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Antimicrobial resistance pattern of Shigella species isolated from human stool in Asia: A systematic review

Submitted:

03 July 2025

Posted:

10 July 2025

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Abstract
Abstract: Background: Shigella species are Gram-negative bacteria responsible for bacillary dysentery, particularly affecting children in low-income countries. The species are highly infectious and are primarily transmitted through contaminated food and water. Treatment typically involves antibiotics, but the rise of multidrug-resistant (MDR) Shigella strains has made management challenging. Methods: A comprehensive literature search was performed using PubMed and Google Scholar to identify studies on the prevalence of Shigella species and its antimicrobial resistance in Asia from 2000 to 2022. Results: The prevalence of Shigella varied widely, ranging from 1.31% to 40.34% in analysis of 25 studies. Among the four Shigella species, S. flexneri emerged as the most prevalent, accounting for 51.38% of isolates (n=6062/11797). S. boydii was the least encountered species, constituting only 1.5% of cases. Ampicillin resistance was high with rates exceeding 80% in eight studies. Tetracycline resistance exceeded 80% in nine out of 15 studies. Cotrimoxazole resistance was also very high with 15 studies showing rates over 80%. Chloramphenicol resistance was less common, with eight of 11 studies showing over 50% susceptibility. Gentamycin resistance was low, with 11 of 12 studies showing over 50% susceptibility. Ciprofloxacin low resistance with 100% susceptibility in five studies. Ceftriaxone resistance was also minimal. Conclusions: This systematic review highlights high burden of Shigella infection in Asia and significant drug resistance to tetracycline, ampicillin, nalidixic acid, and cotrimoxazole. Urgent actions include proper antibiotic use, and conducting clinical trials to develop effective management guidelines for Shigella infections is to be considered. KEYWORDS Shigella, human stool, antimicrobial resistance, asia
Keywords: 
shigella
;  
human stool
;  
antimicrobial resistance
;  
asia
Subject: 
Medicine and Pharmacology  -   Immunology and Allergy

Introduction

Shigella species are Gram-negative, rod-shaped, non-spore-forming, facultative anaerobic bacteria belonging to the family Enterobacteriaceae [1]. These bacteria are the primary causative agents of bacillary dysentery in humans, leading to diarrhea and dysentery [1]. Shigella species are categorized into serotypes and subserotypes based on the O-antigen present in the lipopolysaccharide of their cell envelope. This classification includes serogroup A (S. dysenteriae): 15 serotypes and 2 provisional serotypes, serogroup B (S. flexneri): 6 serotypes and 16 subserotypes, serogroup C (S. boydii): 20 serotypes, serogroup D (S. sonnei): 1 serotype [2]. In 1897, Kiyoshi Shiga, a Japanese scientist, first identified S. dysenteriae, a highly virulent strain producing exotoxins [3]. Globally, S. flexneri is the leading cause of diarrhea, particularly endemic in low- and middle-income countries, particularly 2a, 3a, 1a, 6, and 1b, are predominant in Asian countries [1,6].
Shigellosis, caused by the human pathogen Shigella spp., is a global health concern, disproportionately affecting chiefly the children below 5 years in low-income countries [4,5]. Notably, Shigella exhibits high transmissibility, requiring a low infectious dose of only 10-100 bacteria to cause illness, primarily spread through the fecal-oral route [3,5]. Transmission occurs through contaminated food, water, fomites, or direct contact with infected individuals [3] Sexual transmission, particularly among men who have sex with men, has also been reported [5]. Several outbreaks have been associated with consuming contaminated food and water, particularly foods that are manually handled, minimally processed, or eaten raw [7]. The clinical symptoms of shigellosis encompass a spectrum from mild watery diarrhoea to bloddy,mucoid diarrhoea accompanied by painful abdominal cramps and fever [10].
In shigellosis, the treatment approach depends on the severity of the disease. For mild symptoms, the focus is on hydration and electrolyte management due to water loss. In severe cases, especially for immunocompromised individuals, antibiotics are prescribed to shorten symptoms and reduce infection spread [13,17]. Antimicrobial resistance has complicated shigellosis treatment since the 1940s, starting with sulfonamide resistance in Japan [13]. Over the decades, Shigella developed resistance to tetracycline, chloramphenicol, and ampicillin, leading to the use of co-trimoxazole. However, by the mid-1980s, resistance to co-trimoxazole also emerged, drastically reducing its effectiveness [13]. Shigella spp. acquires drug resistance through several mechanisms: reducing the permeability of its outer membrane, actively pumping out drugs via efflux systems, enhancing the production of enzymes that inactivate or modify drugs, and altering drug targets through mutations. The rise of multidrug-resistant (MDR). Shigella strains and the progression of the disease have made case management more challenging [11]. Various factors, including geographic location, time period, class of antimicrobial usage, and the specific agents used, serotype of bacteria can influence the susceptibility patterns of Shigella [14,15].
The growing prevalence of multidrug resistance (MDR). to existing drugs, the lack of effective vaccines, the increasing global incidence, and the high rates of infection in vulnerable populations all highlight the need for this review.Despite the high prevalence of shigellosis, summary data on Shigella species are very few from Asia. Also the resistance pattern of bacteria may changes with time revealing resistance to newer drugs too. Therefore, this reviewer focused on prevalence and antimicrobial-resistant features of Shigella species in Asia from 2000 to 2023.

