Outbreaks of multidrug-resistant Shigella sonnei gastroenteritis associated with day care centers–Kansas, Kentucky, and Missouri, 2005

Infection with Shigella sonnei that is resistant to antibiotics commonly used in pediatric practice has become more common during the past decade. In 2005, Kansas, Kentucky, and Missouri reported increases in shigellosis cases associated with day care centers caused predominantly by multidrug-resistant (MDR) (i.e., resistant to ampicillin and trimethoprim-sulfamethoxazole [TMP/SMX]) strains of S. sonnei. Pulsed-field gel electrophoresis (PFGE) patterns for isolates from Kansas and Missouri were similar, suggesting a common outbreak in the Kansas City area, whereas isolates from Kentucky had a different pattern. This report describes the investigation of two outbreaks of MDR shigellosis associated with day care centers and reviews measures for prevention and control of S. sonnei infection in these settings. Given the current rates of resistance to antibiotics available to treat children with shigellosis safely, public health measures initiated during shigellosis outbreaks should focus on promoting appropriate handwashing and diapering practices in day care centers.