Multidrug Resistant Shigella Infection in Bangladesh
Multidrug Resistant Shigella Infection in Bangladesh
The purpose of this project is to systematically collect clinical and nutritional outcomes
 information on patients treated for Shigella infection so that physicians and clinical
 laboratories can better define which Shigella infections are "resistant" to antibiotics and
 which are "susceptible", focusing on azithromycin a last-line drug to treat drug resistant
 Shigella
2000 suspected Shigella cases will be recruited from International Centre for Diarrhoeal
 Disease Research hospital, Dhaka who are presenting with diarrhea at the hospital. A stool
 sample will be collected from the participants after consenting by the study staff. Stool
 microscopy will be performed to see the white blood cells(WBC) and red blood cells (RBC). If
 WBC > 10 HPF (4) with any RBC present, culture will be performed from this stool to identify
 Shigella. Such patients with invasive diarrhea are treated with azithromycin per local
 standard of care. Enrolled participant will be invited for further follow up when culture
 from the stool is Shigella positive. Minimal inhibitory concentration (MIC) testing of
 Shigella isolates and Molecular testing of Shigella isolates will be performed from Shigella
 cultures. This is an observational study. This study does not provide any treatment to the
 study participants; they will receive treatment as per International Centre for Diarrhoeal
 Disease Research Dhaka hospital guidelines. We will then examine the effect of the
 azithromycin minimal inhibitory concentration on clinical outcome.
Inclusion Criteria:

 -  diarrheal illness less than 96 hours duration

 -  microscopic evidence of inflammatory diarrhea

 -  plus mucus in stool

 -  plus abdominal pain/cramps

 -  Subject or parents or legal guardian willing to come for follow up at hospital or
 allow study staff for home visit

 -  residence in Dhaka region

 -  presentation during daytime hours

 Exclusion Criteria:

 • Not receiving treatment with azithromycin at enrolment