Methodology

Literature Search

The systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). guidelines [16]. A comprehensive literature search was conducted on the prevalence of shigella species and its antimicrobial resistance pattern among Asian population.Potentially relevant studies were identified through a computerized search using databases of PubMed and Google Scholar.The search was based on the combination of the following special index search terms (medical subject headings (MeSH). and Boolean operations: “Shigella “OR “Shigellosis” “OR “Bacillary Dysentery AND “Prevalence “OR “Epidemiology” AND (‘Drug Resistance’ OR ‘antimicrobial Resistance’ OR ‘Antibiotic resistance’” OR antimicrobial susceptibility AND “Asia” in the title,abstract or keywords fields.Published in the English language, onwards from 2000 AD till dated 2022 AD. The records found through database searching were combined and the duplicates were removed using Covidence.The study initially screened all unique published articles based on title and abstract and further filtered out by reviewing full articles considering inclusion and exclusion criteria. This systematic review was exempt from Institutional Review Board review and was not registered.

Inclusion Criteria

  • An article published in English from Asia, dating from 2000 AD to 2023 AD.
  • Shigella isolates only from human stool
  • Mentioned total number of Shigella isolates and antibiotic resistance/susceptible percentage of bacteria.
  • Study design been cohort study, cross sectional or hospital surveillance.

Exclusion Criteria

  • Studies having Shigella isolates from animal, or poultry origin.
  • Shigella isolates other than human stool like food, water sources and other environmental in origin.
  • Published between 2000AD and 2023 AD , language other than English , population included outside Asia
  • Study design been case report, case series and reviews, conference abstract
  • Resistance rates were not recorded

Data Extraction

The data extraction was done by two researcher (GB and AA). independently from included studies using a standardized and pretested format prepared in Microsoft Excel. A detailed review of each article was done to gather information about the first author, year of publication, enrollment time, country, type of study, population characteristics(percentage of male and female), age group of study participants, total stool sample, number of Shigella isolates, number and prevalence of different serogroups of Shigella, AST methods and resistance pattern of Shigella in eight different antibiotics including Ampicillin, tetracycline, cotrimoxazole, chloramphenicol, nalidixic acid, gentamycin, ciprofloxacin and ceftriaxone. The information was recorded in google sheet. Two researchers, AA and GB, performed data extractions separately to negotiate any possible errors. Disagreement on data extractions between researchers were resolved through discussion and consensus. The extracted data were checked at least twice for their accuracy.

