Globally, shigellosis remains the second leading cause of diarrhea-associated deaths among children under five years of age, and the infections are disproportionately higher in resource-limited settings due to overcrowding, poor sanitation, and inadequate safe drinking water. The emergence and global spread of multidrug-resistant (MDR) Shigella are exacerbating the shigellosis burden. We adopted a cross-sectional study design to determine the distribution and antimicrobial susceptibility (AST) patterns of Shigella serogroups among children aged below five years presenting with diarrhea at Banadir Hospital in Mogadishu, Somalia, from August to October 2019. Stool and rectal swab samples were collected from 180 children consecutively enrolled using a convenient sampling technique and processed following standard bacteriological methods. AST was determined using the Kirby–Bauer disc diffusion method and interpreted as per the Clinical Laboratory Standard Institute (2018) guidelines. Shigellosis prevalence was 20.6% (37/180), and S. flexneri (26/37 (70.3%)) was the predominant serogroup. All the serogroups were 100% resistant to ampicillin (AMP), trimethoprim-sulfamethoxazole (SXT), and tetracycline (TE). Ceftriaxone (CRO) resistance was the highest among S. sonnei (66.7%) isolates. 19.2% of S. flexneri and S. sonnei (50%) serogroups were resistant to ciprofloxacin (CIP), but all S. dysenteriae type 1 isolates remained (100%) susceptible. Forty percent of CIP-susceptible S. dysenteriae type 1 were resistant to CRO. Seven MDR Shigella phenotypes were identified, dominated by those involving resistance to AMP, SXT, and TE (100%). Our findings showed a high prevalence of shigellosis with S. flexneri as the most predominant serogroup among children under five years of age in Banadir Hospital, Somalia. AMP and SXT are no longer appropriate treatments for shigellosis in children under five years in Banadir Hospital. MDR Shigella strains, including those resistant to CIP and CRO, have emerged in Somalia, posing a public health challenge. Therefore, there is an urgent need for AMR surveillance and continuous monitoring to mitigate the further spread of the MDR Shigella strains in Banadir Hospital and beyond.

中文翻译：

---

索马里摩加迪沙巴纳迪尔医院五岁以下腹泻儿童的耐多药志贺菌病

在全球范围内，志贺氏菌病仍然是导致 5 岁以下儿童腹泻相关死亡的第二大原因，由于过度拥挤、卫生条件差和安全饮用水不足，在资源有限的环境中感染率高得不成比例。耐多药 (MDR)志贺氏菌的出现和全球蔓延加剧了志贺氏菌病的负担。我们采用横断面研究设计来确定志贺氏菌的分布和抗菌药物敏感性 (AST) 模式2019 年 8 月至 10 月在索马里摩加迪沙巴纳迪尔医院出现腹泻的 5 岁以下儿童的血清组。使用方便的采样技术从连续登记的 180 名儿童中收集粪便和直肠拭子样本，并按照标准细菌学方法进行处理。AST 使用 Kirby-Bauer 椎间盘扩散法测定，并根据临床实验室标准研究所 (2018) 指南进行解释。志贺氏菌病的患病率为 20.6% (37/180)，而福氏链球菌 (26/37 (70.3%)) 是主要的血清群。所有血清群对氨苄青霉素 (AMP)、甲氧苄啶-磺胺甲恶唑 (SXT) 和四环素 (TE) 均 100% 耐药。头孢曲松 (CRO) 耐药性在S.sonnei (66.7%) 分离株中最高。19.2%S. flexneri和S.sonnei (50%) 血清群对环丙沙星 (CIP) 具有抗性，但所有1 型痢疾杆菌仍然 (100%) 敏感。40% 的 CIP 敏感型 1 型痢疾杆菌对 CRO 具有抗性。鉴定了七种 MDR志贺氏菌表型，主要是对 AMP、SXT 和 TE 的抗性（100%）。我们的研究结果表明，在索马里巴纳迪尔医院的五岁以下儿童中，志贺氏菌病的患病率很高，其中弗氏杆菌是最主要的血清群。在巴纳迪尔医院，AMP 和 SXT 不再适合治疗五岁以下儿童志贺氏菌病。耐多药志贺氏菌包括对 CIP 和 CRO 具有抗性的菌株，已在索马里出现，构成了公共卫生挑战。因此，迫切需要进行 AMR 监测和持续监测，以减轻 MDR志贺氏菌菌株在巴纳迪尔医院及其他地方的进一步传播。