Monitoring Longitudinal Trends and Assessment of the Health Risk of <i>Shigella flexneri</i> Antimicrobial Resistance

Abstract

<i>Shigella flexneri</i> infection is the main cause of diarrhea in humans worldwide. The emergence of antimicrobial resistance (AMR) of <i>S. flexneri</i> is a growing public health threat worldwide, while large-scale studies monitoring the longitudinal AMR trends of isolates remain scarce. Here, the AMR gene (ARG) profiles of 717 <i>S. flexneri</i> isolates from 1920 to 2020 worldwide were determined. The results showed that the average number of ARGs in isolates has increased significantly, from 19.2 ± 2.4 before 1970 to 29.6 ± 5.3 after 2010. In addition, mobile genetic elements were important contributors to ARGs in <i>S. flexneri</i> isolates. The results of the structural equation model showed that the human development index drove the consumption of antibiotics and indirectly promoted the antibiotic resistance. Finally, a machine learning algorithm was used to predict the antibiotic resistance risk of global terrestrial <i>S. flexneri</i> isolates and successfully map the antibiotic resistance threats in global land habitats with over 80% accuracy. Collectively, this study monitored the longitudinal AMR trends, quantitatively surveilled the health risk of <i>S. flexneri</i> AMR, and provided a theoretical basis for mitigating the threat of antibiotic resistance.