Results

Study Selection

After conducting a comprehensive database search, 731 articles were initially retrieved. Following the removal of duplicates, 608 articles remained for further analysis. Subsequently, 482 papers were excluded during title and abstract screening due to non-compliance with inclusion criteria. The full text of the remaining 126 articles was obtained. Among these, 101 were rejected as they did not contain relevant findings. Ultimately, 25 articles were included in the review for our research paper. (Figure 1)

Study Characteristics

In this study, total 25 studies across different age groups were reviewed qualitatively. Among these studies, 19 were cross-sectional study, while 5 are surveillance. The primary countries represented were Iran (5 studies), China (4 studies), and India (4 studies). Additionally, 8 studies were conducted in the WHO Eastern Mediterranean region (including Iran, Pakistan, and Yemen), 7 in the WHO South-East Asia region (including Nepal and India), and 7 in the WHO Western Pacific region (including China, Malaysia, and South Korea). Two studies originated from Turkey. Notably, all the studies were hospital-based; no community-based research was included. The publication timeline spanned from 2001 to 2022, with enrollment occurring between 1999 and 2021.A detailed description of the characteristics of individual studies is provided in Table 1.

Outcome

  • Population Demographics
In our comprehensive review, we analyzed studies spanning various age groups. In 5 studies they had included people of all age group. Notably, 3 studies exclusively focused on children under five years, while 4 studies included children under 16 years. Age groups were unspecified in 10 studies. In most of the studies in which age distribution of disease were given, the prevalence of Shigella infection is more in children under 5 years. For instance, Taneja et al [40]. study in Indian population reported a prevalence of 34.3% in this age group. Similarly, Chang et al's [19]. surveillance study in China found 31.47% prevalence in children under 5, with an even higher incidence in those below 1 year. Additionally, 8 studies recorded gender-specific data, consistently revealing a male predominance of over 50% in all these studies.
  • Shigella Distribution
Across 25 comprehensive studies, a total of 11,797 Shigella species were isolated (Table 2).
These samples were collected from patients presenting with symptoms such as diarrhea and other gastrointestinal issues. Total number of stool sample was reported in 15 studies ranged from 70802 in Chang et al to 233 in SalimiyanRizi et al. The prevalence of Shigella varied widely, ranged from 1.31% to 40.34%. In 9 studies we identified that the Shigella isolates from human stool sample was less than 5%.
Among the four Shigella species, S. flexneri emerged as the most prevalent, accounting for an impressive 51.38% (6062/11797). of isolates. Remarkably, in 10 studies, S. flexneri prevalence exceeded 50%. Conversely, S. boydii was the least encountered species, constituting a mere 1.5% of cases (178/11,797). Intriguingly, six studies reported no S. boydii isolates at all. Shigella sonnei, a common cause of shigellosis, represented 44.39% of cases (5237/11,797). and S.dysenteriae 2.1%(255/11797). Additionally, total 65 species were unclassified Shigella species.
  • Antimicrobial Resistance
The antibiotic-resistance information for Shigella species in different countries of Asia was studied against 8 most common antibiotic agents during 2000-2022 (Table 3). .
In 23 studies AST was done by disc diffusion method and in only 2 it was done by agar dilution method.

Ampicillin

Among 25 studies,ampicillin resistance was recorded in 21 studies.One study noted a 100% resistance rate among all Shigella species. In eight studies, resistance levels exceeded 80%, while only six studies showed susceptibility rates above 50%. Notably, one study reported a resistance rate as low as 10%

Tetracycline

Tetracycline resistance was investigated in 15 studies.In 9 different studies,the resistance was more than 80%.The resistance pattern of tetracycline ranged from 98.7% to 40%.Only 2 out of 9 studies reported the susceptibility of more than 50%.

Cotrimoxazole

Cotrimoxazole resistance was recorded in 24 out of 25 studies. Fifteen studies revealed resistance rates exceeding 80%, with overall resistance ranging from 37.5% to 97.5%. Except for one study, none showed susceptibility rates above 50%

Chloramphenicol

The resistance to chloramphenicol was investigated in 11 studies.One study reported of 100% susceptibility to chloramphenicol and 8 revealed the susceptibility of more than 50% whereas 2 study reported the resistance of more than 70%.

