Distribution of multidrug-resistant human isolates of MDR-ACSSuT Salmonella Typhimurium and MDR-AmpC Salmonella Newport in the United States, 2003-2005.
OBJECTIVE
Multidrug-resistant (MDR) Salmonella strains are associated with excess bloodstream infections, hospitalizations, and deaths compared with pansusceptible strains. Bovine products are sometimes a source of MDR Salmonella. To generate hypotheses for regional differences in risk factors for human infection, we analyzed distributions of the two most prevalent MDR Salmonella phenotypes in the United States, 2003-2005: (i) MDR-ACSSuT (resistant to at least ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline) Typhimurium; (ii) MDR-AmpC (resistant to at least ampicillin, chloramphenicol, streptomycin, sulfonamides, tetracycline, amoxicillin/clavulanic acid, and ceftiofur, and with decreased susceptibility to ceftriaxone) Newport.


METHODS
Participating public health laboratories in all states forwarded every 20th Salmonella isolate from humans to the National Antimicrobial Resistance Monitoring System for Enteric Bacteria for antimicrobial susceptibility testing. Among the serotypes Typhimurium and Newport isolates submitted 2003-2005, pansusceptible, MDR-ACSSuT Typhimurium, and MDR-AmpC Newport were identified. Patterns of resistance, demographic factors, and cattle density were compared across regions.


RESULTS
Of 1195 serotype Typhimurium isolates, 289 (24%) were MDR-ACSSuT. There were no significant differences in region, age, or sex distribution for pansusceptible versus MDR-ACSSuT Typhimurium. Of 612 serotype Newport isolates, 97 (16%) were MDR-AmpC, but the percentage of MDR-AmpC isolates varied significantly across regions: South 3%, Midwest 28%, West 32%, and Northeast 38% (p < 0.0001). The South had the lowest percentage of MDR-AmpC Newport isolates and also the lowest density of milk cows. More Newport isolates were MDR-AmpC in the 10 states with the highest milk cow density compared with the remaining states. Overall, 22% of pansusceptible Newport isolates but only 7% of MDR-AmpC Newport isolates were from patients <2 years of age. For both serotypes, MDR phenotypes had less seasonal variation than pansusceptible phenotypes.


CONCLUSIONS
This is the first analysis of the distribution of clinically important MDR Salmonella isolates in the United States. MDR-ACSSuT Typhimurium was evenly distributed across regions. However, MDR-AmpC Newport was less common in the South and in children <2 years of age. Information on individuals' exposures is needed to fully explain the observed patterns.
Greene
Sharon K
SK
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Stuart
Andrew M
AM
Medalla
Felicita M
FM
Whichard
Jean M
JM
Hoekstra
Robert M
RM
Chiller
Tom M
TM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D005260:Female; D005516:Food Microbiology; D005843:Geography; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010641:Phenotype; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology; D019779:Salmonella enterica / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D012486:Salmonella typhimurium / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D012703:Serotyping; D014481:United States / Q000453:epidemiology; D055815:Young Adult