XDR Shigellosis Signals a New Challenge for Dental Practices

By Ayesha Khan, MBA

Antimicrobial resistance (AMR) is no longer a distant threat confined to intensive care units or hospital-acquired infections. It is rapidly reshaping the management of everyday infections across healthcare settings, including dental practices. One of the latest examples is extensively drug-resistant (XDR) shigellosis, a rapidly emerging gastrointestinal infection caused by Shigella that has developed resistance to multiple first-line and critically important antibiotics. In the United States, shigellosis places a substantial economic burden on the healthcare system, with annual costs estimated to exceed $1 billion, including approximately $93 million in direct medical expenses.

While traditionally considered outside the scope of dentistry, XDR Shigella carries significant implications for dental practitioners through infection control, antibiotic stewardship, and management of medically complex patients.

The Rise of XDR Shigellosis

Shigella is a highly contagious gram-negative bacterium transmitted primarily through the fecal–oral route. With an infectious dose of as few as 10 organisms, it ranks among the most easily transmitted bacterial pathogens. Infection commonly occurs through contaminated food or water, direct person-to-person contact, or poor hand hygiene.

The disease typically presents with diarrhea (which may become bloody), abdominal cramping, fever, tenesmus, and malaise. While many infections resolve without antibiotic therapy, antimicrobial treatment may be necessary for severe disease, vulnerable populations, or to reduce transmission during outbreaks.

The challenge today is that many circulating strains have evolved into extensively drug-resistant (XDR) organisms, demonstrating resistance to nearly every recommended oral antibiotic, including:

• Azithromycin
• Ciprofloxacin
• Ceftriaxone
• Trimethoprim-sulfamethoxazole
• Ampicillin

In the United States, the Centers for Disease Control and Prevention (CDC) estimates that approximately 450,000 cases of shigellosis occur annually, with approximately 242,000 infections considered antimicrobial-resistant. Some strains have even demonstrated decreased susceptibility to carbapenems and other reserve antibiotics.

Recent CDC surveillance involving nearly 17,000 Shigella isolates identified over 500 XDR isolates collected between 2011 and 2023.

Key findings include:

• XDR prevalence increased from 0% (2011–2015) to 8.5% in 2023, leaving clinicians with few effective oral antimicrobial treatment options.
• Approximately 38% of affected patients required hospitalization, highlighting the growing clinical burden of these highly resistant infections.
• Shigella sonnei remains the predominant species, although S. flexneri is increasingly represented among XDR isolates.
• Higher incidence has been observed among men, particularly men who have sex with men (MSM), though infections continue to occur through foodborne transmission, childcare settings, homelessness, travel, and household spread.

The emergence of these strains illustrates how antimicrobial resistance can rapidly transform once-manageable infections into major public health threats.

The Broader AMR Connection to Dentistry

At first glance, gastrointestinal infections may appear unrelated to oral healthcare. However, XDR is part of a much larger antimicrobial resistance crisis.

Global research estimates that antimicrobial resistance in bacteria was directly associated with approximately 1.27 million deaths worldwide in 2019 and contributed to nearly 5 million deaths overall. More recent projections suggest that without effective interventions, AMR could contribute to 10 million deaths annually by 2050.

AMR threatens not only infection treatment but also routine healthcare achievements, including:

• Implant dentistry.
• Oral surgery.
• Cancer therapy.
• Organ transplantation.
• Complex surgical procedures.

Modern dentistry depends on reliable antibiotics when complications arise. Preserving their effectiveness is therefore a professional responsibility.

Antibiotic Stewardship Has Never Been More Important

Dentists account for approximately 7–10% of outpatient antibiotic prescriptions in many developed countries. Although most dental prescriptions are appropriate, research consistently demonstrates unnecessary prescribing for:

• Irreversible pulpitis.
• Localized odontogenic infections.
• Routine extractions.
• Uncomplicated implant placement.

Every unnecessary antibiotic prescription contributes to selective pressure favoring resistant organisms. Responsible prescribing is therefore one of dentistry's most important contributions to combating antimicrobial resistance. Avoid broad-spectrum antibiotics when narrower-spectrum options are appropriate and use the shortest effective treatment duration.

Increased Care for Vulnerable Patients

While healthy individuals often recover, severe XDR shigellosis poses an increased risk among:

• Vulnerable populations such as the elderly or young children.
• Patients receiving immunosuppressive medications (oncology patients and transplant recipients) or living with HIV.

Many dental practices routinely care for these medically complex populations. Understanding current infectious disease trends allows practitioners to better coordinate care with physicians and avoid unnecessary complications.

Implications for Oral Surgery and Sedation

Patients recovering from severe gastrointestinal illness may present with:

• Dehydration.
• Electrolyte imbalance.
• Nutritional deficiencies.
• Fatigue.
• Altered medication regimens.

Before oral surgery or sedation, clinicians should assess overall health and systemic recovery. Communication with the patient's physician may be appropriate before elective surgical procedures.

Maintain Rigorous Infection Prevention

Adherence to standard precautions, hand hygiene, environmental cleaning, and instrument sterilization remains essential.

Educate Patients About Antibiotic Expectations

Patients frequently associate antibiotics with faster recovery. Dental professionals have an important opportunity to explain that:

• Antibiotics do not treat viral infections.
• Antibiotics are not substitutes for dental procedures.
• Completing appropriate therapy exactly as prescribed protects both individual and public health.

Conclusion

The rise of extensively drug-resistant shigellosis represents a pivotal reminder that antimicrobial resistance transcends traditional medical specialties. While dental practitioners may rarely encounter Shigella directly, the principles highlighted by this emerging threat—judicious antibiotic use, early recognition of systemic disease, meticulous infection prevention, and interprofessional collaboration—are central to contemporary dental practice.

As resistant pathogens continue to evolve, dentistry's commitment to evidence-based prescribing and preventive care becomes increasingly important. Every appropriate antibiotic decision made in the dental office contributes to preserving the effectiveness of lifesaving antimicrobial therapies for future generations.

References:

1. Anderer, S. (2026). CDC Reports Rise in Drug-Resistant Shigella Infections.
2. Logan, N., Birhane, M. G., McDonald, S. L., Alarcó, J., Amador, S., Anand, M., ... & XDR Shigella Working Group. (2026). Emergence of extensively drug-resistant shigellosis—United States, 2011–2023. MMWR. Morbidity and Mortality Weekly Report, 75.
3. Hoffmann, S., White, A. E., McQueen, R. B., Ahn, J. W., Gunn-Sandell, L. B., & Scallan Walter, E. J. (2025). Economic burden of foodborne illnesses acquired in the United States. Foodborne Pathogens and Disease, 22(1), 4-14.
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5. Murray, C. J., Ikuta, K. S., Sharara, F., Swetschinski, L., Aguilar, G. R., Gray, A., ... & Tasak, N. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629-655.
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7. Huynh, C. V. T., Gouin, K. A., Hicks, L. A., Kabbani, S., Neuburger, M., & McDonald, E. (2025). Outpatient antibiotic prescribing by general dentists in the United States from 2018 through 2022. The Journal of the American Dental Association, 156(5), 382-389.

Author: Ayesha Khan, MBA, is a former research fellow and enthusiastic blogger. With a wide range of articles published in renowned newspapers and scientific journals, she covers topics such as nutrition, wellness, supplements, medical research, and alternative medicine. Currently serving as the Vice President of Social Communications and Strategy at Renaissance, Ayesha brings her expertise and strategic mindset to drive impactful initiatives. Follow her blog for insightful content on healthcare advancements and empower yourself with knowledge.