Control of escherichia coli infections in veterinary medicine has become especially problematic due to the emergence of multipleantibiotic resistant e. Sandsoutbreak of healthcareassociated infection and colonization with multidrugresistant salmonella enterica serovar. Multidrug resistant salmonella typhimurium in a nursery ashok kumar gopal nath b. Different mechanisms and factors involved in the development and spread of antibiotic resistance in bacterial strains.
Although hospitals are places for treatment and recovery, patients weakened by underlying illness and gastroenteritis may experience a prolonged recovery, serious sequel such as bloodstream infections, or even death. This rise can be explained by indiscriminate use of antibiotics and lacking hygiene measures, especially among medical staff. In addition, nosocomial infections can have farreaching consequences for the hospital personnel and the financial aspects of the hospital. Multidrugresistant salmonella typhimurium in four animal. Greater emphasis must be placed on the prevention of nosocomial infections and containment of multidrugresistant pathogens both to improve patient safety and to optimize the use of increasingly limited financial resources.
Salmonella is a leading cause of foodborne enterocolitis worldwide. Loiwal abstract a nursery epidemic caused by multidrug resistant salmonella typhimurium is reported. Multidrug resistant opportunistic pathogens have become endemic to the veterinary hospital environment. Burden of bacterial bloodstream infectiona brief update. Clinical management of infections caused by multidrug. Article in german gastmeier p, geffers c, herrmann m, lemmen s.
Emergence of multidrugresistant salmonella concord infections in europe and the united states in children adopted from ethiopia, 20032007. Multidrugresistant shigella infections in patients with. In 1999 and 2000, 3 state health departments reported 4 outbreaks of gastrointestinal illness due to salmonella enterica serotype typhimurium in employees, clients, and client animals from 3 companion animal veterinary clinics and 1 animal shelter. These data suggest nosocomial transmission of multidrugresistant tuberculosis occurred from patient to patient and from patient to health care worker and underscore the need for effective acidfast bacilli isolation facilities and adherence to published infection control guidelines in health care institutions. Detection of multidrug resistant salmonella generation. In september 2018, cdc identified salmonella enterica serotype newport newport infections that were multidrug resistant mdr, with decreased susceptibility to azithromycin, a recommended oral treatment agent. Bloodstream infections comprise a wide variety of pathogens and clinical syndromes with considerable overlap with similar syndromes of nonbacteraemic infections and diverse risk factors, therapeutic implications and outcomes. Pdf emergence of multidrugresistant salmonella concord. Cockroaches could play a vector role for nosocomial infections in a neonatal intensive care unit and environmental control measures of these vectors is required to reduce the risk of infection.
In africa, multidrugresistant nontyphoidal salmonellae nts are one of the leading causes of morbidity and high mortality in children under 5 years of age, second in importance only to pneumococcal disease. Multidrugresistant salmonella typhimurium in four animal facilities on this page. Discussion and conclusions the phenotypic mdr pattern of salmonella showed good correlation with the genotypic analysis. A casecontrol study implicated pasteurized milk from a dairy, and an inspection indicated the potential for contamination after pasteurization. The microbes cause nosocomial infections originated in hospitals, clinics, and medical care center. The potential lytic bacteriophages p22b1, p22, pbst10, pbst, pbst32, and pbst 35 were characterized by morphological property, heat and ph stability. Nosocomial infections and infections with multidrug. Though any bacteria may cause a nosocomial infection, there is an increasing incidence of multidrugresistant mdr pathogens causing hospitalacquired infections. Frontiers highly prevalent multidrugresistant salmonella. Persons infected with the outbreak strains of salmonella heidelberg, by week of illness onset n472 for whom information was reported as of february 28, 2014. Antimicrobial resistance has reached crisis stage in human medicine. Nosocomial infections are one of the most common complications of hospitalization and lead to increased morbidity and mortality 1, 2. Invasive multidrug resistant nontyphoidal salmonella infections in africa. Mdr strains have also been isolated with increasing frequency from immigrant workers in.
Enteric bacteria are commonly implicated in hospitalacquired or nosocomial infections. However, salmonella is an important cause of human illness in the united states. Although the problems associated with healthcareassociated infections hai and the emergence of zoonotic and multidrugresistant pathogens in companion animal dogs, cats and horses medicine have been wellknown for decades, current progress with respect to practical implementation of infection control programs in veterinary clinics has been limited. The present study aimed to describe and characterize a nosocomial outbreak caused by a multidrug resistant salmonella typhimurium in hospitalized calves at a veterinary medical teaching hospital from brazil. This study describes the possibility of using bacteriophages as an alternative agent to control multidrug resistant salmonella typhimurium. Nosocomial infections and infections with multidrugresistant pathogens frequency and mortality. Nosocomial infections can be controlled by practicing infection control programs, keep check on antimicrobial use and its resistance, adopting antibiotic control policy.
