MOLECULAR EPIDEMIOLOGY OF MULTIPLY ANTIBIOTIC-RESISTANT SHIGELLA-FLEXNERI IN FORTALEZA, BRAZIL

In northeastern Brazil, strains of Shigella flexneri resistant to mult iple antibiotics are often found in patients in both urban areas and c ommunity hospitals. This study used pulsed-field gel electrophoresis ( PFGE) and plasmid analysis to further analyze the molecular epidemiolo gy of Shigella flexneri strains isolated from hospitals and an urban c ommunity in Fortaleza, Brazil, Twenty-six strains of S. flexneri from three distinct areas in the city of Fortaleza, Brazil, were examined: 14 strains from people with diarrhea who lived in an urban community o f 2,000 persons, 5 strains from patients in the university hospital, a nd 7 strain from children in a pediatric hospital. PFGE identified six unique groups of S. flexneri circulating among patients during the 45 -month study. Seven strains were further studied for antibiotic resist ance plasmid profiles. Three unique antibiotic resistance plasmid prof iles were found, Strains collected from the hospitalized patients demo nstrated the variety of PFGE and antibiotic resistance patterns in the area. Strains collected from the patients living in the urban communi ty setting demonstrated the persistence of certain PFGE patterns as we ll as the acquisition of multiple antibiotic resistance plasmids. Effe ctive interventional strategies for such geographic locations as Forta leza, Brazil, will be more complex than those for single-strain outbre ak situations.