Emergence of Extensively Drug-Resistant Shigellosis — United States, 2011–2023

The Centers for Disease Control and Prevention MMWR report (Vol. 75, No. 13) documents a concerning rise of extensively drug-resistant (XDR) Shigella infections in the United States between 2011 and 2023: the proportion of isolates classified as XDR increased from 0% to 8.5%, with these strains resistant to all commonly used first-line antibiotics and no FDA-approved oral treatment options available. The infections are increasingly observed in adults—predominantly men, with a median age of ~41 years—and often occur without recent travel, indicating domestic transmission; a substantial proportion of cases is associated with immunocompromised individuals, including those with HIV. Because Shigella spreads easily and can transfer resistance genes to other bacteria, the emergence of XDR strains represents a significant public health threat, underscoring the need for enhanced surveillance, prevention, rapid diagnostics, and antimicrobial susceptibility–guided treatment strategies.