Antimicrobial Resistance Reaches Common Infections: Kerala Faces Growing Shigellosis Threat
Antimicrobial resistance (AMR) is no longer confined to hospital settings. Clinicians in Keralam are raising concern over rising resistance to primary antibiotics used for common community-acquired infections such as Shigellosis, a bacterial dysentery. This development has significant implications for antibiotic use in the State.
Data from Keralam's Antimicrobial Resistance Surveillance Network (KARS-NET), one of the strongest surveillance systems in the country, reveals a worrying trend. The network has been tracking Shigellosis since 2023. According to its data, ciprofloxacin, which remains part of national treatment guidelines for Shigella dysentery, now shows a resistance rate of 96%. This means the drug can no longer be relied upon as an empirical treatment for the infection.
Even more concerning is the growing resistance to ceftriaxone, a third-generation cephalosporin antibiotic and a common next-line option. KARS-NET data shows resistance to this drug has climbed to 36%.
“Till now, community-acquired AMR had not been a problem in the State. If you, as a citizen, have never been worried about AMR, you should be now, because it is showing up right at your doorstep. Our arsenal of effective and affordable antibiotics for common infections in the community is shrinking,” said Dr. R. Aravind, head of infectious diseases at Government Medical College, Thiruvananthapuram, and convenor of KARS-NET.
Most acute diarrhoeal diseases are self-limiting and resolve with proper rehydration alone. Shigellosis is largely self-resolving as well. However, in vulnerable populations—children under five and the elderly—the infection can lead to severe dehydration, sepsis, and neurological complications, making antibiotic treatment essential.
Shigella is primarily an enteric pathogen spread through contaminated food and water, from person to person. This makes it a sentinel organism for understanding AMR trends in the community. The rising resistance profile is therefore an early warning signal.
Dr. Aravind explained the clinical implications for severe cases. “Clinicians have been using ceftriaxone for Shigellosis patients who get admitted. But the growing resistance to this drug is immense. For patients with severe dysentery going into septic shock and multiorgan failure, it is absolutely important that the correct antibiotic is administered within an hour and that it is 100% sensitive. This means for such serious patients, we can no longer depend on ceftriaxone and have to go for high-end drugs like meropenem, which belongs to the carbapenem class—widely considered last-resort antibiotics.”
Keralam reports sporadic Shigellosis cases every year, but in June this year, the State experienced one of its major outbreaks. A total of 225 cases and six deaths were reported from Kozhikode, Malappuram, and Wayanad districts. Clinicians warn that the unusually high loss of life should be viewed alongside the rising AMR data, even though there is no exact evidence linking AMR directly to these deaths.
The emergence of resistant strains is not new. More than a decade ago, Keralam documented multidrug-resistant Shigella and ESBL-producing strains. ESBL (Extended Spectrum Beta-Lactamases) enzymes can break down important third-generation antibiotics, rendering them ineffective. A 2018 study by clinicians at Government Medical College, Alappuzha, examined Shigella isolates between 2011 and 2016. It found that 91.6% of the isolates were multidrug-resistant, with eight isolates resistant to ceftriaxone or cefotaxime.
This growing resistance profile underscores an urgent need for antibiotic stewardship and strengthened surveillance. Health authorities and clinicians alike must work towards preserving the effectiveness of existing antibiotics and exploring new treatment strategies to address community-acquired infections.
