Use of Molecular Subtyping in Surveillance for Salmonella enterica Serotype Typhimurium
Jeffrey B. Bender, D.V.M., Craig W. Hedberg, Ph.D., David J. Boxrud, B.S., John M. Besser, M.S., Julie H. Wicklund, M.P.H., Kirk E. Smith, D.V.M., Ph.D., and Michael T. Osterholm, Ph.D., M.P.H.
Background Because Salmonella enterica serotype typhimuriumis the most common serotype isolated from persons with salmonellosisin the United States, it is difficult to detect unusual clustersor outbreaks. To determine whether molecular subtyping couldbe useful in public health surveillance for S. enterica serotypetyphimurium, the Minnesota Department of Health initiated theroutine use of pulsed-field gel electrophoresis (PFGE) of isolates.
Methods Beginning in 1994, all S. enterica serotype typhimuriumisolates submitted by clinical laboratories to the Departmentof Health were subtyped by PFGE. A standard questionnaire wasused to interview patients about possible sources of infection.
Results From 1994 through 1998, 998 cases of infection withS. enterica serotype typhimurium were reported to the MinnesotaDepartment of Health (4.4 cases per 100,000 person-years). PFGEwas performed on 958 of the isolates (96 percent), and 174 differentpatterns were identified. Sixteen outbreaks with a common sourcewere identified, accounting for 154 cases. PFGE subtyping madeit possible to confirm 10 outbreaks that involved small numbersof cases in institutional settings. Of six larger, community-basedoutbreaks, four would probably not have been recognized withoutPFGE subtyping. These four outbreaks accounted for 96 of the154 culture-confirmed outbreak cases (62 percent). Fifty-sixof 209 isolates tested for antimicrobial susceptibility (27percent) were resistant to at least five antimicrobial agents.The multidrug-resistant isolates identified had unique PFGEpatterns.
Conclusions Routine molecular subtyping of S. enterica serotypetyphimurium by PFGE can improve the detection of outbreaks andaid in the identification of multidrug-resistant strains. Combiningroutine molecular subtyping with a method of rapid communicationamong public health authorities can improve surveillance forS. enterica serotype typhimurium infections.
Source Information
From the Acute Disease Epidemiology Section (J.B.B., C.W.H., J.H.W., K.E.S., M.T.O.) and the Division of Public Health Laboratories (D.J.B., J.M.B.), Minnesota Department of Health, Minneapolis.
Address reprint requests to Dr. Bender at the University of Minnesota, 1988 Fitch Ave., St. Paul, MN 55108, or at bende002{at}tc.umn.edu.
Gaul, S. B., Wedel, S., Erdman, M. M., Harris, D. L., Harris, I. T., Ferris, K. E., Hoffman, L.
(2007). Use of Pulsed-Field Gel Electrophoresis of Conserved XbaI Fragments for Identification of Swine Salmonella Serotypes. J. Clin. Microbiol.
45: 472-476
[Abstract][Full Text]
Alcaine, S. D., Soyer, Y., Warnick, L. D., Su, W.-L., Sukhnanand, S., Richards, J., Fortes, E. D., McDonough, P., Root, T. P., Dumas, N. B., Grohn, Y., Wiedmann, M.
(2006). Multilocus Sequence Typing Supports the Hypothesis that Cow- and Human-Associated Salmonella Isolates Represent Distinct and Overlapping Populations. Appl. Environ. Microbiol.
72: 7575-7585
[Abstract][Full Text]
Sawalha, A. H., Saint, S., Ike, R. W., Bronze, M. S.
(2005). Still Consider the Source. NEJM
353: 1503-1507
[Full Text]
Fakhr, M. K., Nolan, L. K., Logue, C. M.
(2005). Multilocus Sequence Typing Lacks the Discriminatory Ability of Pulsed-Field Gel Electrophoresis for Typing Salmonella enterica Serovar Typhimurium. J. Clin. Microbiol.
43: 2215-2219
[Abstract][Full Text]
Martinez-Urtaza, J., Liebana, E., Garcia-Migura, L., Perez-Pineiro, P., Saco, M.
(2004). Characterization of Salmonella enterica Serovar Typhimurium from Marine Environments in Coastal Waters of Galicia (Spain). Appl. Environ. Microbiol.
70: 4030-4034
[Abstract][Full Text]
Qutaishat, S. S., Stemper, M. E., Spencer, S. K., Borchardt, M. A., Opitz, J. C., Monson, T. A., Anderson, J. L., Ellingson, J. L. E.
(2003). Transmission of Salmonella enterica Serotype Typhimurium DT104 to Infants Through Mother's Breast Milk. Pediatrics
111: 1442-1446
[Abstract][Full Text]
Lado, B. H., Yousef, A. E.
(2003). Selection and Identification of a Listeria monocytogenes Target Strain for Pulsed Electric Field Process Optimization. Appl. Environ. Microbiol.
69: 2223-2229
[Abstract][Full Text]
Refsum, T., Heir, E., Kapperud, G., Vardund, T., Holstad, G.
(2002). Molecular Epidemiology of Salmonella enterica Serovar Typhimurium Isolates Determined by Pulsed-Field Gel Electrophoresis: Comparison of Isolates from Avian Wildlife, Domestic Animals, and the Environment in Norway. Appl. Environ. Microbiol.
68: 5600-5606
[Abstract][Full Text]
Kotetishvili, M., Stine, O. C., Kreger, A., Morris, J. G. Jr., Sulakvelidze, A.
(2002). Multilocus Sequence Typing for Characterization of Clinical and Environmental Salmonella Strains. J. Clin. Microbiol.
40: 1626-1635
[Abstract][Full Text]
Chiu, C.-H., Wu, T.-L., Su, L.-H., Chu, C., Chia, J.-H., Kuo, A.-J., Chien, M.-S., Lin, T.-Y.
(2002). The Emergence in Taiwan of Fluoroquinolone Resistance in Salmonella enterica Serotype Choleraesuis. NEJM
346: 413-419
[Abstract][Full Text]
Liebana, E., Guns, D., Garcia-Migura, L., Woodward, M. J., Clifton-Hadley, F. A., Davies, R. H.
(2001). Molecular Typing of Salmonella Serotypes Prevalent in Animals in England: Assessment of Methodology. J. Clin. Microbiol.
39: 3609-3616
[Abstract][Full Text]
Previous