Nalidixic Acid

Most studies (22 out of 25). reported antimicrobial resistance to nalidixic acid. One study found a 100% resistance rate among all Shigella species. Seven studies reported resistance rates higher than 80%, while one study showed a minimal resistance rate of 1%. Only eight studies indicated susceptibility rates above 50%

Gentamycin

Only 12 studies reported the resistance of Shigella to gentamycin.11 studies showed the susceptibility to gentamycin of more than 50% .The resistance pattern ranged from 56.3% in one study to no resistance at all in one study.

Ciprofloxacin

20 out of 25 studies reported the resistance to ciprofloxacin.5 studies revealed 100% susceptibility of ciprofloxacin in all Shigella species and 11 studies showed resistance of less than 20%.Only four studies reported the resistance of more than 50% to ciprofloxacin.

Ceftriaxone

The resistance of Shigella to ceftriaxone was reported in 13 studies.3 studies revealed no resistance of ceftriaxone to Shigella.9 out of 13 studies showed resistance of less than 20%.The maximum resistance recorded was 45.2% in one study.Only 2 studies showed the resistance of more than 30%.
Most Shigella species isolates tested sensitive for gentamycin ciprofloxacin and ceftriaxone. Even though the reports varied in research locations and times, Shigella species were resistant to tetracycline, ampicillin,chloramphenicol, and co-trimoxazole.

