CDC Warns of Rising Drug-Resistant Shigella Infections in the US

A drug-resistant strain of Shigella bacteria is increasing in the United States, with public health officials noting a significant rise in extensively drug-resistant (XDR) infections over the past decade, according to a report from the Centers for Disease Control and Prevention (CDC).

The CDC report, published on April 9 in the Morbidity and Mortality Weekly Report, found that cases of XDR Shigella infections increased by nearly 8.5% from 2011 to 2023. While earlier outbreaks primarily affected children and involved strains treatable with antibiotics, recent surveillance shows a shift in the demographic most impacted.

“Whereas earlier U.S. Outbreaks involved drug-susceptible strains and primarily affected children, national surveillance data indicate that most XDR cases occurred among adult men. Approximately one third of patients were hospitalized,” the report states.

What is Shigellosis?

Shigellosis is an infection caused by Shigella bacteria that affects the intestinal tract, leading to symptoms such as diarrhea — often bloody or prolonged — stomach pain, fever, and a persistent urge to pass stool even when the bowels are empty. The illness is typically spread through ingestion of the bacteria, which can occur via contaminated food, water, surfaces, or direct person-to-person contact, including sexual activity with an infected individual.

Who Is Most at Risk?

According to the CDC, certain populations face a higher risk of contracting Shigellosis. These include people experiencing homelessness, young children under five — particularly in childcare or school settings — and travelers visiting areas with poor sanitation or unsafe food and water practices. However, the recent rise in XDR cases has been most notable among adult men, a shift from historical patterns.

Symptoms and Transmission

Symptoms of Shigellosis typically appear one to two days after exposure and may last several days. In addition to gastrointestinal distress, individuals may experience dehydration due to frequent diarrhea. The bacteria are highly infectious; even a small number of organisms can cause illness. Transmission commonly occurs through the fecal-oral route, meaning contamination of hands, surfaces, or objects with fecal matter can lead to infection if ingested. The CDC emphasizes that Shigella can also be spread through sexual contact, particularly among men who have sex with men, highlighting the importance of awareness and preventive measures in specific communities.

Prevention and Treatment

To reduce the risk of infection, the CDC recommends frequent handwashing with soap and water — especially after using the bathroom, changing diapers, before eating, and after contact with someone who is ill. Additional precautions include avoiding swallowing water while swimming, practicing safe food and water habits when traveling internationally, and refraining from sexual activity for at least two weeks after diarrhea resolves if either partner has been diagnosed with shigellosis. Most people with Shigellosis recover without antibiotics within five to seven days, as the illness often resolves on its own. Treatment primarily focuses on managing symptoms, particularly preventing dehydration through fluid intake and rest. In some cases, healthcare providers may prescribe antibiotics if deemed necessary, though the rise of drug-resistant strains complicates treatment options. Currently, there are no FDA-approved oral treatments specifically for XDR Shigella infections. Public health officials continue to monitor the trend closely and urge individuals experiencing persistent or severe diarrhea — especially if bloody — to seek medical attention. Early diagnosis and appropriate care are essential to prevent complications and limit further transmission.