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Infection with extensively drug-resistant Shigella sonnei harbouring blaCTX-M-27 in a gay man in Italy
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  • Published on: 24 March 2025
    bla-CTX-M-27 Shigella sonnei outbreaks
    • Daniel Richardson, consultant sexual health physician Brighton & Sussex Medical Schoool

    Id like to congratulate the authors for highlighting this case of extensively antimicrobial resistant Shigella sonnei in an MSM in Italy which is most likely part of the current S.sonnei outbreak accross europe which has shown to contain plasmids with CTX-M-27. Sexual health , primary care and gastroenterology clinicians continue to prescribe (sometimes inappropriate) antimicrobials to MSM including for asymptomatic extragenital STIs and empirically for diarrhoeal illnesses despite the emergence of antimicrobial resistant N. gonorrhoea, M. genitalium and enteric pathogens including Shigella spp.. Enteric pathogens are particularly efficient in transmitting AMR genes such as bla-CTX-M27 via horizontal transmission of plasmids, hence the rapid evolution of resistant shigella in MSM. The learning points from your paper for clinicians need to be emphasising the need for far better governance around antimicrobial prescribing in this group including empirical management of diarrhoea. We have recently published UK BASHH guidance on antimicrobial prescribing for diarrhoea and enteric pathogens, however more work is needed to control the evolution and transmission of resistant shigella and other STIs in MSM

    Conflict of Interest:
    None declared.