Discussion

This review analyzed the distribution of Shigella serogroups and antimicrobial resistance patterns, based on data from 25 eligible studies conducted in Asia. The infection caused by this pathogen can be highly life-threatening for infants and children under five years old It has been estimated that approximately 188 million individuals worldwide contract shigellosis each year with 1 million deaths annually [42]. In Asia alone, it is estimated that there are 125 million infections and 14,000 deaths due to shigellosis annually [43]. The burden of disease is exacerbated by multiple serotypes that contribute to repeated infections. While immunity develops with age, shigellosis remains a significant risk for travelers in endemic areas, often manifesting as persistent diarrhea.Changing patterns of antimicrobial susceptibilities among Shigella isolates pose major difficulties in selecting an appropriate drug for the treatment of shigellosis [12].
According to the review and meta-analysis conducted by Basilua Andre Muzembo among five South Asian countries, Shigella flexneri was the most prevalent serogroup, accounting for 58% of the isolates, followed by Shigella sonnei at 19% [44]. In our study, we found a similar pattern, with Shigella flexneri being the most prevalent, representing 51.38% of the isolates, followed by Shigella sonnei at 44.39%. It has been documented that while Shigella flexneri remains the dominant serogroup in underdeveloped countries, its prevalence is declining in many rapidly developing and developed nations. In contrast, Shigella sonnei is on the rise in these rapidly developing and developed regions.This statement is further validated by a study conducted in United states(1999-2002)in which Shigella sonnei accounted for 71.7%, Shigella flexneri accounted for 18.4% [45].Such shift in prevalence has also been noted in some asian countries as in a study conducted in southern Vietnam [46].There was a significant species shift from S. flexneri to S. sonnei between period (1995-1996). (29% S. sonnei). and period (2007-2008). (78% S. sonnei). with an approximate 1:1 ratio of S. flexneri to S. sonnei in the intermediate period (2000-2002).
This systematic review highlights significant variability in antimicrobial resistance patterns in Shigella species across different antibiotics. Ampicillin resistance was notably high, with several studies showing rates exceeding 80%, and some even reaching 100%. Tetracycline resistance was also prevalent, with rates over 80% in some studies. Co-trimoxazole resistance was reported in many studies, with 15 showing resistance rates above 80%. Chloramphenicol resistance varied significantly, with some studies showing high susceptibility rates and others showing high resistance. Nalidixic acid resistance was similarly high, with one study reporting 100% resistance and several others reporting over 80% resistance.
This result is consistent with the findings of Andaman Islands study (2000–2011). in which 100%the shigella isolates were resistance to ampicillin [47]. Another article from China (2010). states 85.4% of shigella isolates were resistant to ampicillin [48].These findings align with a previous review on antimicrobial resistance patterns of Shigella species in Africa, Asia, and South America (2001–2014), which noted that most studies from Africa and Asia demonstrated significant resistance to tetracycline, chloramphenicol, and co-trimoxazole among Shigella serogroups [49]. Additionally, a multicenter study conducted in six Asian countries revealed high resistance rates to ampicillin and co-trimoxazole across all sites, while resistance to nalidixic acid varied widely: 100% of S. flexneri and 98% of S. sonnei strains in China were resistant, compared to 75% of S. sonnei and 48% of S. flexneri strains in Bangladesh, with little or no resistance reported at other sites [50].
The World Health Organization (WHO). guidelines for treating Shigella and dysentery, first issued in 2005 and updated in 2013, recommend ciprofloxacin as the primary treatment [14]. The advised dosage is 15 mg/kg for children and 500 mg for adults, taken twice daily for three days and azithromycin and ceftriaxone are suggested as second line drugs [12]. The guidelines also stated that ceftriaxone and pivmecillinam (amdinocillin pivoxil). are "the only antimicrobials that are usually effective for the treatment of multi-resistant strains of Shigella in all age groups," but their use is restricted due to their expensive formulation (parenteral administration for ceftriaxone, and four times daily dosing for pivmecillinam). As a result, ciprofloxacin-resistant local strains of Shigella were the only circumstances in which pivmecillinam and ceftriaxone were approved for usage.
In our study also the resistance of shigella against ciprofloxacin is relatively low in most studies. Out of 25 studies, 20 reported some level of resistance to ciprofloxacin. However, five studies found 100% susceptibility, meaning no resistance was observed in those cases. In 11 studies, resistance rates were less than 20%, suggesting ciprofloxacin remains largely effective. Only four studies reported higher resistance rates, with over 50% of Shigella strains showing resistance. This suggests that while resistance is emerging in some areas, ciprofloxacin is still generally effective against Shigella in most regions. Also, resistance of Shigella to ceftriaxone was generally low, with most studies showing minimal resistance and only a few reporting higher levels.
