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• The Centers for Disease Control and Prevention (CDC) recently released a report that showed that drug-resistant Shigella is on the rise in the United States.
• Shigella bacteria cause the infection shigellosis.
• Extensively drug-resistant (XDR) Shigella strains are typically resistant to five commonly used antibiotics.
• Shigella can be easily transmitted, including through person-to-person contact and contaminated food.
• There are ways to prevent the spread of Shigella, including regular handwashing.

The Centers for Disease Control and Prevention (CDC) has issued a warning about a drug-resistant, diarrhea-causing “superbug” on the rise in the United States.

According to the CDC, Shigella causes around 450,000 infections in the United States each year.

“Antibiotic resistance is a global issue because antibiotics are overused and used inappropriately around the world,” said William Schaffner, MD, a professor of preventive medicine and professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.

“In the U.S., clinicians and public health have worked hard to become good stewards of antibiotics, using them carefully,” he told Healthline.

The CDC analyzed 16,788 Shigella isolates that were collected through PulseNet between 2011 and 2023.

Around 3% (510) of these isolates were identified as XDR. The proportion of XDR isolates changed from 0% during 2011 to 2015 to 8.5% in 2023.

XDR Shigella is defined by its resistance to five commonly used antibiotics:

The CDC also noted that no oral antibiotics approved by the Food and Drug Administration (FDA) are currently available for XDR Shigella infections.

The CDC report indicates that the epidemiology of XDR Shigella has shifted.

Epidemiology refers to the patterns and distributions of health-related events, such as diseases.

Previously, outbreaks of Shigella in the U.S. were drug-susceptible strains and primarily affected children. In contrast, XDR Shigella cases have mostly occurred in adult males with an average age of 41.

The travel history data also showed that the majority of Shigella cases were acquired domestically.

Among individuals with available data, 76.2% reported no recent domestic travel, and 82.4% reported no recent international travel.

Shigella bacteria are easily spread. These bacteria appear in feces and fecal matter. Swallowing just a small amount of Shigella can make you sick.

Anything that may become contaminated with fecal matter can potentially spread Shigella.

• contaminated food or water
• contact with a person who is sick or has recently been sick with a Shigella infection
• sexual activity with someone who is sick

With the rising prevalence of XDR Shigella strains, the CDC noted in its report that stronger surveillance, routine antimicrobial susceptibility testing, and timely reporting of shigellosis are needed. Shigellosis is a nationally notifiable disease.

The CDC also called for targeted prevention methods to limit further spread of XDR Shigella infections.

Robert Glatter, MD, an attending physician in the Department of Emergency Medicine at Lenox Hill Hospital in New York City and an assistant professor of emergency medicine at Zucker School of Medicine at Hofstra/ Northwell, said that “treatment options for XDR Shigella are extremely limited.”

Schaffner agreed. “Antibiotic-resistant Shigella bacteria are a concern because they leave us with no antibiotics to treat the more serious infections, requiring us to rely on supportive therapy to help patients get over their illness,” he said.

Glatter said that most cases resolve with supportive treatments, such as oral rehydration and electrolyte replacement, continued feeding or resumption of a usual diet after rehydration, and zinc supplementation, especially for malnourished individuals.

“For severe infections requiring antibiotics, physicians may use carbapenems given intravenously, which are the most reliable option for severe XDR infections but require hospitalization,” Glatter said.

“Treatment decisions should be guided by antimicrobial susceptibility testing when available, and physicians must carefully weigh the risks and benefits of antibiotic therapy given the limited options,” he added.

Award-winning actress Lucy Liu will always remember the year 1991. She was 22 years old and found a lump on her breast that led to unnecessary surgery; the lump turned out to be noncancerous.

“I learned a lot about myself, and I think that was the beginning of advocating for myself, with my health and everything else,” she told Healthline. “I think it was a real moment to, I guess, empower myself and recognize the weakness of…not asking questions…and relying solely on the doctor, and also not getting a second opinion.”

“And so, I really didn’t do anything except go in, then go and schedule a surgery,” she said. “I have a lot more curiosity for my health now than I did then.”

Seeking out a second opinion is always critical when it comes to health, said Mikkael Sekeres, MD, chief of hematology at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System.

“Cancer is a serious diagnosis, and it can sometimes be quite complicated to diagnose,” he told Healthline.

“We found that major misdiagnoses occurred 20% of the time, and even more frighteningly, 10% of patients received the wrong treatment for the wrong diagnosis,” Sekeres said. “You owe it to yourself to seek a second opinion on both your diagnosis and the right treatment for that cancer.”

“Knowing that one out of three people are going to be diagnosed with cancer [during their lifetime], that should be initiative enough for us to advocate for ourselves…and motivate ourselves to get an annual checkup,” she said.

Data from 1975 to 2020 estimated that over 1.3 million cancer deaths in the U.S. were averted due to screening programs. The breakdown included:

• Mammograms reduce breast cancer deaths by 260,000 women
• Prostate-specific antigen (PSA) testing reduces prostate cancer deaths by 200,000 men
• Pap smear testing reduces cervical cancer deaths by 160,000 women
• Colonoscopies or other screening tests reduce colorectal cancer deaths by 740,000 people

“A screening test identifies cancer in an individual who does not yet have symptoms from the cancer, before you or your doctor even know it’s there,” said Sekeres.

He said screening tests have become more accurate and less invasive, and that doctors have become better at recommending when to undergo screening tests.

Mammograms, Pap smears, colonoscopies, and regular skin checks are important aspects of maintaining your health and preventing more serious consequences of cancer, he added.

“PSA testing for prostate cancer should involve a conversation between you and your doctor about the risks and benefits, and screening for lung cancer should be undertaken by high risk groups, such as current smokers aged 50 to 80 years,” Sekeres said.

When it comes to screening and your health in general, Liu said, don’t be afraid to ask your doctor questions and drop prefacing your questions with: “This is a stupid question.”

“I try to shut that down because I really think that you don’t want to be in a situation where it’s too late,” she said. “And I know people who have been in that situation, and I’ve lost people who have been in that situation.”

If you think your questions are embarrassing, she said to keep in mind that it’s impossible to be an expert in everything and to allow yourself the grace to know when you don’t know something.

“It’s asking a professional or professionals who have…specialized in this particular field what their thoughts are and what their opinions are and then…pooling that together with all the other information that you receive so that you can make the right choice moving forward for yourself,” said Liu.

Over the years, Liu said she learned that keeping to a strict health regimen isn’t realistic.

“[Because] you expect yesterday or today or tomorrow…to be the same and I think that’s difficult, because the weather changes…events change,” Liu said. “I think that it’s better to just be as present as possible…because if you expect it to be a certain thing every single day, you’re probably going to get disappointed, right?”

Parenthood has reinforced this notion for her. Being a mom to her son, Rockwell, has also pushed her to lead by example in preventive health.

“[Share with your child,] ‘I’m going to go and get my checkup,’” she said. “Don’t make it something that’s scary.”

She hopes that sharing her personal journey publicly will reduce some of the fear around screenings and empower others to take control of their health.

“I don’t often talk about my personal life…and for me to do that…it has to make a difference for someone else,” said Liu. “I often feel like advocacy starts with a personal story, and sometimes you have to reveal something about yourself in order for action to happen, and I’m okay with that.”