Extensively drug-resistant Shigella made up 8.5% of all samples sent to U.S. labs in 2023, a sharp rise from 2011, when none of the tested samples showed drug resistance. The finding matters because Shigella infections were once routinely treated with antibiotics such as azithromycin and ciprofloxacin, but there is now no FDA-approved alternative for patients who catch the most resistant form.
The CDC has called extensively drug-resistant Shigella a public health threat, and the numbers show why. An estimated 450,000 Americans come down with some form of Shigella each year, and a third of the analyzed cases led to hospitalization. Most of the cases the CDC reviewed involved people with no recent travel history, which suggests the threat is no longer confined to infections brought in from abroad.
Shigella can cause intense diarrhea, fever and stomach pain, and it usually clears in about a week with or without antibiotics. But the infection can be life-threatening for children under 5 and for immunocompromised patients, and researchers say XDR cases have been climbing for the last 15 years. Recent outbreaks have also been linked to adult queer men, and scientists worry resistance genes could move into other gut bacteria.
The CDC says people who get sick should drink plenty of fluids to avoid dehydration, and it advises against using Imodium or Lomotil if the diarrhea is bloody. That leaves doctors with fewer tools and patients with fewer options, even as the country records more cases that no longer respond to the medicines that once made Shigella easy to treat.
