E. J. Threlfall

Characterization of plasmids conferring resistance to gentamicin and apramycin in strains of Salmonella typhimurium phage type 204c isolated in Britain

In Salmonella typhimurium phage type 204c isolated in Britain, gentamicin resistance is specified by plasmids of the I1 compatibility group which also confer resistance to apramycin. These plasmids have been subdivided into three types within the I1 group on the basis of their antibiotic resistance specificity, their ability to produce colicin Ib and their restriction enzyme digest fragmentation patterns. All three have been identified in strains from cattle, but as yet only two types have been found in strains from humans. It is suggested that the use of apramycin in animal husbandry is responsible for the appearance of gentamicin resistance in multiresistant strains of phage type 204c, a phage type already epidemic in bovine animals and with an increasing incidence in humans.

Subdivision of Salmonella enteritidis phage types by plasmid profile typing

Differentiation of Salmonella enteritidis by plasmid profile typing has been compared to differentiation by phage typing. Examination of the type strains of the 27 S. enteritidis phage types showed that only 11 profile patterns could be identified. Moreover, two profile patterns were found in 15 of the type strains, including those of the two most common phage types in Britain, types 4 and 8. On this basis, plasmid profile typing is not as sensitive as phage typing for the primary subdivision of S. enteritidis. When differentiation of 534 strains of the 27 phage types was attempted using plasmid profiles, variation in pattern suitable for epidemiological subdivision was found in 13 phage types and there were 9 profile patterns in strains of phage type 4. Plasmid profile typing can, therefore, be regarded as an effective adjunct to phage typing for the subdivision of S. enteritidis.

A comparison of multiple drug resistance in salmonellas from humans and food animals in England and Wales, 1981 and 1990

For Salmonella typhimurium from humans in England and Wales, the incidence of multiple resistance more than doubled over the 8-year period 1981-8 and, over the next 2 years, increased by a further 7%. From 1981 to 1988 both resistance and multiple resistance also increased significantly in S. virchow and although multiple resistance did not increase over the next 2 years, the overall incidence of resistance has continued to rise. In 1990 the majority of S. typhimurium from cattle were multiply-resistant and the occurrence of such resistance has quadrupled since 1981. Multiple resistance has also increased in S. typhimurium from pigs and, to a lesser extent, from poultry. In contrast, multiple resistance has remained uncommon in the poultry-associated serotype S. enteritidis. For S. virchow, multiple resistance was common in a phage type frequently associated with poultry meat imported from France. The continuing use of a range of different antimicrobials in calf husbandry has been an important factor in promoting the emergence of multiply-resistant strains of S. typhimurium in cattle. In contrast, multiple resistance has remained rare in those serotypes associated with poultry, where the use of such antimicrobials has been less intensive. It is hoped that recent recommendations discouraging, in veterinary medicine, the prophylactic use of antibiotics with cross resistance to those used in human medicine will result in a reduction in the occurrence of multiresistant strains in food animals and subsequently in humans.

Widespread occurrence of multiple drug-resistant Salmonella typhi in India

Sixteen multiple drug resistant strains ofSalmonella typhi belonging to Vi-phage types E1 (14) and O (2) and isolated in Southeast India in 1991 were characterized. All strains were resistant to chloramphenicol and the majority to trimethoprim and ampicillin. In all strains these resistances were encoded by plasmids of the H1 incompatibility group with molecular weights ranging from 110 to 120 megadaltons. Physicians in European countries should be aware that treatment may fail if patients with typhoid fever who have recently returned from the Indian sub-continent are given first-line treatment with chloramphenicol, trimethoprim or ampicillin. With the possible exception of young children, ciprofloxacin is currently the best choice for treatment of such patients.

PLASMID CHARACTERISATION IN THE INVESTIGATION OF AN EPIDEMIC CAUSED BY MULTIPLY RESISTANT SHIGELLA DYSENTERIAE TYPE 1 IN CENTRAL AFRICA

A strain of Shigella dysenteriae type 1 resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides, and tetracyclines has caused an epidemic of shiga dysentery in northeast Zaire. Since November 1979, it has caused many deaths in an extensive area which now includes neighbouring Rwanda. The strain carries a resistance plasmid of compatibility group X, indistinguishable from the plasmid previously found in strains from Somalia. This contrasts with multiply resistant strains of Sh. dystenteriae type 1 from Central America and South-East Asia in which resistance is determined by plasmids of compatibility group B.