Although ,A systematic review examined the evolving resistance patterns to ciprofloxacin in the Asia–Africa regions (combined). and found a significant rise in resistance, increasing from 0.6% (95% CI 0.2–1.3%). in 1998–2000 to 29.1% (95% CI 0.9–74.8%). in 2007–2009. This represents a 49-fold increase over 12 years [51]. In another review they conducted between 1999 and 2012, They found a significant increase in ceftriaxone resistance in asia africa region rising from 0.83% (1998-2000) to 14.2% (95% CI 3.9–29.4%). by 2012(52). Ceftriaxone may not be suitable for treating shigellosis in Asia-Africa, according to the authors' conclusion.
A 2013 systematic review examined 48 high-quality randomized controlled trials, mostly conducted in low- and middle-income countries (LMICs). The review showed that following the current WHO treatment guidelines using ciprofloxacin, pivmecillinam, or ceftriaxone reduced clinical failure rates by 82% (95% CI 67–99%). It also found that these treatments successfully eliminated Shigella pathogens in 96% of cases (95% CI 88–99%). The authors concluded that there is strong evidence supporting the effectiveness of these antimicrobial guidelines in reducing serious morbidity and mortality [53]. However, a study conducted in Bangalore between 2002 and 2007 found that while all shigella isolates were sensitive to ciprofloxacin between 2002 and 2004, the resistance pattern gradually increased up to 48% over the course of the year [54]. As a result, the author concluded that ciprofloxacin cannot be used to treat shigellosis. In another study done in Iran ,ciprofloxacin resistance among shigella isolates were found to be 73%.
Given the research highlighting rising resistance to ciprofloxacin and ceftriaxone, a review of international literature was conducted to explore alternative antimicrobials for the treatment of Shigella dysentery.In our review , only 12 studies found resistance to gentamycin and 11 reported over 50% susceptibility suggesting it could be effective against Shigella. In contrast,Global patterns of aminoglycoside resistance in Shigella (from 1999 to 2010). were evaluated in a 2013 comprehensive review, which also showed rising levels of in vitro gentamicin resistance in the Asia–Africa area, reaching 32.4% in 2005–2007 [55]. The 2010 Cochrane study confirmed aminoglycosides' inefficacy, as they typically have poor oral absorption, thus reducing their utility [56].
Azithromycin, a macrolide antibiotic, is recommended as an alternative second-line treatment for adults in both current WHO guidelines and most international guidelines.In earlier (1995-1996) study done in Dhaka [57], azithromycin was effective in the treatment of adult men with moderate to severe shigellosis with clinical rate of cure (82% [CI, 70% to 95%]). and the bacteriologic rate of cure (94% [CI, 80% to 99%]).By 2010/11,azithromycin susceptibility was still 74% [58]. More recently, there have been growing reports of Shigella strains resistant to azithromycin, including documentation by the Centers for Disease Control and Prevention (CDC) [59]. In areas where ciprofloxacin-resistance is evident, azithromycin can be an appropriate second-line alternative therapy owing to its oral administration and affordability [60].
The World Health Organization (WHO). guideline that recommends ciprofloxacin as a first-line treatment and ceftriaxone, pivmecillinam, and azithromycin as alternatives remains effective in many regions but many studies have depicted their inefficacy owing to to rising resistance rates. The global rise in antibiotic resistance presents a significant challenge to managing infectious diseases, and WHO has classified it as a critical issue. The drug resistance pattern in a country typically reflects how effective the current treatment plans are for various diseases and helps guide future strategies. To address the global challenge of antimicrobial resistance and limit its spread, constant monitoring of susceptibility patterns is necessary. It is for selection of appropriate antimicrobial agents for therapy when indicated.
This growing resistance demands the urgent development of new antibiotics and strategies to preserve the effectiveness of existing ones. Evidence suggests that antibiotic prescribing contributes to resistance not only on a societal scale but also at the individual patient level, making this information crucial for clinicians [61]. In light of the rapid development of multi-drug resistance, focusing on vaccine development against the most common Shigella strains could offer a promising alternative. It is essential to carefully monitor any changes in the prevalence of serotypes and resistance patterns of Shigella strains in different regions to adapt treatment strategies accordingly [47].

