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Azithromycin (AZM), a macrolide, is currently the first-line treatment for shigellosis in Bangladesh; ciprofloxacin (CIP) and ceftriaxone (CRO) are also used frequently. We aimed to evaluate the current epidemiology of antimicrobial resistance (AMR) and mechanism(s) of increasing macrolide resistance in\n                    <jats:italic>Shigella<\/jats:italic>\n                    in Bangladesh. A total of 2407 clinical isolates of\n                    <jats:italic>Shigella<\/jats:italic>\n                    from 2009 to 2016 were studied. Over the study period,\n                    <jats:italic>Shigella sonnei<\/jats:italic>\n                    was gradually increasing and become predominant (55%) over\n                    <jats:italic>Shigella flexneri<\/jats:italic>\n                    (36%) by 2016. We used CLSI-guided epidemiological cut-off value (ECV) for AZM in\n                    <jats:italic>Shigella<\/jats:italic>\n                    to set resistance breakpoints (zone-diameter\u2009\u2264\u200915\u00a0mm for\n                    <jats:italic>S. flexneri<\/jats:italic>\n                    and\u2009\u2264\u200911\u00a0mm for\n                    <jats:italic>S. sonnei<\/jats:italic>\n                    ). Between 2009 and 2016, AZM resistance increased from 22% to approximately 60%, CIP resistance increased by 40%, and CRO resistance increased from zero to 15%. The\n                    <jats:italic>mph<\/jats:italic>\n                    A gene was the key macrolide resistance factor in\n                    <jats:italic>Shigella<\/jats:italic>\n                    ; a 63MDa conjugative middle-range plasmid was harboring AZM and CRO resistance factors. Our findings show that, especially after 2014, there has been a rapid increase in resistance to the three most effective antibiotics. The rapid spread of macrolide (AZM) resistance genes among\n                    <jats:italic>Shigella<\/jats:italic>\n                    are driven by horizontal gene transfer rather than direct lineage.\n                  <\/jats:p>","DOI":"10.1038\/s41598-024-57423-1","type":"journal-article","created":{"date-parts":[[2024,3,23]],"date-time":"2024-03-23T05:02:39Z","timestamp":1711170159000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Multidrug-resistant conjugative plasmid carrying mphA confers increased antimicrobial resistance in Shigella"],"prefix":"10.1038","volume":"14","author":[{"given":"Asaduzzaman","family":"Asad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Israt","family":"Jahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moriam Akter","family":"Munni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruma","family":"Begum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morium Akter","family":"Mukta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazi","family":"Saif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shah Nayeem","family":"Faruque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoma","family":"Hayat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhahirul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,23]]},"reference":[{"key":"57423_CR1","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1590\/S1517-83822010000400015","volume":"41","author":"CMD de Paula","year":"2010","unstructured":"de Paula, C. 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