Centers for Disease Control and Prevention

Antimicrobial Resistance Threats Report

Drug-resistantShigella

Threat Level: SERIOUS

In the United States in 2023:

CDC changed methodologies and data sources to produce the most comprehensive AR Threats Report to date. Direct comparison of this threat's data to previous reports is not recommended.

What you need to know

Shigella bacteria can cause bloody diarrhea, fever, stomach pain, and other symptoms. Shigella spread easily through contaminated food, water, surfaces, and objects and through direct contact with someone who is sick or was recently sick with a Shigella infection, including through sexual contact. People disproportionately affected by Shigella infections include gay, bisexual, and other men who have sex with men, people experiencing homelessness, young children, and international travelers.

Most people with a Shigella infection get better in five to seven days with fluids and rest, but people with a severe infection may need antibiotic treatment. Some Shigella are resistant to antibiotics, which can limit treatment options. Healthcare providers can order laboratory tests to determine which antibiotics might be effective.

Drug-resistant Shigella data

The percentage of Shigella causing drug-resistant infections has increased since 2017, and the percentage of Shigella causing extensively drug-resistant (XDR) infections has increased since 2020. As resistance increased, drug-resistant Shigella caused an increasing number of infections and hospitalizations.

Estimated number of drug-resistant Shigella infections and hospitalizations by year in the U.S.

Drug-resistant Shigella caused an estimated 484,000 infections in 2022 and 679,000 infections in 2023. These bacteria caused an estimated 5,100 hospitalizations in 2022 and 7,100 hospitalizations in 2023.

The estimated percentage of drug-resistant Shigella isolates (pure samples of Shigella) has increased since 2017.

Percent resistant or nonsusceptible to antibiotics by year among Shigella isolates tested in the U.S.

The percentage of Shigella isolates with resistance to ciprofloxacin, azithromycin, or ceftriaxone increased from 6.8% to 57.2% between 2011 and 2023. In 2020, the estimated percentage of extensively drug-resistant (XDR) Shigella isolates—defined as resistant to ampicillin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and nonsusceptible (resistant or not completely susceptible) to azithromycin—began to increase, reaching 10% in 2023.

Resistance to ciprofloxacin remained less than 5% in 2011 through 2016 before increasing in 2017. The percentage of isolates nonsusceptible to azithromycin increased between 2017 and 2021, peaking at 47% in 2021 then decreased between 2021 and 2023, but remained above 25% in 2023. Resistance to ceftriaxone began to increase in 2018, with a 20.6% increase between 2022 and 2023. XDR Shigella are resistant to all antibiotics typically used for treatment in the United States, which can limit treatment options.

Antimicrobial susceptibility testing helps healthcare providers know which treatment to use for patients. As antimicrobial resistance increases, selecting an effective antibiotic when treatment is needed for Shigella infection is becoming more challenging, underscoring the importance of detecting and monitoring antimicrobial resistance. Timely reporting helps public health officials detect and respond to outbreaks of resistant infections, monitor resistance trends over time, inform treatment recommendations, and guide prevention efforts.

CDC alerts healthcare providers, others to increase in dangerous Shigella infections

A couple shops for vegetables at a market stand.

CDC collaborates with state and international public health agencies to disseminate tailored communications to ensure key audiences are aware of emerging drug-resistant threats and are prepared with steps to prevent and treat infections.

By 2023, CDC scientists had become concerned about increasing extensively drug-resistant (XDR) Shigella infections. XDR Shigella are resistant to all antibiotics typically used for treatment in the United States, which can limit treatment options. To raise awareness of this serious and emerging threat, CDC conducted targeted communication outreach. CDC sent a health advisory, with an estimated reach of more than one million people, including healthcare and public health professionals and the public. The advisory provided recommendations for each audience and advised people disproportionately affected by Shigella infections—particularly gay, bisexual, and other men who have sex with men and international travelers—to practice good hand hygiene and safer sex.
To reach these groups, CDC partnered with social media influencers. Their videos reached more than 22,000 people. Additionally, CDC's targeted social media posts and online ads garnered more than 22 million impressions.
CDC also collaborated with state and international public health agencies to provide information about XDR Shigella infections and answer questions in a webinar for healthcare professionals. Other CDC activities included presenting information on XDR Shigella infections at meetings and conferences, and in media interviews and podcasts.
These timely, tailored communications were designed to ensure key audiences were aware of XDR Shigella and prepared with steps to prevent and treat infections.

How CDC combats drug-resistant Shigella

  • Detecting concerning infections

    CDC monitors Shigella infections using surveillance systems designed to rapidly detect outbreaks and drug-resistant strains. Information from surveillance helps public health departments respond to outbreaks before they grow larger. Public health officials also use surveillance information to implement interventions that help prevent the spread of Shigella among people at risk.

  • Establishing clinical standards

    CDC collaborates with laboratories to provide data that help healthcare providers determine whether an antibiotic is likely to treat a patient's Shigella infection. Notably, CDC data were used to establish the first-ever clinical breakpoints for azithromycin for Shigella. Breakpoints help laboratories determine whether bacteria are susceptible (responsive to an antibiotic) or resistant and help healthcare providers get patients on the right treatment sooner to improve care and outcomes.

  • Providing guidance and resources

    CDC provides guidance to healthcare providers, laboratories, and public health practitioners on how to respond to Shigella infections and outbreaks. Resources include the Shigella Prevention and Control Toolkit for health departments and prevention tips for people at risk.

  • Using data for action

    CDC provides evidence-based strategies to prevent Shigella infections among sexually active people and stop the spread of drug-resistant Shigella, including during outbreaks.

Drug-resistant Shigella resources

Illustration of Drug-resistant Shigella