During 20162018, typhoid fever was diagnosed in 29 u. Nosocomial infections are those which are acquired by the patient within 4872 h or 3 days of admission in the hospital or medical care unit. Outbreak of multidrugresistant salmonella infections. Nosocomial infections are a serious threat to optimum patient care. The increasing levels of antimicrobial resistance in salmonella combined with their ability to cause serious disease means this group of bacteria is of considerable public health importance. The aim of the study was to determine the extent and pattern of antibiotic resistance of enteric bacteria isolated from patients and environmental sources at the. Although there is considerable information concerning the. This page contains surveillance reports published by cdc using data from the national healthcare safety network nhsn. Fiorella, rebecca crouse, carina blackmore, roger sanderson, christina l. They mainly caused invasive infections in adults linked to africa. Multidrug resistant salmonella typhimurium isolates have recently emerged as an important cause of nosocomial infections in children in belarus and russia 8. Multidrugresistant salmonella strains expressing emerging antibiotic resistance determinants. Health, general animal shelters health aspects research salmonella typhimurium case studies. Multidrugresistant nontyphoid salmonella infections in a medical center article in journal of microbiology, immunology, and infection wei mian yu gan ran za zhi 352.
In a controlled study, martin and coworkers22 found that patients infected with. Characterization of multidrugresistant escherichia coli. Multidrugresistant salmonella typhimurium infection from. The cdc first identified the multidrugresistant strain salmonella enterica serotype newport in september 2018 during an outbreak investigation. Emergence of extensively drugresistant salmonella typhi. Nosocomial infections george washington university.
Gordon 1 3 0 university of malawi college of medicine, blantyre 1 malawi liverpool. To prevent outbreaks with mrab we propose a screening for multidrug resistant gram negative bacteria mdrgn in patients transferred from countries with a high prevalence of mdrgn. Invasive multidrugresistant nontyphoidal salmonella. Reports are organized by topic, and include summaries of healthcareassociated infections, antimicrobial use and resistance, healthcare personnel influenza vaccination rates, and dialysis events. Pdf a nosocomial outbreak of fluoroquinoloneresistant. Management of multiple drugresistant salmonella infections. Human infections with nontyphoidal salmonella are commo.
Virulence profiles and innate immune responses were studied in acinetobacter baumannii from nosocomial infections collected over one year in a tertiary care hospital in mexico. Many different definitions for multidrug resistant mdr, extensively drug resistant xdr and pandrug resistant pdr bacteria are being used in the medical literature to characterize the different patterns of resistance found in healthcareassociated, antimicrobial resistant bacteria. Multidrugresistant salmonella strains expressing emerging. Salmonella, shigella, campylobacter, yersinia, entamoeba histolytica, etc. Cockroaches as a source of high bacterial pathogens with. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Cid three epidemics of invasive multidrug resistant salmonella bloodstream infection in blantyre, malawi, 19982014 nicholas a. One isolate was resistant to fluoroquinolones and cephalosporins and showed decreased susceptibility to azithromycin. Salmonella enterica infections are common causes of bloodstream infection in lowresource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. During the 1990s, this clone acquired a large conjugative inchi1 pst6 plasmid encoding resistance to.
The authors studied nts isolates from paediatric admissions at two hospitals in nairobi, kenya, and followed the index cases to their homes, where rectal swabs and stools from parents. Control of escherichia coli infections in veterinary medicine has become especially problematic due to the emergence of multipleantibioticresistant e. Isolates from the united kingdom containing virulenceresistance plasmids were characterized. Antimicrobial resistance nosocomial infections are an important factor in the emergence and spread of multidrug resistant mdr bacteria. Prevention of hospitalacquired and multidrugresistant infections patient information. To describe overall sitespecific hospitalacquired infection hai rates and to describe the microbiological and antibiotic resistance profiles of infecting pathogens, together with their impact on multidrugresistant mdr bacteriaassociated mortality. Multistate outbreak of multidrugresistant salmonella. These infections prolong hospitalization, require more extensive diagnostics and treatment, and are associated with additional costs 3, 4. A nosocomial outbreak of fluoroquinoloneresistant salmonella infection article pdf available in new england journal of medicine 34421. Multidrug resistant salmonella typhimurium in four animal facilities. We observed multidrug resistance in 10 91% of 11 shigella isolates from a diarrheal surveillance study in cambodia. Infection with multidrugresistant pathogens can also further complicate treatment. Because use of antimicrobial agents contributes to increasing resistance and facilitates transmission of multidrug resistant salmonellae, promoting guidelines aimed at improving appropriate use of antimicrobial agents may help prevent transmission of multidrug resistant salmonella infections in veterinary facilities. Samuel kariuki 1,2, gunturu revathi 3, nyambura kariuki 3, john kiiru 1, joyce mwituria 1, jane muyodi 1, jane w.
