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The Centers for Disease Control and Prevention (CDC) today presented in detail an unusual outbreak of 255 cases of Salmonella Infections in Newport in 32 states are linked to both beef and soft cheese and show resistance to multiple antibiotics.
"The infections have been linked to beef obtained in the United States and soft cheese obtained in Mexico, suggesting that this strain could be present in cattle in both countries," said the CDC in a survey sent to doctors as part of its outreach and communication with clinicians. (COCA) efforts.
"The antibiotic sensitivity tests showed that the strain had reduced susceptibility to azithromycin and a non-susceptibility to ciprofloxacin – two commonly prescribed oral antibiotics," the agency added. "This leaves ceftriaxone, an injectable antibiotic, as a recommended treatment option."
Ian Plumb, MBBS, lead author of a study on the epidemic today in Weekly report on morbidity and mortality (MMWR), we continue to see cases occur in patients. The antibiotic resistance pattern of this strain is alarming because the main oral antibiotics used to treat Salmonella the infection may not work. "
Plumb is an epidemiologist in the CDC enteric diseases branch. He and his colleagues MMWR Updated says azithromycin orally is also an option. Plumb added by email, "Most patients with Salmonella infections do not require antibiotic treatment, but some patients do, if there is a serious illness or if a clinician identifies the risk factors for a serious illness. "
He added, "The best way for clinicians to guide treatment is to check if a bacterium is resistant to that particular patient." Plumb also noted that the American Society for Infectious Disease had issued guidelines Salmonella infections here.
Sixty hospitalized, two dead
Epidemic cases date from June 2018 to March 2019 and the CDC first identified the multidrug resistance virus. Salmonella strain in September, according to the MMWR report. Of 206 patients for whom information was available, 89 (43%) reported a recent trip to Mexico.
Sixty out of 209 patients (29%) were hospitalized, of which four (6% of those for whom data are available) requiring intensive care. Ten of the 255 patients (4%) had Salmonella bacteremia (blood infection), and two patients died, said the CDC.
Patients were younger than 1 to 90 years old and the median age was 36 years old. More than half (58%) were women and 65% were Hispanics.
The CDC said in its COCA e-mail: "Resistant infections can be harder to treat and patients are more likely to develop serious complications."
Of the patients who traveled to Mexico and had information about the foods they ate, 41 out of 47 (87%) reported eating beef and 29 out of 46 (63%) reported eating soft cheese MMWR report noted. Of the 29 people who ate soft cheese, 23 (79%) said they had obtained this cheese in Mexico, most often in queso fresco, a typical raw milk cheese (unpasteurized).
Of the patients who did not travel to Mexico, 20 out of 70 (29%) reported eating Mexican-style soft cheese and 68 of 73 (93%) reported eating beef. The inspectors detected the epidemic strain in beef samples taken in November 2018 and March 2019 in two slaughter and processing facilities in Texas, the CDC said in the newspaper. MMWR report. However, he added that "the examination of patient data did not identify a common supplier of contaminated meat or cheese".
When asked why the CDC announced this outbreak via MMWR Plumb stated that the report summarized a complex investigation and that "decisions made to alert the public during an investigation are based on a number of factors, including whether a source of infection has been identified, and if new recommendations for consumers.
"This survey did not identify a specific contaminated product, and the cases were not geographically related.Our findings support the CDC's existing recommendations to safely prepare beef and consume only cheese. soft cheese made with pasteurized milk. "
Dairy cattle source possible
Isolates of Mexican cheese, beef cattle cecum and beef samples were closely compared by whole genome sequencing.
"In this MDR outbreak, consumption of cheese and beef was associated with the disease, indicating that dairy cattle were a likely source of these infections," said the president. MMWR the authors said. "The discovery of the epidemic strain in cheese purchased in Mexico and the high percentage of travelers to Mexico who reported eating Mexican-style soft cheese suggest that soft cheese from Mexico was a source of infection. .
"Mexican cheese has already been identified as a source of other Salmonella outbreaks. Reported consumption of queso fresco, trips to various parts of Mexico and the detection of Newport strains indistinguishable in beef and cheese suggest that contamination of soft cheese was a result of cattle rather than poor transportation. hygiene when producing cheese.
"Dairy cattle are often used as a source of ground beef and have been implicated in previous MDR outbreaks in Newport."
Plumb said: "Any use of antibiotics in humans or in animals can increase the risk of spreading resistant bacteria, so it is important to use antibiotics only when It is necessary to avoid the unnecessary use of antibiotics in cattle that are also used to treat prevent the spread of bacteria and may reduce the risk of resistant strains in animals leading to disease in humans . "
Recent emergence of drug resistance
Of the 252 isolates tested for antibiotic resistance, 226 (90%) had trimethoprim-sulfamethoxazole, tetracycline and chloramphenicol resistance genes, and reduced susceptibility to azithromycin, experts said. CDC in their report. And 143 isolates (57%) demonstrated additional resistance to ampicillin and streptomycin, as well as a non-susceptibility to ciprofloxacin. All resistance genes were located on an IncR plasmid.
"The presence of resistance genes on a plasmid is worrisome because of the risk of spreading to other bacteria," he said. MMWR the authors said. Plasmids can transfer genetic material not only between bacteria of the same species but also between species of pathogens.
"The outbreak strain appears to have emerged recently because Newport, with reduced susceptibility to azithromycin, has not been detected in animal isolates, retail meat or any other species. in humans in the NARMS. [National Antimicrobial Resistance Monitoring System] surveillance before 2016, "note the authors.
The authors conclude that "Whole genome sequencing was useful for linking human infections to food sources, distinguishing the epidemic strain of MDR from an antibiotic-susceptible strain causing a simultaneous epidemic and predicting antibiotic resistance." a patient on antibiotic likely to have been ineffective ".
See also:
August 23 MMWR report
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