L. R. Ward

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.

SALMONELLA ENTERITIDIS PHAGE TYPE 4 INFECTION OF BROILER CHICKENS: A HAZARD TO PUBLIC HEALTH

The pericardial fluids and contents of caeca and spleens from 81 broiler chickens that had been condemmed at processing factories because of macroscopic pericarditis were examined for Salmonella species. 47 (58%) of these chickens yielded S enteritidis phage type (PT) 4. Viable counts of the organism in fluids from 6 of the most severely affected hearts ranged from 10(4) to 10(7) colony-forming units/ml. S enteridis PT4 was also isolated from 8 of 20 fresh chilled chickens on retail sale. No other serotype of Salmonella or phage type of S enteritidis was cultured either from the chickens with pericarditis or from the fresh chilled chicken.

Two outbreaks of Salmonella enteritidis phage type 4 infection associated with the consumption of fresh shell-egg products

In 1988 there were two outbreaks of infection with Salmonella enteritidis phage type 4 in adjacent local authorities. The first affected 18 of 75 helpers and guests who attended a private function. Investigations revealed that home-made vanilla ice-cream containing uncooked eggs was the vehicle of infection and the causative organism was identified at the premises of the egg producer. The second affected 84 of 422 delegates attending a conference dinner, and 12 of 50 hotel staff at risk. A dessert made with lightly-cooked egg yolk and raw egg white was associated with infection, and the epidemic strain was cultured from the shell of an egg and an environmental sample from the producers farm. It is of interest that one outbreak involved free-range and one battery-produced eggs, and that in one the vehicle was prepared at home and in the other in commercial premises. In neither incident was any deficiency in standards of egg production or catering practice discovered.

Acquisition of a drug resistance plasmid converts Salmonella enteritidis phage type 4 to phage type 24.

Salmonella enteritidis accounted for 55% of the 27,478 salmonellae isolated from humans in England and Wales during 1988. Within this serotype phage type 24 has increased from 24 isolations in 1987 to 201 in 1988. The high frequency of drug resistance in this phage type has been shown to be due to the presence of plasmids belonging to Inc N and coding for resistance to a range of antimicrobial drugs among which resistance to ampicillin, streptomycin, tetracycline (AST) and T predominate. These plasmids are phage-type determining and convert strains of phage type 4 to phage type 24.

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.

A national outbreak of Salmonella typhimurium DT 124 caused by contaminated salami sticks

An outbreak of Salmonella typhimurium DT 124 infection which affected 101 people in England in December 1987 and January 1988 was detected through surveillance of laboratory reports from medical microbiology laboratories of the NHS and PHLS. Within 1 week of noting the increase in reports, epidemiological and microbiological investigations identified a small German salami stick as the vehicle of infection and the product was withdrawn from sale. The epidemiological investigation highlighted the occurrence of a long incubation period, bloody diarrhoea. Prompt recognition and investigation of the outbreak prevented further cases of severe infection.

Molecular epidemiology of an outbreak caused by Salmonella enterica serovar Newport in Finland and the United Kingdom.

Between December 1997 and January 1998 an increase in the number of isolates of Salmonella enterica serovar Newport, a serotype rarely causing indigenous infections in Finland, was detected. This included two clusters of gastroenteritis following funeral meals. An inquiry via Enter-net revealed a concomitant increase in cases of S. Newport in the United Kingdom. To investigate the Finnish outbreak, a total of 56 S. Newport strains (22 from the outbreak period, 27 from pre- and post-outbreak period, and 7 from imported food producing animals) were studied by pulsed-field gel electrophoresis (PFGE); selected isolates were also phage typed. Two retrospective questionnaire studies evaluating food exposures among the funeral attendants were conducted. All isolates from the clusters had an identical PFGE pattern which was also found in 13 infections temporally close to but not associated with the clusters. The Finnish outbreak was caused by the same phage type as the one in the United Kingdom. In both clusters, an epidemiological link between illness and exposure to cured ham was found. In conclusion, the outbreak was not limited to the two clusters but was more widely spread both in and outside Finland. Early alarm systems of food-borne outbreaks and collaboration between European countries are needed for investigating international outbreaks.

Salmonella enteritidis phage types in Germany

In order to monitor the epidemiological situation ofS. enteritidis in Germany, in 1990–91 1138 isolates from more than 180 locations in West Germany were phage typed. 1124 strains (98.8%) from all sources were typeable, belonging to 21 different phage types (PT). PT4 strains were isolated most frequently (70.8%). In addition, PT7, 25, 34 and 8 were of epidemiological relevance with incidences of 7.2 to 4.5%. The comparison of data shows that in Germany, like in other parts of Europe, PT4 predominates. This phage type is, however, infrequent in North America, where PT8 has the highest incidence.