| Summary: | <p>Abstract</p> <p>Between 2002 and 2007, travel related cases of <it>Shigella sonnei </it>and <it>S</it>. <it>flexneri </it>in Alberta, Canada were acquired from Central America, the Indian subcontinent and North America. Of this group, resistance to ciprofloxacin and nalidixic acid was identified in isolates from patients who had travelled to the Indian subcontinent. This study provides a Canadian perspective to a growing body of literature linking ciprofloxacin and nalidixic acid resistance to travel to the Indian subcontinent.</p> <p><it>Shigella </it>is a common cause of diarrheal illness in North America with a rate of 2.0 per 100,000 in Canada <abbrgrp><abbr bid="B1">1</abbr></abbrgrp> and a rate of 3.2 per 100,000 in the United States <abbrgrp><abbr bid="B2">2</abbr><abbr bid="B3">3</abbr></abbrgrp>. Imported cases of <it>Shigella </it>infections have been reported in developed countries following travel to a foreign or developing country <abbrgrp><abbr bid="B4">4</abbr><abbr bid="B5">5</abbr></abbrgrp> and may be impacted by factors including socio-economic factors <abbrgrp><abbr bid="B6">6</abbr></abbrgrp>, food distribution networks <abbrgrp><abbr bid="B5">5</abbr></abbrgrp> and microbiologic factors <abbrgrp><abbr bid="B7">7</abbr></abbrgrp>. Across multiple geographic regions, high rates of antimicrobial resistance to multiple agents (e.g. sulfonamides, tetracycline, chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) have limited the choices for empiric antimicrobial therapy required to manage <it>Shigella </it>infections and reduce fecal excretion of the bacteria <abbrgrp><abbr bid="B8">8</abbr><abbr bid="B9">9</abbr><abbr bid="B10">10</abbr></abbrgrp> with descriptions of shifting species dominance and changes in antimicrobial susceptibility <abbrgrp><abbr bid="B10">10</abbr><abbr bid="B11">11</abbr></abbrgrp>. Generally, <it>Shigella flexneri </it>and <it>Shigella sonnei </it>are the dominant species and are heavily impacted by changes in antimicrobial susceptibility <abbrgrp><abbr bid="B12">12</abbr><abbr bid="B13">13</abbr></abbrgrp>.</p> <p>This study identifies the global regions associated with travel-related cases of <it>S</it>. <it>flexneri </it>and <it>S</it>. <it>sonnei </it>in Alberta, Canada and compares antibiotic resistance patterns of these isolates for 2002 to 2007 inclusive.</p> <p>Specimens collected 2002-2007 (inclusive) from <it>S. flexneri </it>and <it>S. sonnei </it>infections in Alberta, Canada were included for study. Data collected at time of specimen submission included: date of specimen collection, outbreak association if present, travel history and antibiogram (data source-ProvLab Information Systems; Communicable Disease Report at Alberta Health and Wellness). Outbreaks were defined by public health officials as ≥ 2 epidemiologically related cases. Each outbreak was assigned a unique incident number. Repeat isolates received within six months of original case infections were excluded. Only one representative case for each outbreak was included, unless the isolates had different antibiotic susceptibility patterns. Based on travel history the origin of an isolate was grouped into corresponding regions and continents. Regions included in the study represented major travel destinations for individuals living in Canada. Domestic exposures were defined as "travel within North America."</p>
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