1291. Shigella Bacteremia in Georgia, 2002-2012
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • postertemplate4 20130924.pdf (372.4 kB)
  • Background: Shigella is a common cause of bacterial gastroenteritis but is uncommonly identified as a cause of bacteremia.  Associated demographic, clinical, and risk factors are not well described.

    Methods: Patients with Shigella isolated from any site were identified through population-based active surveillance in Georgia (EIP/FoodNet) from 2002 –2012. Duplicate isolates identified within 30 days of the initial isolate were excluded. Demographic, epidemiologic, and clinical information was collected using a standard case report form. More detailed laboratory and exposure data were collected from 2005-2012.  HIV-infection status was available for bacteremic patients only.  Shigella identification, speciation and serotyping were performed at the State laboratory.  Bacteremic patients were compared with patients with Shigella isolated only from stool. Because most isolates were either S. flexneri (SF) or S. sonnei (SS), other species were excluded from analysis.

    Results: During 2002-2012, 11,262 Shigella infections, of which 72 were isolated from blood, were identified.  The median age of bacteremic patients was 29 years (range 0 – 67); the male-female ratio was 2.4:1.  Association with international travel or outbreaks was rare among bacteremic patients.   Bacteremic patients were more likely to be black (58/71 [82%] vs. 3882/9130 [43%]; p < 0.01) and male (51/72 [71%)] vs. 5350/10746 [50%]; p<0.01) than patients with only stool isolates.  SS 35/72 (49%) and SF 30/72 (42%) species were both common in bacteremic patients while stool only infections were predominantly SS: 8966/10,770 (83%); SF: 950/10,770 (9%) (p<0.01).  Among serotyped SF isolates, SF 2A was significantly associated with bacteremia (7/27[26%] vs 0/482[0%]; <0.01). Thirty-seven (51%) of the 72 bacteremic patients were HIV-infected. Among bacteremic patients with known species, SF occurred in 28/37 (76%) HIV-infected vs. 2/28 (7%) with negative or unknown HIV status (p<0.01).

    Conclusion: Male gender and black race were associated with Shigella bacteremia.  More than half occurred in HIV-infected individuals. SF, in particular SF 2A, was associated with bacteremia.  Both host and pathogen factors may lead to Shigella bacteremia.

    Melissa Tobin-D'angelo, MD, MPH1,2, Nadine Oosmanally, MSPH1,2, Siri Wilson, MPH1, Suzanne Segler, MPH2,3, Lynett Poventud, MT (ASCP)4 and Evan J. Anderson, MD2,5, (1)Georgia Department of Public Health, Atlanta, GA, (2)Georgia Emerging Infections Program (EIP), Atlanta, GA, (3)Atlanta VA Medical Center, Decatur, GA, (4)Georgia Department of Public Health, Decatur, GA, (5)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA


    M. Tobin-D'angelo, None

    N. Oosmanally, None

    S. Wilson, None

    S. Segler, None

    L. Poventud, None

    E. J. Anderson, None

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