Emergence of multidrug-resistant Salmonella Paratyphi B dT+, Canada

We document an increase in the number of multidrug-resistant Salmonella enterica serovar Paratyphi B dT+ identified in Canada. Most of these strains harbor Salmonella genomic island 1 (SGI1). Further studies are needed to determine factors contributing to the observed emergence of this multidrug-resistant strain.     

Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.     

Emergence of Salmonella enterica serotype Paratyphi A as a major cause of enteric fever in Kathmandu, Nepal

We performed pulsed-field gel electrophoresis (XbaI) on 114 bloodstream isolates of Salmonella enterica serotype Paratyphi A and S. enterica serotype Typhi collected from febrile patients in Kathmandu, Nepal. Of the 56 S. Paratyphi A isolates, 51 (91%) were indistinguishable, which suggests the emergence of a single clone. In contrast, only 21 (36%) of the 58 S. Typhi isolates exhibited a common genotype, which is consistent with endemic disease from multiple sources.     

Bacteremia and antimicrobial drug resistance over time, Ghana

Bacterial distribution and antimicrobial drug resistance were monitored in patients with bacterial bloodstream infections in rural hospitals in Ghana. In 2001-2002 and in 2009, Salmonella enterica serovar Typhi was the most prevalent pathogen. Although most S. enterica serovar Typhi isolates were chloramphenicol resistant, all isolates tested were susceptible to ciprofloxacin.     

Potential international spread of multidrug-resistant invasive Salmonella enterica serovar enteritidis

In developing countries, Salmonella enterica serovar Enteritidis causes substantial illness and death, and drug resistance is increasing. Isolates from the United Kingdom containing virulence-resistance plasmids were characterized. They mainly caused invasive infections in adults linked to Africa. The common features in isolates from these continents indicate the role of human travel in their spread.     

Ciprofloxacin-Resistant Campylobacter spp. in Retail Chicken,Western Canada

During 2005–2010, the Canadian Integrated Program for Antimicrobial Resistance Surveillance identified increased prevalence of ciprofloxacin (a fluororquinolone) resistance among Campylobacter isolates from retail chicken in British Columbia (4%–17%) and Saskatchewan (6%–11%), Canada. Fluoroquinolones are critically important to human medicine and are not labeled for use in poultry in Canada.     

Extended-Spectrum Cephalosporin-Resistant Salmonella enterica serovar Heidelberg Strains,the Netherlands

Extended-spectrum cephalosporin-resistant Salmonella enterica serovar Heidelberg strains (JF6X01.0022/XbaI.0251, JF6X01.0326/XbaI.1966, JF6X01.0258/XbaI.1968, and JF6X01.0045/XbaI.1970) have been identified in the United States with pulsed-field gel electrophoresis. Our examination of isolates showed introduction of these strains in the Netherlands and highlight the need for active surveillance and intervention strategies by public health organizations.     

Deletion of a prophage-like element causes attenuation of Salmonella enterica serovar Enteritidis and promotes protective immunity

Salmonella enterica serovar Enteritidis (S. Enteritidis) is a wide host range serovar belonging to the S. enterica genus. Worldwide, it is one of the most frequent causes of food borne disease. Similar to S. Typhimurium, some virulence genes of S. Enteritidis are located in pathogenicity islands and prophages. In this study we have generated a mutant strain of S. Enteritidis lacking a prophage-like element, denominated ?SE12. The resulting mutant strain was attenuated and promoted protective immunity in infected mice. Although S. Enteritidis strains lacking the complete prophage ?SE12 remained capable of surviving inside phagocytic cells, they showed a significantly reduced capacity to colonize internal organs and failed to cause lethal disease in mice. Consistent with these data, infection with S. Enteritidis strains lacking prophage ?SE12 promoted the production of anti-Salmonella IgG antibodies and led to protection against a challenge with virulent strains of S. Enteritidis. These results suggest that strains lacking this prophage can induce a protective immunity in mice and be considered as potential attenuated vaccines against S. Enteritidis.     

Ciprofloxacin treatment failure in typhoid fever case, Pakistan

We report a case of ciprofloxacin treatment failure in a typhoid fever patient at a tertiary care hospital in Rawalpindi, Pakistan. This case shows not only the emergence of fluoroquinolone resistance in typhoid salmonellae but also the inadequacy of the current laboratory guidelines for detection of this resistance.     

Emergence of ceftriaxone-resistant Salmonella isolates and rapid spread of plasmid-encoded CMY-2-like cephalosporinase,Taiwan

Of 384 Salmonella isolates collected from 1997 to 2000 in a university hospital in Taiwan, six ceftriaxone-resistant isolates of Salmonella enterica serovar Typhimurium were found in two patients in 2000. The resistance determinants were on conjugative plasmids that encoded a CMY-2-like cephalosporinase. During the study period, the proportion of CMY-2-like enzyme producers among Escherichia coli increased rapidly from 0.2% in early 1999 to >4.0% in late 2000. Klebsiella pneumoniae isolates producing a CMY-2-like beta-lactamase did not emerge until 2000. The presence of bla(CMY)-containing plasmids with an identical restriction pattern from Salmonella, E. coli, and K. pneumoniae isolates was found, which suggests interspecies spread and horizontal transfer of the resistance determinant. Various nosocomial and community-acquired infections were associated with the CMY-2-like enzyme producers. Our study suggests that the spread of plasmid-mediated CMY-2-like beta-lactamases is an emerging threat to hospitalized patients and the public in Taiwan.     

