In vivo development of quinolone resistance in Salmonella enterica serotype typhimurium DT104

Rapid detection of Salmonella enterica serovar Typhimurium DT104 strains by the polymerase chain reaction

Background

Infection with Salmonella enterica is a major public health concern in developed countries, and multidrug-resistant strains have become increasingly prevalent. S. enterica serovar Typhimurium DT104 (DT104) strains are prevalent in livestock in Japan and include numerous strains of multidrug-resistant S. enterica. Epidemiological analysis of these strains is critical for both agriculture and public health; however, diagnostic tests for these strains have yielded inconsistent results.

Results

We developed a rapid, simple, and inexpensive polymerase chain reaction test to detect multi-drug resistant DT104 strains. We designed primers specific to the prophage ST104 sequence encoded by DT104 strains and assessed the specificity of these primers by assaying a panel of 50 S.enterica isolates. Amplification products of the expected size were generated from the genomes of each of the DT104 strains; however, the ST104 primers failed to amplify products from non-DT104 strains of S.enterica serovar Typhimurium or other S. enterica serovars. Furthermore, a probe generated using the ST104 primers detected a restriction fragment encoding the ST104 region of DT104 by Southern hybridization.

Conclusions

The ST104 primers exhibit specificity to DT104 strains and are suitable for epidemiological applications.

Use of Antimicrobial Agents in Veterinary Medicine and Implications for Human Health

This review discusses why veterinary usage of antimicrobial agents is wrongly accused of causing a substantial part of the problem of resistant human pathogens. Without doubt, resistant organisms in animals are selected by veterinary antimicrobials. However, these are not a major human health risk either because the role of veterinary usage in selection or propagation is insignificant, or because resistant populations selected by veterinary usage do not pose a substantial risk to human health. Indeed, resistant bacterial infections in humans causing serious quantitative and qualitative health consequences are rarely food-borne and are not the same as those selected by veterinary usage of antimicrobial agents. The available evidence for veterinary selection of resistance, transmission to humans, and subsequent health consequences are reviewed for food-borne zoonotic pathogens. A risk assessment strategy is proposed to quantify potential hazards in order to decide on the most effective risk management strategy.

A Bayesian approach to acute infectious diarrhea in adults

Acute infectious diarrhea is a yearly occurrence for most Americans, and is associated with 1 million hospitalizations and about 6000 deaths in the United States annually. Up to 80% of acute infectious diarrhea is caused by noroviruses, which produce a clinically mild illness with a predictable short course and good outcome that make laboratory testing and antimicrobial treatment unnecessary. Most diarrhea-causing bacteria and protozoa can cause a clinical illness "like norovirus"; when they do so in healthy adults neither specialized testing nor antimicrobials is required. The presence or absence of epidemiologic evidence (such as travel, hospitalization, antibiotic use, other exposures)and clinical evidence (such as diarrhea frequency and duration, severity of abdominal pain and fever, character of stool, presence of chronic illness or immune deficiency) can change the probability of "not norovirus" from as low as 8% to as high as 100%. Such probabilities guide the use of laboratory testing and antimicrobial therapy in patients who have acute infectious diarrhea.

Analysis of Salmonella spp. with resistance to extended-spectrum cephalosporins and fluoroquinolones isolated in North America and Latin America: report from the SENTRY Antimicrobial Surveillance Program (1997–2004)

Emerging antimicrobial-resistant Salmonella spp. requires increased efforts to appropriately test susceptibility. The SENTRY Antimicrobial Surveillance Program monitored Salmonella spp. and detected nalidixic acid-resistant strains with elevated fluoroquinolone minimum inhibitory concentration (MIC) results and strains with extended-spectrum beta-lactamase (ESBL) "phenotypes" over the last 8 years. A total of 786 stool and bloodstream isolates from North American and Latin American medical centers (2001-2003) were tested by reference broth microdilution methods. Genetic analysis was used to further characterize the resistance mechanisms. Twenty-one sites forwarded 89 (11.3%) nalidixic acid-resistant (MIC, > or =32 microg/mL) strains. Nineteen of these isolates were studied to determine mutations in the quinolone resistance-determining region (QRDR). Among the nalidixic acid-resistant Salmonella spp. isolates, fluoroquinolone MIC values were also elevated (8- to 32-fold) compared with "wild-type" strains. Ciprofloxacin and gatifloxacin (MIC(90), 0.5 microg/mL) were more potent than levofloxacin and garenoxacin (1 microg/mL) against nalidixic acid-resistant strains. Single gyrA mutations were responsible for elevated fluoroquinolone MIC values and included D87Y (5), S83F (7), D87N (5), and S83Y (2). During 2001, 9 sites contributed 11 (2.9%) strains that met ESBL screening criteria (> or =2 microg/mL) for aztreonam or ceftazidime or ceftriaxone. ESBL confirmation was evaluated by Etest (AB BIODISK, Solna, Sweden) ESBL strips and the enzymes were characterized by polymerase chain reaction and gene sequencing. The ESBL phenotype isolates had the following MIC patterns: ceftazidime (> or =16 microg/mL), aztreonam (4 to >16 microg/mL), and ceftriaxone (8-32 microg/mL). All strains were susceptible to cefepime, carbapenems, gentamicin, and fluoroquinolones. No strains were inhibited by clavulanic acid consistent with all isolates producing the identified CMY-2, AmpC-like enzyme. Fluoroquinolones may be compromised among isolates with QRDR mutations detected using nalidixic acid as a screening agent. Salmonella spp. with ESBL phenotypes were likely to harbor CMY-2 (not an ESBL) and remain susceptible to cefepime, carbapenems, and fluoroquinolones, which can be used for serious invasive Salmonella spp. infections. Compared with the stool culture isolates, the blood culture isolates had higher QRDR mutations, but remained susceptible to the fluoroquinolones. The blood culture isolates were more susceptible to penicillins (ampicillin and ticarcillin) and not significantly different for ceftriaxone or trimethoprim/sulfamethoxazole susceptibility patterns. No QRDR trends over time were detected in North America, but increased resistance was observed in Latin America.