National outbreak of Salmonella senftenberg associated with infant food

Eight cases of Salmonella senftenberg infection in infants were identified in the first half of 1995 in England, five were indistinguishable S. senftenberg strains. A case-control study showed an association between illness and consumption of one brand of baby cereal (P = 0.03). The cereal manufacturer reported isolating S. senftenberg in June 1994 from an undistributed cereal batch. Outbreak strains and the cereal strain were all plasmid-free in contrast to other human isolates of S. senftenberg in the same period. Changes in the production process were implemented to prevent further contamination. Surveillance centres should strengthen the detection and investigation of outbreaks of gastrointestinal infection in susceptible groups, especially young children. In this outbreak, the study of only five cases led to identification of the vehicle of infection. Even when few cases are reported, epidemiological investigation in conjunction with molecular typing may lead to public health action which prevents continuing or future outbreaks.

Ciprofloxacin versus ceftriaxone in the treatment of multiresistant typhoid fever

A randomized trial comparing ceftriaxone (3 g given parenterally per day for 7 days) to ciprofloxacin (500 mg given orally twice a day for 7 days) in the treatment of blood culture positive typhoid fever was conducted. Twenty patients were openly randomized to receive ciprofloxacin and 22 to receive ceftriaxone. The outcome was classified as clinical failure in 6 patients (27 %) in the ceftriaxone group, but in none in the ciprofloxacin group (p=0.01). The mean duration of fever was four days in the ciprofloxacin group and about five days in the ceftriaxone group (p=0.04). In the six patients in the ceftriaxone group who experienced failure, therapy was switched to ciprofloxacin and the patients became afebrile and asymptomatic within 48 hours. Patients with resistant strains ofSalmonella typhi and patients with sensitive strains responded equally well to ciprofloxacin therapy. Analysis of a subset of 12 of the multiresistant strains revealed that resistance was encoded for by a transferable 180 kilobase plasmid. Ciprofloxacin represents a useful treatment option in areas where multiresistant strains are likely to be encountered.

Subtyping of Listeria monocytogenes on the basis of plasmid profiles and arsenic and cadmium susceptibility

The susceptibilities to arsenic and cadmium together with the detection of plasmid DNA were evaluated for use as epidemiological markers for the subtyping of Listeria monocytogenes. Plasmid DNA was detected in 34% of 322 apparently unrelated isolates of L. monocytogenes. The resistance to cadmium and arsenic differentiated 565 apparently unrelated cultures into four groups, the smallest being 5% of cultures resistant to both agents, and the largest (53%) being sensitive to cadmium and resistant to arsenic. The resistance patterns to these agents and the presence of plasmid DNA varied markedly between the serotypes of the cultures. The detection of plasmid DNA was strongly associated with cadmium resistance in serogroup 1/2 cultures, but not within those of serogroup 4. Arsenic resistance was not associated with plasmid DNA. All methods were sufficiently stable to be useful for epidemiological investigations. The techniques described here offer simple methods which can be easily utilized in laboratories without a specialized expertise for this bacterium.

Salmonella gold-coast from outbreaks of food-poisoning in the British Isles can be differentiated by plasmid profiles

Four distinctive plasmid profile types have been identified in strains of Salmonella gold-coast isolated in Britain. Strains of one type, designated plasmid profile type 4, caused an extensive outbreak of food-poisoning in 1984, and it has been confirmed that the vehicle of infection was imported French pâté.

Use of plasmid profile typing for surveillance of Salmonella enteritidis phage type 4 from humans, poultry and eggs.

Plasmids were found in 1022 of 1089 (94%) of drug-sensitive strains of Salmonella enteritidis phage type 4 from humans (sporadic and outbreak cases), poultry (chickens) and eggs in England and Wales in the 5-year period 1988-92 and 25 plasmid profile patterns were identified. Strains characterized by a single plasmid of 38 MDa predominated (= plasmid profile type SE 38), comprising over 90% of isolates from humans, 70% from poultry and 92% from eggs. Eleven profile types were identified in strains from humans, 21 in strains from poultry and 3 in strains from eggs. Eight of the 11 patterns identified in human isolates were found in strains from poultry and 2 in strains from eggs. In contrast 15 patterns seen in poultry were not found in strains from humans. Four percent of strains from humans and 13% from poultry did not carry the 38 MDa plasmid but all strains from eggs were found to carry this plasmid. The second most common profile type in strains isolated between 1981 and 1988 was not identified in strains isolated from 1988-92. It is concluded that plasmid profile typing is a useful method for rapid differentiation within phage type 4 of S. enteritidis but that methods which can discriminate within the predominant profile type, SE 38, are now required.