Intratumoral injection of attenuated Salmonella vaccine can induce tumor microenvironmental shift from immune suppressive to immunogenic

Attenuated Salmonella vaccines show therapeutic anti-cancer effects, but the underlying mechanism has not been well investigated. In the current study, intratumoral (i.t.) injection of recombinant attenuated Salmonella enterica serovar Typhimurium vaccine (RASV) significantly inhibited Her-2/neu-expressing tumor growth. Although depletion of CD8⁺ cells in RASV-treated mice significantly restored tumor growth, the induction of Her-2/neu-specific cytotoxic T lymphocytes (CTLs) was not well correlated with the generation of the anti-tumor effect. Therefore, we hypothesized that RASV might induce a tumor microenvironmental shift, from immune suppressive to immunogenic, to reduce the suppressive force and finally elicit a successful anti-tumor response. We found that i.t. injection of RASV significantly increased the level of CD11b⁺Gr-1⁺ myeloid cells identified as myeloid-derived suppressor cell (MDSC), but a significant portion of these cells were TNF-α-secreting Ly6-G^high subsets, which can function as antitumor effector cells. We further investigated whether RASV can modulate immunosuppressive Treg cells, and CD4⁺CD25⁺ Foxp3⁺ Tregs was significantly reduced in RASV-treated mice. Thus, i.t. injection of RASV may offer a novel anti-cancer approach by eliciting transformation of immunosuppressive MDSCs into TNF-α-secreting neutrophils and reducing the generation of Treg cells, especially in the presence of tumor-specific CTLs. Collectively, these data will provide us an insight for the development of new anti-tumor approaches to overcome the immunosuppressive environment generated by tumors.     

Cefotaxime-Resistant Salmonella enterica in Travelers Returning from Thailand to Finland

During 1993–2011, cefotaxime resistance among Salmonella enterica isolates from patients in Finland increased substantially. Most of these infections originated in Thailand; many were qnr positive and belonged to S. enterica serovar Typhimurium and S. enterica monophasic serovar 4,[5],12:i:-. Although cefotaxime-resistant salmonellae mainly originate in discrete geographic areas, they represent a global threat.     

Increase in extraintestinal infections caused by Salmonella enterica subspecies II-IV

To garner information regarding site of infection and age and sex of persons infected with Salmonella enterica subspecies II-IV, we retrospectively analyzed data on Salmonella spp. infections in California, USA, 1985-2009. These subspecies were found to cause significantly more frequent invasive disease (e.g., bacteremia) than did Salmonella subspecies I strains.     

Multidrug resistance in Salmonella enterica serovar typhi isolated from patients with typhoid fever complications in Lagos, Nigeria

OBJECTIVE: The aim of this study was to determine the prevalence of Salmonella enterica serovar typhi in patients with pyrexia of unknown origin (PUO), and antimicrobial resistance in strains isolated from patients with S. typhi in Lagos, Nigeria. STUDY DESIGN: In total, 103 patients were included in this study, subdivided into two categories. Category A comprised 74 patients presenting with PUO, and Category B comprised 29 patients harbouring S. typhi who did not respond to initial treatment. METHODS: Blood samples were cultured for bacterial isolates and identified by standard procedures. Susceptibility testing was performed according to the National Committee for Clinical Laboratory Standards. Plasmid DNA extraction was performed using the alkaline lysis method with Escherichia coli v517 used as the standard. Conjugation and transformation experiments were performed using standard methods. For the latter, E. coli K12 HB 101 (ara-14, galK2, hsd 520, lacyl, leu, mtl-1, Pro A2, rec A13, rps L20, sup E44, thii xyl-5) was used as the recipient and plasmid PBR 322 was used as the positive control. RESULTS: The prevalence of S. typhi in PUO was 16.2% (12/74). In all, 25 of 41 (61.0%) cases were multidrug resistant (MDR) with phenotypic-resistant patterns: ACoCT, ACTCeS, ACTCoCe and ACTS were commonly encountered among the strains. Interestingly, four of the strains harbouring similar plasmid DNA were isolated from patients with hepatosplenomegaly, and a strain harbouring a large transferable plasmid of 81.2MDa was isolated from a psychosis patient. CONCLUSIONS: Our study confirmed the circulation of MDR S. typhi in Lagos, Nigeria. Periodic review of antibiotics used in hospitals is essential as the efficacies of chloramphenicol, ampicillin and cotrimoxazole are now doubtful. Ciprofloxacin and ofloxacin are effective drugs for treatment of typhoid fever, but with current trends of drug abuse in Nigeria, resistance is likely to develop. These results, therefore, provide an early warning signal for the prudent use of fluoroquinolone antimicrobials to preserve their usefulness.     

