Ceftriaxone-Resistant Salmonella Infection Acquired by a Child from Cattle
Paul D. Fey, Ph.D., Thomas J. Safranek, M.D., Mark E. Rupp, M.D., Eileen F. Dunne, M.D., M.P.H., Efrain Ribot, Ph.D., Peter C. Iwen, M.S., Patricia A. Bradford, Ph.D., Frederick J. Angulo, D.V.M., Ph.D., and Steven H. Hinrichs, M.D.
Background The emergence of resistance to antimicrobial agentswithin the salmonellae is a worldwide problem that has beenassociated with the use of antibiotics in livestock. Resistanceto ceftriaxone and the fluoroquinolones, which are used to treatinvasive salmonella infections, is rare in the United States.We analyzed the molecular characteristics of a ceftriaxone-resistantstrain of Salmonella enterica serotype typhimurium isolatedfrom a 12-year-old boy with fever, abdominal pain, and diarrhea.
Methods We used pulsed-field gel electrophoresis and analysisof plasmids and ß-lactamases to compare the ceftriaxone-resistantS. enterica serotype typhimurium from the child with four isolatesof this strain obtained from cattle during a local outbreakof salmonellosis.
Results The ceftriaxone-resistant isolate from the child wasindistinguishable from one of the isolates from cattle, whichwas also resistant to ceftriaxone. Both ceftriaxone-resistantisolates were resistant to 13 antimicrobial agents; all butone of the resistance determinants were on a conjugative plasmidof 160 kb that encoded the functional group 1 ß-lactamaseCMY-2. Both ceftriaxone-resistant isolates were closely relatedto the three other salmonella isolates obtained from cattle,all of which were susceptible to ceftriaxone.
Conclusions This study provides additional evidence that antibiotic-resistantstrains of salmonella in the United States evolve primarilyin livestock. Resistance to ceftriaxone, the drug of choicefor invasive salmonella disease, is a public health concern,especially with respect to children, since fluoroquinolones,which can also be used to treat this disease, are not approvedfor use in children.
Source Information
From the Nebraska Public Health Laboratory (P.D.F., P.C.I., S.H.H.), Omaha; the Departments of Internal Medicine (P.D.F., M.E.R.) and Pathology and Microbiology (P.D.F., P.C.I., S.H.H.), University of Nebraska Medical Center, Omaha; the Department of Health and Human Services, Lincoln, Nebr. (T.J.S.); the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (E.F.D., E.R., F.J.A.); and Wyeth–Ayerst Research, Pearl River, N.Y. (P.A.B).
Address reprint requests to Dr. Fey at the Departments of Internal Medicine and Pathology and Microbiology, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198-5400, or at pfey{at}unmc.edu.
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