Although much of the problem stems from overuse and misuse of antimicrobial agents in human medicine, largescale use of. Antimicrobial use in food animals is the driving force for antimicrobial resistance among salmonella particularly in highincome countries. Multidrugresistant salmonella and nosocomial infections. An outbreak of multidrugresistant salmonella enterica serotype typhimurium infections occurred in pennsylvania and new jersey. The impact of hospitalacquired infections with multidrug. Mar 16, 2012 multidrug resistance was seen in all organisms.
Evaluation of lytic bacteriophages for control of multidrug. Emergence of multidrugresistant salmonella enterica. An outbreak in an idaho clinic was caused by multidrugresistant s. Efficient surveillance system can play its part at national and international level. Until 2017, decreased susceptibility to azithromycin had occurred in fewer than 0. Persontoperson transmission was the most likely mechanism of spread of the infection, expedited due to a breakdown.
The use of antimicrobial agents prescribed by veterinarians may contribute to increased transmission of multidrugresistant salmonella spp. Multidrug resistant enteric bacterial pathogens in a. Virulence profiles and innate immune responses against highly. Antimicrobial resistance has emerged in salmonella enterica, initially to the. The mode of transfer of hospitalacquired infection can be either by direct or by indirect contact. Shea guideline for preventing nosocomial transmission of. Cdc and public health and regulatory officials in several states investigated a multistate outbreak of multidrugresistant salmonella infections linked to raw chicken products. Although the problems associated with healthcareassociated infections hai and the emergence of zoonotic and multidrug resistant pathogens in companion animal dogs, cats and horses medicine have been wellknown for decades, current progress with respect to practical implementation of infection control programs in veterinary clinics has been limited. Outbreak of salmonella newport infections with decreased.
Three epidemics of invasive multidrugresistant salmonella. More information about salmonella, and steps people can take to reduce their risk of infection, can be found on the cdc salmonella web page. Drugresistant salmonella outbreak linked to ground beef. Detection of multidrug resistant salmonella with next generation sequencing 27 chloramphenicol and sulphonamide resistance genes. Shea guideline for preventing nosocomial transmission of multidrugresistant strains of staphylococcus aureus and enterococcus volume 24 issue 5 carlene a. Resistance to up to all the 12 antimicrobials tested was observed in different pathogens. Multidrugresistant salmonella enterica serotype typhi. Nosocomial infections hospitalacquired infections amboss. Burden of bacterial bloodstream infectiona brief update on. Though any bacteria may cause a nosocomial infection, there is an increasing incidence of multidrug resistant mdr pathogens causing hospitalacquired infections.
Multidrugresistant nontyphoid salmonella infections in a. Potential international spread of multidrugresistant. Brian faragher 2 jane mallewa 0 macpherson mallewa 0 calman a. Three epidemics of invasive multidrug resistant salmonella. Clinical management of infections caused by multidrugresistant enterobacteriaceae mercedes delgadovalverde, jesu. Epidemiology, clinical presentation, laboratory diagnosis. A group of international experts came together through a joint initiative by the european centre for disease. Outbreak of healthcareassociated infection and colonization.
The clinical microbiologist should be responsible for the identification of all isolates of nosocomial infections and work effectively with all other members of the infection control committee to identify and control outbreaks. Department of agricultures food safety and inspection service usdafsis monitored the outbreak. Human multidrugresistant salmonella newport infections, wisconsin, 20032005. In total, 21 infants developed symptomatic illness. Review of 21 retrospective and prospective hospitalacquired e.
Multidrugresistant opportunistic pathogens challenging. Nosocomial outbreaks by multidrugresistant gramnegative. Efforts are required by all stakeholders to prevent and control nosocomial infections. Since 1989, strains of salmonella typhi resistant to chloramphenicol, ampicillin, and trimethoprim i. 1015% of nosocomial infections leading cause of death from nosocomial infection crude mortality 3550% ventilatorassociated pneumonias occur 4872 h post endotracheal intubation organisms may originate from endogenous flora, other patients, visitors, or environmental sources. Carbapenemase genes, active efflux mechanism to imipenem and meropenem and outer membrane proteins profile were analyzed to evaluate their. The information collected for cases associated with each strain indicates that each of the strains is linked to this outbreak of multidrugresistant salmonella heidelberg infections and that foster farms brand chicken is the likely source. Typhimurium rtype ackssut with 2 isolates demonstrating additional resistance to ceftriaxone, an antimicrobial agent commonly used to treat children with severe salmonella infections. Prevention of hospitalacquired and multidrugresistant. A nosocomial outbreak of fluoroquinoloneresistant salmonella.
