The aim of our study was to delineate an outbreak of gastroenteritis caused by Shigella flexneri and affecting sixteen persons between May and June 2014 in Bilbao, Spain. All patients exhibited symptoms after consuming kebab in the same kebab shop.The outbreak is described through the clinical cases, the microbiological and molecular genetic diagnosis, and the epidemiologic investigation. Minimum inhibitory concentrations for ampicillin, amoxicillin plus clavulanic acid, third and fourth generation cephalosporins, carbapenems, monobactams, aminoglycosides, fluoroquinolones, co-trimoxazole, colistin and tigecycline were measured. The S. flexneri strains were screened by PCR for TEM, SHV, CTX-M beta-lactamases and plasmidic AmpCs and aac(6')-Ib gene. Serotyping, pulsed field gel-electrophoresis, conjugation assay, plasmid sizing by S1 enzyme digestion and Southern blot hybridization were accomplished.All the S. flexneri isolates proved to be serotype 2 and produced extended-spectrum beta-lactamase (ESBL). Carbapenems, fluoroquinolones, tigecycline, colistin, and co-trimoxazole remained active antibiotics. All the strains harboured blaCTX-M-15 and blaOXA-1 genes. The strains hosted two high-molecular weight plasmids of 100 and 230 kb, respectively. According to the hybridization assay blaCTX-M-15 was located on the plasmid of 230 kb. The identical pulsotype verified the presence of outbreak.Remarkable, that one of the food handlers has travelled recently to Pakistan, where ESBL-producing Shigella strains had been reported previously. To the best of our knowledge, this is the first outbreak caused by CTX-M-15-expressing S. flexneri in Spain and as well as in Europe.

中文翻译：

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由在西班牙产生 CTX-M-15 的福氏志贺氏菌引起的病例群。

我们研究的目的是描述 2014 年 5 月至 6 月期间在西班牙毕尔巴鄂爆发的由福氏志贺菌引起并影响 16 人的胃肠炎暴发。所有患者在同一家烤肉店食用烤肉串后均出现症状。通过临床病例、微生物学和分子遗传学诊断以及流行病学调查对暴发进行了描述。测定了氨苄西林、阿莫西林加克拉维酸、第三代和第四代头孢菌素、碳青霉烯类、单环内酰胺类、氨基糖苷类、氟喹诺酮类、复方新诺明、粘菌素和替加环素的最低抑菌浓度。通过 PCR 筛选 S. flexneri 菌株的 TEM、SHV、CTX-M β-内酰胺酶和质粒 AmpCs 和 aac(6')-Ib 基因。血清分型、脉冲场凝胶电泳、结合测定、通过S1酶消化和Southern印迹杂交完成了质粒大小测定。所有的S. flexneri分离物均被证明是血清型2并产生超广谱β-内酰胺酶(ESBL)。碳青霉烯类、氟喹诺酮类、替加环素、粘菌素和复方新诺明仍然是活性抗生素。所有菌株都含有 blaCTX-M-15 和 blaOXA-1 基因。这些菌株分别承载两个 100 和 230 kb 的高分子量质粒。根据杂交测定，blaCTX-M-15位于230kb的质粒上。相同的脉搏型证实了爆发的存在。值得注意的是，其中一名食品处理人员最近前往巴基斯坦，那里以前曾报道过产 ESBL 的志贺氏菌菌株。据我们所知，这是第一次由表达 CTX-M-15 的 S 引起的爆发。