New Study Identifies Emergence of Multidrug-Resistant Strain of Salmonella
AUG. 3, 2011 - A new study has identified the recent emergence of a multidrug-resistant strain of Salmonella
that has a high level resistance to ciprofloxacin, a common treatment for severe Salmonella infections. The study, led by
François-Xavier Weill, MD, and Simon Le Hello, PharmD, at the Pasteur Institute in France, is published in The
Journal of Infectious Diseases and is now
available online .
Salmonella infection represents a major public health problem worldwide. An estimated 1.7 million such infections
occur in North America each year. More than 1.6 million cases were reported between 1999 and 2008 in 27 European countries. Although
most Salmonella infections produce only mild gastroenteritis, elderly and immunocompromised patients are especially at risk for
life-threatening infections. These cases are typically treated with antimicrobials called fluoroquinolones, such as ciprofloxacin.
Dr. Weill and colleagues studied information from national surveillance systems in France, England and Wales,
Denmark, and the United States. The data showed that a multidrug-resistant strain of Salmonella, known as S. Kentucky, infected 489
patients in France, England and Wales, and Denmark between 2000 and 2008. In addition, researchers reported that the first
infections were acquired mainly in Egypt between 2002 and 2005, while since 2006 the infections have also been acquired
in various parts of Africa and the Middle East. The absence of reported international travel in approximately
10 percent of the patients suggests that infections may have also occurred in Europe through consumption
of contaminated imported foods or through secondary contaminations.
In this study, multidrug-resistant S. Kentucky was isolated from chickens and turkeys from Ethiopia, Morocco,
and Nigeria, suggesting that poultry is an important agent for infection. The common use of fluoroquinolones in chicken and turkey
production in Nigeria and Morocco may have contributed to this rapid spread.
This study highlights the importance of public health surveillance in a global food system. According to Dr. Le Hello, "We hope that
this publication might stir awareness among national and international health, food, and agricultural authorities so that they take
the necessary measures to control and stop the dissemination of this strain before it spreads globally, as did another
multidrug-resistant strain of Salmonella, Typhimurium DT104, starting in the 1990s." The investigators from the
Pasteur Institute and its international network, the Centers for Disease Control and Prevention in the U.S.,
the Health Protection Agency in the United Kingdom, and the Statens Serum Institute and Technical
University of Denmark reported that they will continue to monitor this multidrug-resistant
strain as well as help strengthen the capacities of national and regional laboratories
in the surveillance of Salmonella and other major foodborne pathogens through the
World Health Organization Global Foodborne Infections Network.
Craig Hedberg, PhD, from the University of Minnesota School of Public Health, noted in an accompanying editorial that the ability to
integrate public health surveillance is limited by differences in national surveillance systems. The study by Dr. Le Hello and
colleagues reported that the percentage of Salmonella isolates submitted from clinical laboratories to national health
reference laboratories ranged from 65 percent in France to 99 percent in Denmark. "Given the medical costs and public
health impact associated with the spread of multidrug-resistant organisms," Dr. Hedberg noted, "the potential
benefits of such a system should far outweigh its costs."
- This study found that a multidrug-resistant strain of Salmonella , known as S. Kentucky, infected 489 patients in France, England and Wales, and Denmark between 2000 and 2008.
- Poultry appears to be a major vehicle for spreading these infections.
- International public health surveillance systems are needed to limit the spread of such multidrug-resistant organisms.
NOTE: The study and accompanying editorial are available online. They are embargoed until 12:01 a.m. EDT on Wednesday, Aug. 3, 2011:
International Spread of an Epidemic Population of Salmonella enterica Serotype Kentucky ST198 Resistant to Ciprofloxacin
Challenges and Opportunities to Identifying and Controlling the International Spread of Salmonella
Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and
on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. It is published under the auspices of the Infectious Diseases Society of America (IDSA).
Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. www.idsociety.org
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