title: Clinical outcomes of nalidixic acid, ceftriaxone, and multidrug-resistant nontyphoidal salmonella infections compared with pansusceptible infections in FoodNet sites, 2006-2008.
abstract: BACKGROUND
  Nontyphoidal Salmonella causes an estimated 1.2 million infections, 23,000 hospitalizations, and 450 deaths annually in the United States. Most illnesses are self-limited; however, treatment with antimicrobial agents can be life-saving for invasive infections.
  
  
  METHODS
  The Foodborne Diseases Active Surveillance Network and the National Antimicrobial Resistance Monitoring System collaborated on a prospective cohort study of patients with nontyphoidal Salmonella bloodstream and gastrointestinal infections to determine differences in the clinical outcomes of resistant compared with pansusceptible infections. Interviews were conducted within 85 days of specimen collection date.
  
  
  RESULTS
  Of 875 nontyphoidal Salmonella isolates, 705 (81%) were pansusceptible, 165 (19%) were resistant to at least 1 agent, and 5 (0.6%) had only intermediate resistance. The most common pattern, found in 51 (31%) of resistant isolates, was resistance to at least ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (ACSSuT); 88% of isolates with this pattern were serotype Typhimurium or Newport. Fourteen (52%) of the 27 ceftriaxone-resistant isolates were also ACSSuT resistant. Adjusted for age and serotype, bloodstream infection was significantly more common among patients infected with strains resistant to only two, only three, or only five antimicrobial classes, to ACSSuT with or without other agents, to ACSSuT only, or to nalidixic acid with or without other agents than among patients with pansusceptible isolates. Adjusted for age, serotype, and bloodstream infection, hospitalization was significantly more common among patients infected with strains resistant to only three agents or to ceftriaxone (all ceftriaxone-resistant isolates were resistant to other agents) than among patients with pansusceptible isolates.
  
  
  CONCLUSIONS
  This study extends evidence that patients with antimicrobial-resistant nontyphoidal Salmonella infections have more severe outcomes. Prevention efforts are needed to reduce unnecessary antimicrobial use in patient care settings and in food animals to help prevent the emergence of resistance and infections with resistant nontyphoidal Salmonella.
authors.affiliation: 1 Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Amy L
authors.initials: AL
authors.lastname: Krueger
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Greene
authors.forename: Ezra J
authors.initials: EJ
authors.lastname: Barzilay
authors.forename: Olga
authors.initials: O
authors.lastname: Henao
authors.forename: Duc
authors.initials: D
authors.lastname: Vugia
authors.forename: Samir
authors.initials: S
authors.lastname: Hanna
authors.forename: Stephanie
authors.initials: S
authors.lastname: Meyer
authors.forename: Kirk
authors.initials: K
authors.lastname: Smith
authors.forename: Gary
authors.initials: G
authors.lastname: Pecic
authors.forename: Dina
authors.initials: D
authors.lastname: Hoefer
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002443:Ceftriaxone / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005506:Food Contamination / Q000032:analysis; D005516:Food Microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009268:Nalidixic Acid / Q000494:pharmacology*; D011446:Prospective Studies; D012475:Salmonella / Q000187:drug effects / Q000302:isolation & purification; D012478:Salmonella Food Poisoning / Q000188:drug therapy / Q000453:epidemiology*; D013307:Streptomycin / Q000494:pharmacology; D013444:Sulfisoxazole / Q000494:pharmacology; D013752:Tetracycline / Q000494:pharmacology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D009268:Nalidixic Acid; D002701:Chloramphenicol; D013444:Sulfisoxazole; D002443:Ceftriaxone; D000667:Ampicillin; D013752:Tetracycline; D013307:Streptomycin