We determined the frequency of multidrug resistant (MDR) infections with Shigella spp. and Vibrio cholerae O1 at an urban (Dhaka) and rural (Matlab) hospital in Bangladesh. We also compared sociodemographic and clinical features of patients with MDR infections to those with antibiotic-susceptible infections at both sites. Analyses were conducted using surveillance data from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), for the years 2000–2012. Compared to patients with antibiotic-susceptible for Shigella infections, those in Dhaka with MDR shigellosis were more likely to experience diarrhea for >24 hours, while, in Matlab, they were more likely to stay inhospital >24 hours. For MDR shigellosis, Dhaka patients were more likely than those in Matlab to have dehydration, stool frequency >10/day, and diarrheal duration >24 hours. Patients with MDR Vibrio cholerae O1 infections in Dhaka were more likely than those in Matlab to experience dehydration and stool frequency >10/day. Thus, patients with MDR shigellosis and Vibrio cholerae O1 infection exhibited features suggesting more severe illness than those with antibiotic-susceptible infections. Moreover, Dhaka patients with MDR shigellosis and Vibrio cholerae O1 infections exhibited features indicating more severe illness than patients in Matlab. 1. Introduction Shigella and Vibrio cholerae O1 are widely recognized causes of dysentery and acute watery diarrhea, respectively [1, 2]. Both have been responsible for producing epidemics [3] and often require antibiotic treatment to mitigate the severity of disease [4–6]. For Shigella infections, in particular, increasing antibiotic resistance has led to fewer antibiotics capable of producing bacteriostatic or bactericidal minimum inhibitory concentrations (MICs) [5, 7]. The challenge is compounded by the fact that while the regional prevalence of infection may be similar, rates of antibiotic resistance may differ substantially from one nation to another [5, 8]. Since 1979 and 2000, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), has tested a systematic random sample of patients seeking care at an urban Dhaka Hospital and rural Matlab Treatment Centre for a spectrum of diarrhea-causing pathogens, including Shigella and Vibrio cholerae O1 [9]. Antimicrobial susceptibility patterns for these two pathogens are determined to inform clinicians about appropriate antibiotic treatment options [10]. Underscoring the need for antimicrobial sensitivity testing is the emergence of multidrug resistance (MDR),
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