Plasmid-mediated quinolone resistance among non-Typhi Salmonella enterica isolates, USA

We determined the prevalence of plasmid-mediated quinolone resistance mechanisms among non-Typhi Salmonella spp. isolated from humans, food animals, and retail meat in the United States in 2007. Six isolates collected from humans harbored aac(6')Ib-cr or a qnr gene. Most prevalent was qnrS1. No animal or retail meat isolates harbored a plasmid-mediated mechanism.     

International spread of multidrug-resistant Salmonella Schwarzengrund in food products

We compared 581 Salmonella enterica serotype Schwarzengrund isolates from persons, food, and food animals in Denmark, Thailand, and the United States by antimicrobial drug susceptibility and pulsed-field gel electrophoresis (PFGE) typing. Resistance, including resistance to nalidixic acid, was frequent among isolates from persons and chickens in Thailand, persons in the United States, and food imported from Thailand to Denmark and the United States. A total of 183 PFGE patterns were observed, and 136 (23.4%) isolates had the 3 most common patterns. Seven of 14 isolates from persons in Denmark had patterns found in persons and chicken meat in Thailand; 22 of 390 human isolates from the United States had patterns found in Denmark and Thailand. This study suggests spread of multidrug-resistant S. Schwarzengrund from chickens to persons in Thailand, and from imported Thai food products to persons in Denmark and the United States.     

Increasing ceftriaxone resistance in Salmonellae, Taiwan

In Taiwan, despite a substantial decline of Salmonella enterica serotype Choleraesuis infections, strains resistant to ciprofloxacin and ceftriaxone persist. A self-transferable bla(CMY-2)-harboring IncI1 plasmid was identified in S. enterica serotypes Choleraesuis, Typhimurium, Agona, and Enteritidis and contributed to the overall increase of ceftriaxone resistance in salmonellae.     

Salmonella enteritidis in broiler chickens, United States, 2000-2005

US Department of Agriculture Food Safety and Inspection Service (FSIS) data on Salmonella enterica serotype Enteritidis in broiler chicken carcass rinses collected from 2000 through 2005 showed the annual number of isolates increased >4-fold and the proportion of establishments with Salmonella Enteritidis-positive rinses increased nearly 3-fold (test for trend, p<0.0001). The number of states with Salmonella Enteritidis in broiler rinses increased from 14 to 24. The predominant phage types (PT) were PT 13 and PT 8, 2 strains that a recent Foodborne Diseases Active Surveillance Network (FoodNet) case-control study associated with eating chicken. FSIS is directing more sampling resources toward plants with marginal Salmonella control to reduce prevalence in products including broilers. The policy targets establishments with common Salmonella serotypes of human illness, including Salmonella Enteritidis. Voluntary interventions should be implemented by industry.     

Stress-induced prophage DNA replication in Salmonella enterica serovar Typhimurium

Salmonella Typhimurium, a foodborne pathogen, is the cause of new outbreaks every year. The virulence of new pathogens is determined by their virulence genes, many of them carried on transferable elements, such as prophages. In bacteria harboring multiple prophages such as Salmonella, the reassortment of these genes plays a major role in the emergence of new pathogens and consequently new epidemics. This gene transfer depends on prophage induction and the initiation of the phage lytic cycle. In the present study we have tested the effects of bacterial extracytoplasmic stress on prophage induction. We developed a quantitative real-time PCR assay to quantify variations in phage genes copy number, representative of phage DNA replication associated with the initiation of the lytic cycle. The induction of the four Salmonella enterica serovar Typhimurium LT2 prophages (Fels-1, Fels-2, Gifsy-1 and Gifsy-2) was measured during exponential growth, stationary phase, starvation, as well as after treatment with Mitomycin C, Ampicillin or heat. Our results show that the four prophages respond differently to each treatment. Gifsy-2 showed constant low level of induction independently of the extracytoplasmic stress, Fels-1 was strongly induced after DNA damage, Fels-2 showed spontaneous induction only during optimal bacterial growth, and Gifsy-1 was repressed in all conditions. These findings show that the transfer of virulence genes can respond to and depend on variations of the bacterial surrounding conditions, and help to explain the appearance of new Salmonella outbreaks.     

Tandem repeat analysis for surveillance of human Salmonella Typhimurium infections

In Denmark, as part of the national laboratory-based surveillance system of human enteric infections, all Salmonella enterica serotype Typhimurium isolates are currently subtyped by using phage typing, antimicrobial resistance profiles, and pulsed-field gel electrophoresis (PFGE). We evaluated the value of real-time typing that uses multiple-locus variable-number tandem-repeats analysis (MLVA) of S. Typhimurium to detect possible outbreaks. Because only a few subtypes identified by PFGE and phage typing account for most infections, we included MLVA typing in the routine surveillance in a 2-year period beginning December 2003. The 1,019 typed isolates were separated into 148 PFGE types and 373 MLVA types. Several possible outbreaks were detected and confirmed. MLVA was particularly valuable for discriminating within the most common phage types. MLVA was superior to PFGE for both surveillance and outbreak investigations of S. Typhimurium.