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Antimicrobial resistance

How has childhood shigellosis in Vietnam changed over 14 years?

Vinh H, Nhu NT, Nga TV, et al. · BMC infectious diseases · 2009

Open access · cc by · source: Europe PMC

Over 14 years the dominant cause of childhood dysentery in southern Vietnam switched from S. flexneri to S. sonnei, resistance to key drugs like ceftriaxone rose, and admitted children appeared more severely ill.

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Study at a glance

Design
Cross-sectional — Serial comparison of three independent hospital studies (1995-96, 2000-02, 2006-08) with re-tested stored isolates and pooled clinical records
N
N=279 · 279 children with culture-confirmed shigellosis had clinical data (63, 113 and 103 across the three periods); 297 Shigella strains were analysed microbiologically
Population
Children under 14 admitted with diarrhoea or dysentery to a tropical-diseases hospital in Ho Chi Minh City and a provincial hospital in southern Vietnam
Outcome
Shigella species mix, antimicrobial susceptibility profiles, and clinical features of disease across the three periods

Structured fields used in claim comparison tables when every cited study has a complete layer.

Key findings

S. sonnei rose from 29% of isolates in the first period to 78% in the last, replacing S. flexneri as the dominant species. Resistance to nalidixic acid, ofloxacin and ceftriaxone climbed step by step (by the last period 23% were ceftriaxone-resistant and 68% nalidixic-acid-resistant), while resistance to older drugs like ampicillin and chloramphenicol fell. Children in later periods were older, had more watery diarrhoea, abdominal pain and febrile convulsions, higher white-cell counts and longer hospital stays, suggesting more severe disease, although the two species produced only subtly different clinical pictures.

Methodology

The researchers combined data from three separate hospital studies of children with diarrhoea or dysentery in southern Vietnam, run in 1995-96, 2000-02 and 2006-08. Stored Shigella isolates were re-identified and re-tested against seven antibiotics using disk diffusion and E-test MICs. Clinical details recorded on standard forms (age, symptoms, blood counts, stool microscopy, length of stay) were compared across the periods and between species.

Limitations

The three source studies had different aims and entry criteria (the middle one enrolled any diarrhoea rather than dysentery, and its treatment was not controlled), so changes across periods may partly reflect who was enrolled rather than true change in the disease. Only hospitalised children at referral hospitals were included, so the authors say they cannot estimate incidence or the wider community picture. The link between rising severity and the switch to S. sonnei is a temporal association, not a demonstrated cause, and the explanation that antibiotic use drives resistance is the authors' interpretation rather than something measured.

How this study connects

Role on claims

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  • SupportsAntimicrobial Resistanceconcept

    Yesterday's antibiogram can mislead today's prescription.

    Resistance patterns shift over time as drug use changes. In southern Vietnamese children with shigellosis, S. sonnei replaced S. flexneri (29% to 78% of isolates) while resistance to nalidixic acid, ofloxacin and ceftriaxone rose stepwise (23% ceftriaxone-resistant in the last period) and resistance to ampicillin and chloramphenicol fell. Among candiduria isolates, fluconazole resistance rose from 6.8% in 2010-11 to 29.5% in 2012-13.

    Evidence for the claim as stated.

History

When this study was placed

Dated entries from the concept change log — when this paper was added or removed as support, challenge, or qualifier on a claim.

  1. 2026-09-24

    Placed as supporting evidence on Antimicrobial Resistance

    Resistance patterns shift over time as drug use changes. In southern Vietnamese children with shigellosis, S. sonnei replaced S. flexneri (29% to 78% of isolates) while resistance to nalidixic acid, ofloxacin and ceftriaxone rose stepwise (23% ceftriaxone-resistant in the last period) and resistance to ampicillin and chloramphenicol fell. Among candiduria isolates, fluconazole resistance rose from 6.8% in 2010-11 to 29.5% in 2012-13.

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