Conclusions

This review study suggests that the current treatment mechanism might not be addressing the full burden of Shigella-associated mortality in Asia. The pooled estimate provides high burden of Shigella infection and its high proportion of drug resistance pattern to tetracycline, ampicillin, chloramphenicol, and cotrimoxazole in Asia. Clinicians should continue to aggressively aware shigellosis, particularly vulnerable children with diarrhea, such as those younger than 5 years or identification and treatment of Shigella infection which might be life-saving. As a result, initiating and scaling-up drug susceptibility testing for each shigellosis case, educating the community and health care providers on appropriate antibiotic use, and conducting clinical trials are all urgently needed to

Author Contributions

All authors wrote the manuscript, performed the research, and analyzed the data. G.B and A.A designed the research. R.G and S.B reviewed the research article. All authors have read and agreed to the published version of the manuscript.

Data Availability Statement

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Acknowledgments

We would like to thank the faculty of Department of infectious disease, Clinical Pharmacology, Microbiology and all collaborators who provided excellent assistance during the study.

Ethics Approval and Consent to Participate

No ethical approval and consent was needed from institutional review committee.

Conflicts of Interest

The authors declare that they have no competing interests.

List of abbreviations

AMR-Antimicrobial Resistance
MDR-Multi Drug Resistance
WHO-World Health Organization
CDC-Centre for Disease Prevention and Control

