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Multidrug-resistant Salmonella strain spread internationally
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Researchers have identified an emergence of Salmonella enterica serotype Kentucky ST198 isolates with increased resistance to ciprofloxacin in France, England, Wales, Denmark and the United States between 2005 and 2008.
“This increase is due to the emergence of the ST198-X1 CIPR Kentucky clone … Although the first infections were reportedly acquired in Egypt during 2002-2005, the geographic spread has increased to include countries throughout Africa and the Middle East,” François-Xavier Weill, MD, PhD, of the WHO Collaborating Center for Reference and Research on Salmonella, in Paris, and colleagues wrote in the study.
Data were pooled from national surveillance systems in France, England, Wales, Denmark, and the United States for comprehensive molecular epidemiologic analyses on human and nonhuman isolates.
Weill and colleagues identified 489 cases of S. enterica serotype Kentucky ST198 between 2002 (n=3) and 2008 (n=174).
Among S. enterica serotype Kentucky cases with travel information available (n=307), 272 reported international travel within the 2 weeks before illness onset. Between 2002 and 2005, most patients reported travel to northeastern and eastern Africa; as of 2006, cases reported travel to northeastern, eastern, western and northern Africa, and the Middle East.
In addition, the researchers identified poultry as a significant agent for infection by this strain. The strain was isolated from chickens and turkeys in Ethiopia, Morocco and Nigeria.
“The unregulated use of antimicrobials in food-producing animals is a major hazard for public health,” Weill told Infectious Disease News. “Although this issue has been addressed by the majority of developed countries, this, and food safety in general, is not the first priority of developing countries. The use of fluoroquinolones for the empirical treatment of severe human nontyphoidal salmonella infections should be carefully weighed and eventually guided by the antimicrobial susceptibly testing.”
The researchers said they suggest implementation of continued surveillance and appropriate control measures by national and international authorities to limit the spread of the strain. – by Ashley DeNyse
For more information:
- Hedberg CW. J Infect Dis. 2011;doi:10.1093/infdis/jir392.
- Le Hello SL. J Infect Dis. 2011;doi:10.1093/infdis/jir409.
Disclosure: This research was supported by the Institut Pasteur; the Danish Research Agency (274-05-0117); the WHO Global Foodborne Infections Network; the Institut National de la Recherche Agronomique; the Health Protection Agency; the Statens Serum Institute; the CDC; the Institut Pasteur du Maroc; the University of Ibadan; the Agence Francxaise de Se’curite’ Sanitaire des Aliments; the Re’seau international des Instituts Pasteur et instituts associe’s; and the Institut de Veille Sanitaire. Permanent financial support came from the institutes, universities or national agencies of the authors. The work conducted at the National Food Institute, Technical University of Denmark was supported by the WHO Global Foodborne Infections Network (www.who.int/gfn) and the Danish Research Agency (274-05-0117).
This is one more study showing the emergence of antibiotic-resistant bacteria that will complicate therapy. For milder cases of salmonella gastroenteritis in healthy persons, antibiotics are not needed. For bacteremic salmonellosis, characteristically seen in people at extremes of age and patients with underlying medical problems, including cancer and immunosuppression, end-stage renal failure on hemodialysis, sickle cell anemia and inflammatory bowel disease, antibiotics can be life-saving. The fluoroquinolone antibiotics are drugs of choice for systemic salmonellosis in older children and adults. Having a fluoroquinolone-resistant strain of Salmonella showing widespread geographic dissemination is of great public health significance and underscores the need for typing of strains of Salmonella and performing antimicrobial susceptibility testing to guide therapy.
– Herbert L. DuPont, MD
Infectious Diseases News Editorial Board member
Disclosure: Dr. DuPont reports no relevant financial disclosures.