{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T10:11:29Z","timestamp":1760609489875,"version":"3.40.5"},"reference-count":31,"publisher":"Akademiai Kiado Zrt.","issue":"4","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2022,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The aim of our study was to delineate an outbreak of gastroenteritis caused by <jats:italic>Shigella flexneri<\/jats:italic> and affecting sixteen persons between May and June 2014 in Bilbao, Spain. All patients exhibited symptoms after consuming kebab in the same kebab shop.<\/jats:p><jats:p>The outbreak is described through the clinical cases, the microbiological and molecular genetic diagnosis, and the epidemiologic investigation. Minimum inhibitory concentrations for ampicillin, amoxicillin plus clavulanic acid, third and fourth generation cephalosporins, carbapenems, monobactams, aminoglycosides, fluoroquinolones, co-trimoxazole, colistin and tigecycline were measured. The <jats:italic>S. flexneri<\/jats:italic> strains were screened by PCR for TEM, SHV, CTX-M beta-lactamases and plasmidic AmpCs and <jats:italic>aac(6\u2032)-Ib<\/jats:italic> gene. Serotyping, pulsed field gel-electrophoresis, conjugation assay, plasmid sizing by S1 enzyme digestion and Southern blot hybridization were accomplished.<\/jats:p><jats:p>All the <jats:italic>S. flexneri<\/jats:italic> isolates proved to be serotype 2 and produced extended-spectrum beta-lactamase (ESBL). Carbapenems, fluoroquinolones, tigecycline, colistin, and co-trimoxazole remained active antibiotics.\u00a0All the strains harboured <jats:italic>bla<\/jats:italic><jats:sub>CTX-M-15<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>OXA-1<\/jats:sub> genes. The strains hosted two high-molecular\u00a0weight plasmids of 100 and 230\u2009kb, respectively. According to the hybridization assay <jats:italic>bla<\/jats:italic><jats:sub>CTX-M-15<\/jats:sub> was located on the plasmid of 230\u2009kb. The identical pulsotype verified the presence of outbreak.<\/jats:p><jats:p>Remarkable, that one of the food handlers has travelled recently to Pakistan, where ESBL-producing <jats:italic>Shigella<\/jats:italic> strains had been reported previously. To the best of our knowledge, this is the first outbreak caused by CTX-M-15-expressing <jats:italic>S. flexneri<\/jats:italic> in Spain and as well as in Europe.<\/jats:p>","DOI":"10.1556\/030.2022.01902","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T12:53:23Z","timestamp":1669899203000},"page":"345-350","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":1,"title":["Cluster of cases due to Shigella flexneri producing CTX-M-15 in Spain"],"prefix":"10.1556","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8532-4009","authenticated-orcid":true,"given":"Erika","family":"Kocsis","sequence":"first","affiliation":[{"name":"Clinical Microbiology and Infection Control, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain"},{"name":"Medical Mycology Laboratory, Department of Plant Production and Microbiology, Campus of Sant Joan d\u2019Alacant, University Miguel Hern\u00e1ndez, Ctra. Alicante-Valencia N 332, 03550, Alicante, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Luis","family":"D\u00edaz de Tuesta","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infection Control, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infection Control, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosaura","family":"Santamar\u00eda","sequence":"additional","affiliation":[{"name":"Unit of Epidemiology of Bizkaia, Public Health, Basque Government, Alameda de Rekalde 39 A, 48008, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Moragas","sequence":"additional","affiliation":[{"name":"Department of Health and Consumer Affairs, Council of Bilbao, Calle Ugalde 7, 48012, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Herrera-Le\u00f3n","sequence":"additional","affiliation":[{"name":"Unit of Enterobacteria, National Centre of Microbiology, Instituto de Salud Carlos III, Carretera de Majadahonda a Pozuelo km 2, 28220, Majadahonda, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ram\u00f3n","family":"Cisterna","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infection Control, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"B1","series-title":"PLoS Med","first-page":"e353","article-title":"A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology","volume":"3","author":"von SeidleinL","year":"2006","unstructured":"von SeidleinL, KimDR, AliM, LeeH, WangX, ThiemVD, et\u00a0al. 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