Infections caused by multidrug-resistant shigellae resistant to broad-spectrum cephalosporins are becoming more prevalent in the Middle East. We report a case of severe diarrhea due to a multiresistant Shigella flexneri 1 strain carrying four different ß-lactamase genes. A one-year-old Syrian infant presented with severe acute diarrhea, vomiting and dehydration. She did not respond to empirical treatment with amoxicillin-clavulanic acid followed by cefotaxime. Later, stool culture revealed S. flexneri 1 resistant to both these drugs. The patient was successfully treated with meropenem to which S. flexneri 1 was susceptible. The isolate was resistant to eight classes of antibiotics, and the whole genome sequence (WGS) identified four ß-lactamase genes (blaCTX-M-15, blaEC-8, blaOXA-1, and blaTEM-1) along with genes mediating resistance to seven other antibiotic classes. The WGS also identified several virulence genes including senA that encodes ShET-2 which induces watery diarrhea. Phylogenetically, the isolate was closely related to isolates from South Asia. This report highlights the emergence of extremely resistant Shigella that has acquired multiple resistance genes to cephalosporins rendering these drugs ineffective.

中文翻译：

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携带多种头孢菌素编码基因的弗氏志贺氏菌1引起的婴儿腹泻

在中东，由对广谱头孢菌素具有抗药性的多重耐药志贺氏菌引起的感染正变得越来越普遍。我们报告了由于携带四个不同的ß-内酰胺酶基因的多重耐药志贺氏菌1株引起的严重腹泻病例。一名1岁的叙利亚婴儿表现为严重的急性腹泻，呕吐和脱水。她对阿莫西林-克拉维酸接着是头孢噻肟的经验性治疗没有反应。后来，粪便培养显示出弗氏链球菌1对这两种药物均具有抗性。该患者已成功用美罗培南治疗，其中弗氏链球菌1易感。分离株对八种抗生素具有抗性，整个基因组序列（WGS）鉴定出四个ß-内酰胺酶基因（blaCTX-M-15，blaEC-8，blaOXA-1，和blaTEM-1）以及介导对其他七种抗生素类药物产生抗性的基因。WGS还鉴定了几种毒力基因，包括编码ShET-2的senA，后者诱导水样腹泻。在系统发育上，该分离物与来自南亚的分离物密切相关。该报告强调了极度耐药的志贺氏菌的出现，该菌已获得对头孢菌素的多种耐药基因，使这些药物无效。