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Fluoroquinolone-Resistant Salmonella Outbreak

Antibiotics are often used to treat salmonella infections, even though such treatment is not usually required in immunocompetent patients without invasive disease. Fluoroquinolones are commonly used because of increasing salmonella resistance to other antibiotics, such as ampicillin and trimethoprim-sulfamethoxazole. This report describes the first identified outbreak of fluoroquinolone-resistant salmonella infection. Of further concern is that the infection was spread nosocomially, rather than through the usual route of contaminated food.

Between February 1996 and April 2000, 11 patients were identified with a specific fluoroquinolone-resistant subtype of Salmonella enterica. The median patient age was 85. Fluoroquinolones had been used in the previous 6 months in 80 percent of these patients, as compared with 15 percent of a control group of patients without salmonella infection, a significant difference. In addition, the nursing home where 9 of the patients resided was found to use more fluoroquinolones than other nursing homes in the region. The index patient most likely acquired the organism during a hospital stay in the Philippines. Subsequent spread occurred in the index patient's nursing home and in a separate hospital and second nursing home, in both of which 1 case was identified. The index patient shed the organism for at least 12 months before the infection was identified.

Comment: This is the first report documenting transmission of fluoroquinolone-resistant salmonella in the U.S., and it reinforces two old lessons: avoid the unnecessary use of antibiotics and practice good infection control procedures. This report is a grim reminder of the downside of widespread antibiotic use.

— JG Adams

Published in Journal Watch Emergency Medicine July 5, 2001

Citation(s):

Olsen SJ et al. A nosocomial outbreak of fluoroquinolone-resistant salmonella infection. N Engl J Med 2001 May 24 344 1572-1579.

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