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Table 1. Study Information.
Table 1. Study Information.
Author Country WHO region Enrollment Time Published Year Type of study Age group included Male% Female% Total Stool Sample Number of Shigella Isolates
Tariq [17] Pakistan Eastern Mediterranean 2009-2010 2012 Cross sectional NR NR NR 2500 95
Zhang [18] china Western Pacific 2006-2012 2015 Cross sectional 2-90 years NR NR NR 2226
Chang [19] China Western Pacific 2004-2014 2016 Surveillance All age group. 31.47% in under 5.More in child below 1 66 35 70802 6278
Maharjan [20] Nepal South East 2014 2017 Cross sectional 15-90.More in 15-30 56 54 640 29
Banajeh [21] Yemen Eastern Mediterranean 1998 2001 Cross sectional 1-60 month NR NR 561 37
Gharibi [22] Iran Eastern Mediterranean 2002-2008 2012 Cross sectional NR NR NR NR 121
SalimiyanRizi [23] Iran Eastern Mediterranean 2018-2019 2020 Cross sectional Less than 14 NR NR 233 94
Saran [24] Turkey European Region 2008-2009 2013 Cross sectional NR NR NR NR 60
Mamishi [25] Iran Eastern Mediterranean 2021 2022 Cross sectional 1-16 yrs 51 49 7121 183
Taneja [26] India South East 2015-2019 2021 Retrospective 9 month to 78 years.34.3% in Child below 5 60 40 10456 137
Shakya [27] Nepal South East 2003-2007 2016 Surveillance All age.24.5% Child below 10 More in male Less 332
Zafar [28] Pakistan Eastern Mediterranean 2002-2003 2005 Cross sectional NR NR NR 4688 193
Özmert [29] Turkey European Region 2003-2009 2011 Cross sectional 5-202 months(16.8 yrs).More in child under 5 57 43 14803 238
Srinivasa [30] India South East 2002-2007 2009 Cross sectional All age.41.8% in child under 14 and 52.2% in adult More Less 2941 134
MoezArdalan [31] Iran Eastern Mediterranean 2001-2002 2003 Cross sectional NR NR NR 734 123
Dhital [32] Nepal South East 2014 2017 Cross sectional Child under 5 NR NR 717 15
Salmanzadeh-Ahrabi [33] Iran Eastern Mediterranean 2003-2005 2007 Cross sectional NR NR NR 1350 155
Dutta [34] India South East 1995-2000 2002 Surveillance Child under 5 NR NR 2855 166
Karacan [35] Turkey European Region 2002 2007 Cross sectional Range 1-16 Mean 4.83 57 43 198
Mamatha [36] India South East 2001-2006 2012 Cross sectional NR NR NR 2100 77
Yang [37] China Western Pacific 2005-2011 2013 Surveillance 3month to 92 year.Median age 4.More common in child under 4 53 47 308
Gu [38] China Western Pacific 2002-2011 2017 Surveillance NR NR NR 340
Koh [39] Malaysia Western Pacific 2007-2009 2012 Cross sectional NR NR NR 70
Chuang [40] Taiwan Western Pacific 2001-2002 2006 Cross sectional 0-16 yrs included.Mean age 6.1 51 49 122
Jin [41] South Korea Western Pacific 1999-2008 2010 Cross Sectional NR NR NR NR 66
Table 2. Shigella Species Distribution.
Table 2. Shigella Species Distribution.
Author Number of Shigella Isolates % of Shigella S.dysentrie % No.S.dysentrie S. flexneri % No.S.flex eri S. sonnei % No.S.sonnei S. boydii % No.S.boydii Unidentified AST Method
Tariq 95 3.8 29 28 49 47 13 12 9 8 0 Disc Diffusion
Zhang 2226 13.1 0 0 36 802 63.9 1424 0 0 0 Disc Diffusion
Chang 6278 8.87 0.61 38 63.86 4009 34.89 2191 0.63 40 0 Agar Dilution
Maharjan 29 4.5 10 3 59 17 8 8 3 1 0 Disc Diffusion
Banajeh 37 6.6 18 7 34 13 8 3 20 4 10 Disc Diffusion
Gharibi 121 0 1 5 38 46 51 62 16 8 0 Disc Diffusion
SalimiyanRizi 94 40.34 1 1 23.4 22 70.2 66 0 0 5 Disc Diffusion
Saran 60 0 1.6 1 16.6 10 81.6 49 0 0 0 Disc Diffusion
Mamishi 183 2.5 0 0 30 55 70 128 0 0 0 Disc Diffusion
Taneja 137 1.31 0.7 1 63.5 87 8.8 12 6.6 9 28 Disc Diffusion
Shakya 332 0 28.6 95 50 166 27.54 34 6.6 15 22 Disc Diffusion
Zafar 193 4.1 11 21 58 112 16 31 15 29 0 Disc Diffusion
Özmert 238 1.6 0 0 10.5 25 87.8 209 1.7 4 0 Disc Diffusion
Srinivasa 134 4.6 3.7 7 64.9 87 21.6 29 8.2 11 0 Disc Diffusion
MoezArdalan 123 16.8 15 19 45 55 31 38 9 11 0 Disc Diffusion
Dhital 15 2 0 0 80 12 20 3 0 0 0 Disc Diffusion
Salmanzadeh-Ahrabi 155 11.5 4.5 7 30.8 48 55.1 85 9.6 15 0 Disc Diffusion
Dutta 166 5.8 5 8 58 96 28 47 9 15 0 Disc diffusion
Karacan 198 0 5.1 10 10.1 20 83.3 165 1.5 3 0 Disc Diffusion
Yang 77 3.7 1.3 1 94.8 73 3.9 3 0 0 0 Disc Diffusion
Gu 308 0 0.9 3 84.4 260 13 40 0.7 5 0 Agar Dilution
Koh 340 0 0 0 0 0 All 340 0 0 0 Disc Diffusion
Chuang 70 0 0 0 0 0 All 70 0 0 0 Disc Diffusion
Mamatha 122 0 0 0 0 0 All 122 0 0 0 Disc Diffusion
Jin 66 0 0 0 0 0 All 66 0 0 0 Disc Diffusion
Table 3. Antimicrobial Resistance Pattern.
Table 3. Antimicrobial Resistance Pattern.
Author Number of Shigella Isolates Ampicillin % Tetracycline % Cotrimoxazole % Chloramphenicol % Nalidixic acid % Gentamycin % Ciprofloxacin% Ceftriaxone%
Tariq 95 97 94 97 73 66 17 13 20
Zhang 2226 87 79 79 27 98 56 11 0
Chang 6278 89 88 0 0 89 34 22 0
Maharjan 29 58 0 55 7 76 0 52 0
Banajeh 38 0 0 84 52 19 48 0 0
Gharibi 121 0 93 86 0 12 0 4.3 0
SalimiyanRizi 94 57 0 83 0 16 27 3.8 44
Saran 60 27 68 92 0 0 0 0 0
Mamishi 183 96 0 96 0 64 2 18 0
Taneja 137 68 71 76 21 0 7.6 62 45
Shakya 332 88 0 76 0 80 0 39 0
Zafar 193 56 0 88 0 39 0 0 0
Özmert 238 36 0 70 0 4.7 0 0 0
Srinivasa 134 55 0 81 43 62 0 21 0
MoezArdalan 123 0 74 70 0 1 0 3.1 2
Dhital 15 0 80 67 0 80 0 67 6.7
Salmanzadeh-Ahrabi 155 81 99 94 28 2.6 0 0 0
Dutta 166 67 92 96 46 29 3 4 0
Karacan 198 14 0 90 0 0 0 0 2
Yang 308 93 91 81 76 96 39 28 27
Gu 340 68 74 69 0 75 36 0 0
Koh 70 10 40 38 10 2.5 0 0 0
Chuang 122 32 0 98 0 98 0 0 27
Mamatha 77 100 84 90 0 100 0 87 2.5
Jin 66 41 94 95 0 65 9 0 1.5
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