Drug-Resistant Shigella on the Rise in the United States
Federal health officials are warning about a growing threat from extensively drug-resistant (XDR) Shigella, a strain of bacteria that causes shigellosis and is increasingly common across the United States. According to a report released by the Centers for Disease Control and Prevention (CDC) on April 9, 2026, XDR Shigella infections have risen significantly over the past decade, posing a serious public health concern due to limited treatment options and high transmissibility.
What Is XDR Shigella?
Shigella bacteria cause shigellosis, an infection characterized by diarrhea, stomach pain, and fever. In some cases, the diarrhea may be bloody and prolonged. Extensively drug-resistant Shigella strains are defined as being resistant to five commonly used antibiotics: ampicillin, azithromycin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. This resistance leaves few effective treatment options, particularly for oral medications.
The infection spreads easily through person-to-person contact, including sexual activity with an infected person, as well as through consumption of contaminated food or water. Shigella is highly infectious, requiring only a small number of bacteria to cause illness.
CDC Findings on Rising XDR Shigella Cases
The CDC analyzed 16,788 Shigella isolates collected through PulseNet between 2011 and 2023. Of these, approximately 3% (510 isolates) were identified as extensively drug-resistant. The proportion of XDR cases increased from 0% during 2011–2015 to 8.5% in 2023.
While earlier outbreaks of shigellosis primarily affected children and involved drug-susceptible strains, recent national surveillance data show that most XDR Shigella cases now occur among adult men. About one-third of patients with XDR shigellosis require hospitalization due to the severity of symptoms.
There are currently no Food and Drug Administration–approved oral treatments available for XDR Shigella infections, which complicates management and increases reliance on intravenous antibiotics in severe cases.
Public Health Implications
The CDC emphasizes that the high transmission potential of XDR Shigella strains underscores the need for strengthened surveillance, timely reporting, and targeted prevention strategies. Healthcare providers are urged to suspect shigellosis in patients with compatible symptoms, obtain stool cultures for diagnosis, and perform antimicrobial susceptibility testing to guide treatment.
Public health officials recommend preventive measures such as regular handwashing with soap and water, safe food handling practices, and awareness of transmission risks during sexual activity. Prompt reporting of cases to local health departments helps facilitate outbreak detection and response.
Ongoing Threat and National Impact
Shigella causes an estimated 450,000 infections annually in the United States. While most cases resolve without antibiotics, the rise of drug-resistant strains raises concerns about future treatment limitations and potential for wider spread, particularly in communities with close-contact settings.
The CDC continues to monitor trends through national surveillance systems and collaborates with state and local health departments to track and respond to emerging threats. As of April 2026, no federally approved drug exists to treat XDR Shigella infections, highlighting the importance of prevention and stewardship of existing antibiotics.
Key Takeaways
- Extensively drug-resistant (XDR) Shigella infections are increasing in the U.S., rising from 0% of cases in 2011 to 8.5% in 2023.
- XDR Shigella is resistant to five common antibiotics, leaving few treatment options, especially oral therapies.
- Most XDR cases now occur among adult men, a shift from earlier outbreaks that primarily affected children.
- About one in three patients with XDR shigellosis requires hospitalization.
- The infection spreads easily through person-to-person contact, contaminated food, and water.
- There are currently no FDA-approved oral treatments for XDR Shigella.
- Prevention relies on handwashing, safe food practices, and awareness of transmission routes.
- Timely diagnosis, susceptibility testing, and reporting are critical to controlling spread.
Frequently Asked Questions
What is shigellosis?
Shigellosis is an infectious disease caused by Shigella bacteria, leading to symptoms such as diarrhea (sometimes bloody), abdominal cramps, and fever. It is likewise known as bacillary dysentery.
How does XDR Shigella differ from regular Shigella?
Extensively drug-resistant (XDR) Shigella strains are resistant to multiple antibiotics that typically treat shigellosis, including ampicillin, azithromycin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. This resistance limits treatment options and may require intravenous antibiotics in severe cases.
Who is most at risk for XDR Shigella infection?
Recent CDC data show that most XDR Shigella cases in the United States occur among adult men, although anyone can be infected through exposure to the bacteria.
How is shigellosis transmitted?
Shigella spreads through ingestion of the bacteria, which can occur via person-to-person contact (including sexual activity), eating contaminated food, or drinking contaminated water. The bacteria are present in the stool of infected individuals and can spread easily in settings with poor hygiene or close contact.
Is there a treatment for XDR Shigella?
There are currently no FDA-approved oral antibiotics to treat XDR Shigella infections. In severe cases, doctors may employ intravenous antibiotics based on susceptibility testing. Mild cases may be managed with hydration and supportive care.
How can I prevent shigellosis?
Prevention includes washing hands thoroughly with soap and water—especially after using the bathroom, changing diapers, and before preparing or eating food—avoiding swallowing water from pools or untreated sources, practicing safe food handling, and being aware of risks during sexual activity with someone who is ill or recently recovered.