![]() sonnei has acquired resistance to azithromycin, one of the second line agents, particularly in communities where antibiotic use is high 17. More recently, ciprofloxacin resistant S. sonnei, Lineage 3 13, disseminating from South-East Asia, has acquired ciprofloxacin resistance, conferred by three mutations in the quinolone resistance determining region (QRDR) of the gyrA and parC genes 16. Furthermore, a recently defined subclade of the globally dominant genomic subtype of S. These characteristics contributed to its ability to become endemic in the human population and evolve over time towards resistance to an increasing number of antimicrobials. sonnei into Vietnam highlighted the ability of Shigella to refine its accessory genome repertoire whereby introduced subclades were observed to acquire AMR genes, and genes encoding colicins that facilitate killing of other bacteria 15. For example, a study of the introduction of S. sonnei into four genomic lineages 13, and further clades and subclades 14, has facilitated the study of its relationship with AMR and surveillance of global transmission. As a single serotype species, the splitting of S. sonnei already exhibited multidrug resistance (MDR), to sulphonamides, ampicillin, streptomycin, and tetracycline, throughout the 1960s, conferred by different combinations of antimicrobial resistance (AMR) genes 11, 12. sonnei between men who have sex with men (MSM) has contributed to a high proportion of diagnoses in the UK 10. However, in recent decades more infections were imported by travellers returning from low and middle income countries (LMIC) 8, sometimes followed by on-going transmission within close knit communities 9. sonnei in the UK and other higher-income nations were associated with schools and other institutional settings 7. sonnei is the most frequently detected species 6. ![]() ![]() In the UK, approximately 1650 cases of shigellosis are notified to UK Health Security Agency (UKHSA) each year, and S. dysenteriae) are responsible for approximately 212,400 deaths per year globally, 30% of which occur in young children aged under five years old 3. Shigella infection has no substantial non-human reservoir and is transmitted from person to person by contact with an infected individual 1, or by the consumption of food and/or water contaminated by human faeces 4, 5. However, in lower to middle income countries (LMIC), shigellosis is associated with higher levels of morbidity and mortality 3. In middle- and higher-income nations, although symptoms can be severe, the duration of illness is usually short-lived 2. Similar content being viewed by othersīacteria belonging to the genus Shigella cause shigellosis, a gastrointestinal infection characterised by a combination of profuse, often bloody, diarrhoea with abdominal pain, fever, nausea and/or vomiting 1. Our results highlight the persistent threat of horizontally transmitted antimicrobial resistance and the value of continuing to work towards early and open international sharing of genomic surveillance data. Our genomic epidemiological analyses of 3,304 isolates from the United Kingdom, Australia, Belgium, France, and the United States of America revealed an internationally connected outbreak with a most recent common ancestor in 2018 carrying a low-fitness cost resistance plasmid, previously observed in travel associated sublineages of S. Here, we aimed to identify the genetic basis, evolutionary history, and international dissemination of the outbreak strain. sonnei was reported in the United Kingdom. Recently, an MSM-associated outbreak of extended-spectrum β-lactamase producing, extensively drug resistant S. sonnei is common including against World Health Organisation recommended treatment options, azithromycin, and ciprofloxacin. Shigella sonnei causes shigellosis, a severe gastrointestinal illness that is sexually transmissible among men who have sex with men (MSM). Nature Communications volume 14, Article number: 1983 ( 2023) The evolution and international spread of extensively drug resistant Shigella sonnei
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