SHIGELLA GASTROENTERITIS - CLINICAL AND EPIDEMIOLOGIC ASPECTS, AND ANTIBIOTIC SUSCEPTIBILITY

The epidemiology and antibiotic sensitivity of Shigella species is cha nging worldwide. The present study surveyed the changing clinical and epidemiological characteristics and antibiotic susceptibility of Shige lla gastroenteritis in Hacettepe University Ihsan Dogramaci Children's Hospital Diarrhoea Training and Treatment Unit between 1987 and 1994. Among 19 812 diarrheal admissions, 618 (3.2%) patient Files with Shig ella gastroenteritis were reviewed retrospectively. Shigella soneii ha s been the commonest isolate (64%) since 1987 followed by S. flexineri (30%), S. boydii (5%) and S. dysenteriae (1%), the latter having not been isolated since 1990. The isolate rate of S. sonnei has increased whereas the isolation rate of S. flexineri has decreased concomitantly since 1987 (r= -0.94; P < 0.001). The majority of cases (365/618, 59% ) were between 1 and 5 years of age. On admission bloody diarrhea was present in 36%, seizures in 3% and mild-moderate dehydration in 11% of cases. No case had severe dehydration. Only six patients (1%) were ho spitalized. No deaths were recorded. The resistance rate for trimethop rim-sulfamethoxazole has increased from 27% in 1990 to 66% in 1994 (P < 0.05) while the resistance rate for ampicillin has decreased from 81 % in 1987 to 32% in 1993 (P < 0.001). Shigella flexineri was found to have higher resistance rates to ampicillin, sulbactam-ampicillin, chlo ramphenicol and gentamicin than S. sonnei. Changing Shigella sp. over the years may be the reason for the mild course of Shigella gastroente ritis. Further regional epidemiological studies are necessary to devel op more appropriate management guidelines, especially in developing co untries.