading across the United States, marking a major shift in how the disease behaves.
According to a new report from the Centers for Disease Control and Prevention (CDC), cases of extensively drug-resistant (XDR) Shigella have jumped from 0% in 2011 to 8.5% of all cases in 2023.
The bacteria, which cause an infection known as shigellosis, are now resistant to all five common oral antibiotics usually used to treat it. This leaves doctors with no FDA-approved oral treatment options for these “super-bug” strains.
Historically, shigellosis was a disease that primarily affected children in daycare settings. However, the new data shows a distinct change in the demographic. Between 2011 and 2023, the CDC analyzed nearly 17,000 samples and found that the vast majority of XDR cases—over 86%—occurred in adult men.
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The median age for those infected with these resistant strains is 41. Health officials also noted that among patients whose HIV status was known, nearly 47% were co-infected with HIV, a group at higher risk for severe complications.
While most stomach bugs eventually clear up on their own, antibiotics are critical for severe cases or to stop the spread in high-risk environments. The XDR strains are particularly concerning because they can spread their resistance genes to other types of bacteria in the gut.
The infection is highly contagious; it takes as few as 10 organisms to make a person sick. It typically spreads through:
- Direct person-to-person contact
- Sexual contact
- Contaminated food or water
- Touching contaminated surfaces
The CDC’s findings highlight a steady and concerning climb in resistance. While no XDR cases were detected between 2011 and 2015, the first samples appeared in 2016. By 2022 and 2023, the surge became more pronounced, with 84% of all recorded XDR cases occurring in just those two years.
Hospitalization rates are also significant. About 38% of patients with these resistant infections required hospital care. While two species of the bacteria were identified—Shigella sonnei and Shigella flexneri—the latter is causing concern because it is often linked to more severe symptoms and higher rates of hospitalization.
Public health officials are urging doctors to use detailed lab testing to see which drugs, if any, might still work for a specific patient. Because there are no approved oral pills for XDR Shigella, some patients may require IV treatments or alternative medications that haven’t been officially cleared for this specific illness.
“The high transmission potential of XDR Shigella strains highlights the importance of susceptibility testing and timely reporting,” the CDC report stated. For now, health agencies are focusing on early detection and prevention strategies to keep the resistant strains from moving further into the general population.
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