Cockroaches as a source of high bacterial pathogens with multidrug resistant strains in gondar town, ethiopia. We describe a nosocomial outbreak of diarrheal disease caused by extendedspectrum. Considerations in control and treatment of nosocomial. In denmark the diagnosis of human salmonella infections is car.
Multidrugresistant opportunistic pathogens have become endemic to the veterinary hospital environment. Nosocomial infections and multidrugresistant organisms in. In each facility, employees, clients, or both, became infected after animal illness. There is no agreement about the frequency of nosocomial infections and infections caused by multidrug resistant organisms mdro in germany. Outbreak of multidrug resistant salmonella typhimurium in. Multidrugresistant, extensively drugresistant and pandrug. Escherichia coli isolates resistant to 12 antibiotics were isolated from two dogs that were housed in the intensive care unit at the university of georgia veterinary teaching hospital within 48 h of each other. The common features in isolates from these continents indicate the role of human travel in their. Dairy cattle are the likely reservoir, and milk may be an important vehicle of salmonella transmission to humans. The outbreak peaked between may 2012 and july 2012.
Jul 2, 2002 cidrap news story drugresistant salmonella newport infections linked with eating ground beef karon ae, archer jr, sotir mj, et al. The rapid acceleration of multidrug resistant bacteria in the past 2 decades has overtaken new drug development, and patients and clinicians are faced with the prospect of untreatable infections. What is the risk of getting a hospitalacquired infection. Hospitalacquired infections represent a major problem in high or uppermiddle income countries, with an incidence rate of 5% in the united states and 7.
Once detected within specific areas of the hospital, various levels of intervention have been attempted to reduce the incidence and prevalence of infection due to mdrab. Molecular characterisation of 34 isolates from nosocomial infections revealed that the isolates probably belonged to the same clone, and that all contained the bla ctxm5 gene 8. Molecular characterization of class 1, 2 and 3 integrons in. Original article from the new england journal of medicine emergence of multidrugresistant salmonella enterica serotypetyphimurium dt104 infections in the united states. High load of multidrug resistant nosocomial neonatal. In developing countries, salmonella enterica serovar enteritidis causes substantial illness and death, and drug resistance is increasing. Nontyphoidal salmonella nts infections that are multidrug resistant mdr nonsusceptible to.
Decreased susceptibility to azithromycin has been rare among nontyphoidal salmonella that cause human infections in the united states, said the reports senior author cindy friedman, md, an epidemiologist in the cdcs enteric diseases branch. In a 6 year long outbreak of a multidrug resistant strain of s. So, it is important to should focus on salmonella serotype and strengthend the longterm monitoring of mdr serotype salmonella in animalderived foods. Yet, this heterogeneous entity has the advantage to be pathogendefined compared with the broad and even more heterogeneous entity sepsis, and so has become. Enterobacteriaceae showing resistance to cephalosporins due to extendedspectrum. Increasing isolation of multidrugresistant acinetobacter baumannii mdrab has been reported worldwide, and it is now one of the most difficult nosocomially acquired gramnegative pathogens to control and treat. The most common sites of infection are the bloodstream, lungs, urinary tract, and surgical wounds. Which hospitalacquired infections are the most problematic. Sep 22, 2017 the emergence of antibiotic resistant bacteria can cause serious clinical and public health problems.
In ghana, these infections constitute an important public health problem but little is known about their contribution to antibiotic resistance. Molecular characterisation of multidrugresistant salmonella. Dancerthe role of environmental cleaning in the control of hospitalacquired infection. Multidrug resistance increases concern about shigellosis treatment options. This study indicated that salmonella was widespread in chicken and pork at retail markets in guangdong province and has high multidrug resistance, especially multidrug resistant serotype salmonella. Outbreak of healthcareassociated infection and colonization with multidrugresistant salmonella enterica serovar senftenberg in florida volume 28 issue 7 robyn s. Nosocomial outbreak of salmonella enterica serovar. Health outcomes from multidrugresistant salmonella. The number of reported infections from all seven outbreak strains of salmonella heidelberg returned to baseline levels in january and the outbreak appeared to be over, as noted in the previous update on january 16, 2014.
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