title: Emergence of multidrug-resistant salmonella concord infections in Europe and the United States in children adopted from Ethiopia, 2003-2007.
abstract: BACKGROUND
  Multidrug-resistant Salmonella serovar Concord infections have been reported from children adopted from Ethiopia. We interviewed patients, characterized the isolates, and gathered information about adoptions from Ethiopia to assess public health implications.
  
  
  METHODS
  Information about Salmonella Concord cases and adoptions were provided from Austria, Denmark, England (and Wales), Ireland, the Netherlands and the United States. Patients from Denmark and the United States were interviewed to determine the orphanages of origin; orphanages in Ethiopia were visited. Isolates were subtyped by pulsed-field gel electrophoresis and antimicrobial susceptibility; specific antimicrobial resistance genes were characterized.
  
  
  RESULTS
  Salmonella Concord was isolated from 78 persons from 2003 to 2007. Adoption status was known for 44 patients <or=3 years of age; 98% were adopted from Ethiopia. The children adopted from Ethiopia were from several orphanages; visited orphanages had poor hygiene and sanitation and frequent use of antimicrobial agents. The number of children adopted from Ethiopia in the participating countries increased 527% from 221 in 2003 to 1385 in 2007. Sixty-four Salmonella Concord isolates yielded 53 pulsed-field gel electrophoresis patterns including 6 patterns with >2 indistinguishable isolates; one isolate from an Ethiopia adoptee. Antimicrobial susceptibility was performed on 43 isolates; 81% were multidrug-resistant (>or=3 agents). Multidrug-resistant isolates were from Ethiopian adoptees and were resistant to third and fourth generation cephalosporins and 14% had decreased susceptibility to ciprofloxacin.
  
  
  CONCLUSIONS
  Improved hygiene and sanitation and more appropriate use of antimicrobial agents are needed in orphanages in Ethiopia. Culturing of stool specimens of children adopted from Ethiopia and appropriate hygiene may prevent further disease transmission.
authors.affiliation: WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens and EU Community Reference Laboratory for Antimicrobial Resistance, National Food Institute, Technical University of Denmark, Copenhagen V, Denmark. rshe@food.dtu.dk
authors.forename: Rene S
authors.initials: RS
authors.lastname: Hendriksen
authors.forename: Matthew
authors.initials: M
authors.lastname: Mikoleit
authors.forename: Christian
authors.initials: C
authors.lastname: Kornschober
authors.forename: Regan L
authors.initials: RL
authors.lastname: Rickert
authors.forename: Susan Van
authors.initials: SV
authors.lastname: Duyne
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kjelsø
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasman
authors.forename: Martin
authors.initials: M
authors.lastname: Cormican
authors.forename: Dik
authors.initials: D
authors.lastname: Mevius
authors.forename: John
authors.initials: J
authors.lastname: Threlfall
authors.forename: Frederic J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: Frank M
authors.initials: FM
authors.lastname: Aarestrup
mesh_terms: D000293:Adolescent; D000300:Adoption; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015373:Bacterial Typing Techniques; D002648:Child; D054540:Child, Orphaned; D002675:Child, Preschool; D016172:DNA Fingerprinting; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005002:Ethiopia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019372:Orphanages; D012475:Salmonella / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents