by Brianna Crandall — April 6, 2015—Serving as a reminder for facilities and cleaning professionals to remain diligent in their quest to keep facilities as germ-free as possible for building occupants and visitors, a report just released by the U.S. Centers for Disease Control and Prevention (CDC) shows that some international travelers are bringing a multidrug-resistant intestinal illness to the United States and spreading it to others who have not traveled.
Shigella sonnei bacteria resistant to the antibiotic ciprofloxacin sickened 243 people in 32 states and Puerto Rico between May 2014 and February 2015. Research by the CDC found that the drug-resistant illness was being introduced as ill travelers returned and was then infecting other people in a series of outbreaks around the country.
The CDC and public health partners investigated several recent clusters of shigellosis in Massachusetts (45 cases), California (25 cases), and Pennsylvania (18 cases) and found that nearly 90 percent of the cases tested were resistant to ciprofloxacin (Cipro). Cipro is currently the first choice to treat shigellosis among adults in the United States since in this country most Shigella is already resistant to the antibiotics ampicillin and trimethoprim/sulfamethoxazole.
About half of the recent cases involved travel to the Dominican Republic and India. According to the CDC, shigellosis can spread very quickly in groups like children in childcare facilities, homeless people and gay and bisexual men, as occurred in these outbreaks.
CDC statistics show that Shigella causes an estimated 500,000 cases of diarrhea in the United States every year. It spreads easily and rapidly from person to person and through contaminated food and recreational water. It can cause watery or bloody diarrhea, abdominal pain, fever, and malaise.
Although diarrhea caused by Shigella typically goes away without treatment, people with mild illnesses are often treated with antibiotics to stop the diarrhea faster. Until recently, Cipro resistance has occurred in just two percent of Shigella infections tested in the United States, but was found in 90 percent of samples tested in the recent clusters.
To prevent the spread of shigellosis, CDC recommends that people wash their hands often with soap and water, especially after using the toilet and before preparing food or eating; keep children home from childcare and other group activities while they are sick with diarrhea; avoid preparing food for others while ill with diarrhea; and avoid swimming for a few weeks after recovering.
Improving access to toilets and soap and water for washing hands may help prevent Shigella transmission among the homeless, adds the CDC. Because Cipro-resistant Shigella is spreading, CDC recommends doctors use lab tests to determine which antibiotics will effectively treat shigellosis, and that doctors and patients consider carefully whether an infection requires antibiotics at all.
Travelers to developing countries can take additional precautions to avoid diarrhea and minimize infection with resistant bacteria, such as choosing only steaming hot foods and drinking only from sealed containers (see the CDC’s Can I Eat This? app); washing hands frequently, particularly before eating and after using the toilet; and taking bismuth subsalicylate to prevent travelers’ diarrhea. The CDC recommends treating diarrhea with over-the-counter drugs like bismuth subsalicylate or loperamide and reserving antibiotics for severe cases.
See also FMLink’s “Ebola reference guide: FMLink’s resource compilation and action plans for facilities managers” as well as ISSA’s “Cleaning & Hygiene: The Foundation of Infection Control—How FMs can ensure that their cleaning program is the best defense against the spread of infectious diseases”.
