Dr Vicky Tittle Chelsea and Westminster Hospital, London
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1 Dr Vicky Tittle Chelsea and Westminster Hospital, London
2 Exploring the epidemiology and management of shigellosis in a large acute hospital Trust Lauren Bull, Vicky Tittle, Nabeela Mughal, Luke Moore, Stephen Hughes, Hannah Skene, Mark Nelson, Rachael Jones, Mike Rayment
3 S. flexneri, S. sonnei, S. dysenteria, S. boydii Transmission Low infective dose Background Persistent /asymptomatic carriage Travel/Group sex/rimming
4 PHE data Non travel exceeds travel related cases Increased by 502% - Decreased by 47% - Non- travel related in MSM fell by 51%
5 Clusters S. flexneri 2a Largest cluster Persisting for 2 years + 4months 98% are MSM in London Immunosuppression and multiple drug resistance factors contributing to persistence S. sonnei MSM was the population of the largest cluster Persistent for 39 months
6 PHE recommendations Sexual and travel history Increase awareness amongst MSM 48 hours post- symptoms/7 days Consider antibiotics
7 Previous data. In our unit. In 2012 (looking back 3.5 years) 54 stool positive Shigella spp. 72% (39) S. flexneri
8 Aim To review the epidemiology and management of cases in our Trust and compare to national trends
9 Methods All stool cultures between November January 2018 reviewed for one Trust Patient case review of all positive samples Demographic Behavioural data Travel Sexual Species Antibiotics and resistance Prevention advice
10 Results: 35/6229 stool cultures
11 Results: Demography 94% (33) male Median age = 35 yrs (range 16-91yrs) 54% (19) PLWH 9% (3) on PREP 20% (7) had concomitant STI
12 Results: Behavioural data HIV/GU service (n=26) A&E/ general medicine (n=9) Male (n=33) Sexual history % (n) Travel history % (n) Female (n=2) Sexual History % (n) Travel history % (n) 100 (26) 8 (2) n/a n/a 11 (1) 56 (5) * 0 (0) 11 (1) * 44% (4) had a positive travel history
13 Results: Behavioural data (2) MSM Of those with a documented sexual history (27) 93% (25) were MSM 30% (8) reported fisting/rimming/group sex 1 reported foreign travel
14 Results: Species Shigella spp Percentage (%) (n) S. sonnei 54% (19) S. flexneri 43% (15) Mixed 3% (1)
15 Number of Shigella cases by time No of cases Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 Time (three monthly intervals between Nov Jan 2018) Sonnei Flexneri
16 Results: Antibiotics 51% (18) treated empirically; 72% (13) ciprofloxacin 33% (6) required change of antibiotic
17 Results: Resistance 31% (12) ciprofloxacin resistance Shigella spp Ciprofloxacin resistance (%) (n=12) S. sonnei (n=19) 58% (11) S. Flexneri (n=15) 7% (1)
18 Prevention Poor documentation of infection control measures 6% (2) documented 20% (7) were informed about no SI, but with STI Direct notification by labs to HPT when details available Deferred to our unit for sexual health numbers (11)
19 Conclusions: general Many of shigellosis cases Men PLWH Reporting sexual risk behaviours Cases seen in ED/medicine were unlikely to be asked a sexual history although travel related shigellosis more prominent in this group
20 Conclusions: Microbiologically Predominant species overall and in sexually acquired cases was S.Sonnei - differs to previous surveillance data Prevalence of quinolone resistance significantly greater in S.Sonnei in this sample
21 Conclusions: prevention Poor infection control prevention advice No SI Hand washing/food hygiene
22 Limitation Only reviewed stool cultures Missing data on all gastroenteritis presentations
23 Thank you
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