Use of multiple markers for investigation of an epidemic of Shigella sonnei infections in Monroe County, New York.

Antibiotic susceptibility patterns, plasmid profiles, and endonuclease restriction analysis of plasmid DNA were used in the investigation of an epidemic of Shigella sonnei infections in Monroe County, New York, in 1988 and 1989. The epidemic peaked during the winter, included the simultaneous transmission of the disease from person to person and from common food sources, and especially affected inhabitants of the poor, inner-city neighborhoods, young children of both sexes, and women. Resistance to ampicillin, tetracycline, or trimethoprim-sulfamethoxazole, encoded in a 70-MDa plasmid, was found in most of the examined isolates. Unexpectedly, isolates from patients involved in a food-borne outbreak exhibited three different antibiotic susceptibility patterns, suggesting deletion of antibiotic resistance determinants in some strains. Antibiograms clearly separated food-borne outbreak-related and non-foodborne outbreak-related strains, distinguished more strains than did the plasmid profiles, and were useful in tracing the dissemination of individual isolates in the community. Restriction endonuclease analysis substantially increased the discriminatory value of plasmid profiles and validated the antibiogram results. The present study illustrates the complexity of epidemics of S. sonnei infections and shows the value of combining different biological markers in the investigation.