Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 5, Number 1—February 1999
Letter

Extended-Spectrum Beta-Lactamase-Producing Salmonella Enteritidis in Trinidad and Tobago

On This Page
Article Metrics
12
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Salmonella Enteritidis, a predominantly localized pathogen of the human gastrointestinal tract, can become invasive in very young, very old, malnourished, and immunocompromised patients. In recent years, S. Enteritidis has emerged as a major intestinal pathogen in Trinidad and Tobago (population 1.2 million); in 1997, S. Enteritidis caused 79 (66%) of 119 culture-confirmed salmonella infections, in contrast to 18 (18%) of 99, 48 (47%) of 102, and 107 (61%) of 178 in 1994, 1995, and 1996, respectively. Increased incidence of S. Enteritidis infections has been reported worldwide (1,2). Of 216 human S. Enteritidis isolates tested for antimicrobial susceptibility between 1994 and 1996 in Trinidad, none were resistant to cephalosporins, aminoglycosides, ampicillin, trimethoprim-sulphamethoxazole, chloramphenicol, and norfloxacin/ciprofloxacin by the Kirby-Bauer disk diffusion method, which uses the National Committee for Clinical Laboratory Standards (NCCLS) breakpoints (3).

Here we report an unusual isolate of S. Enteritidis resistant to all penicillins and cephalosporins—including third-generation cephalosporins, gentamicin, tobramicin, and trimethoprim-sulphamethoxazole—by the Kirby-Bauer disk diffusion method. Amoxicillin-clavulanate and piperacillin-tazobactam disks gave zone sizes of 15 mm and 19 mm, respectively, which are classified as intermediate in the NCCLS guidelines. This isolate was recovered from the blood culture of a febrile, nonneutropenic patient with multiple myeloma on two occasions 24 hours apart in March 1998. The isolate was sensitive only to ofloxacin and imipenem. Admitted to the hospital with compressed fracture of the spine for physiotherapy in December 1997, the patient had several febrile episodes and received several courses of multiple empirically prescribed antibiotics (cefotaxime, gentamicin, and piperacillin). The patient had not traveled abroad during the previous 6 months.

Because cephalosporin resistance in salmonellae has not been reported before in the Caribbean, we investigated the mechanism behind this third-generation cephalosporin resistance further. Using amoxicillin-clavulanate in combination with ceftazidime, ceftriaxone, and aztreonam, we performed the double disk synergy test to determine whether this strain was an extended-spectrum beta-lactamase producer as described elsewhere (3); augmentation of the zone at the junction of amoxicillin-clavulanate and aztreonam/ceftriaxone/ceftazidime zones confirmed that indeed it was.

In the past few years, third-generation cephalosporin resistance in S. Enteritidis has been described in Europe (4), the United States (5), Turkey (6), India (7,8), and Argentina (9). Few reports exist of extended-spectrum beta-lactamasemediated third-generation cephalosporin resistance in Salmonella spp. To our knowledge, this is the first report of this type of resistance among S. Enteritidis in the Caribbean. This patient was treated with ciprofloxacin for 1 week; subsequent blood cultures were negative.

This unusual isolate highlights the need to establish an antimicrobial resistance surveillance network for Salmonella isolates, including S. Enteritidis, to monitor the trends and new types of resistance mechanisms in the Caribbean. An epidemiologic study of S. Enteritidis infections is being planned to describe the extent of the problem and to define risk factors and vehicles of human infections in three Caribbean countries, including Trinidad and Tobago.

Top

B.P. Cherian*, Nicole Singh*, W. Charles*, and P. Prabhakar*†
Author affiliations: *Port of Spain General Hospital, Port of Spain, Trinidad;; †Caribbean Epidemiology Center (CAREC), Port of Spain, Trinidad

Top

References

  1. Centers for Disease Control and Prevention. Salmonella surveillance annual tabulation summary, 1993-1995. Atlanta: U.S. Department of Health and Human Services; 1997.
  2. Communicable Disease Surveillance Center. Salmonella in humans: PHLS salmonella data set, England and Wales, 1981-1996. London: The Center; 1997.
  3. National Committee for Clinical Laboratory Standards. Performance standards for the anti-microbial disk susceptibility tests for bacteria that grow aerobically. Approved standard M7 - A4. Villanova (PA): The Committee; 1997.
  4. Fantin  B, Pangon  B, Potel  G, Caron  F, Vallee  E, Vallois  JM, Activity of sulbactam in combination with ceftriaxone in vitro and in experimental endocarditis caused by Escherichia coli producing SHV-2-like beta- lactamases. Antimicrob Agents Chemother. 1990;34:5816.PubMedGoogle Scholar
  5. Morosini  MI, Blasquez  J, Negri  MC, Canton  R, Loza  E, Baquero  F. Characterization of a nosocomial outbreak involving an epidemic plasmid encoding for TEM-27 in Salmonella enteritidis. J Infect Dis. 1996;174:101520.PubMedGoogle Scholar
  6. Herikstad  H, Hayes  PS, Hogan  J, Floyd  P, Snyder  L, Augulo  FJ. Ceftriaxone resistant Salmonella in the United States. Pediatr Infect Dis J. 1997;16:9045. DOIPubMedGoogle Scholar
  7. Vahaboglu  H, Hall  LM, Mulazimoglu  L, Dodanli  S, Yildirim  I, Livermore  DM. Resistance extended spectrum cephalosporins caused by PER-1 beta lactamase, in Salmonella typhimurium in Istanbul, Turkey. J Med Microbiol. 1995;43:2949. DOIPubMedGoogle Scholar
  8. Kumar  A, Nath  G, Bhatia  BD, Bhargava  V, Loiwal  V. An outbreak of multidrug resistant Salmonella typhimurium in a nursery. Indian Pediatr. 1995;980:8815.
  9. Wattal  C, Kaul  V, Chigh  TD, Kler  N, Bhandari  SK. An outbreak of multi drug resistant Salmonella typhimurium in Delhi (India). Indian J Med Res. 1994;100:2667.PubMedGoogle Scholar
  10. Rossi  A, Lopardo  H, Woloj  M, Picanet  A, Marino  M, Galds  M, Non-typhoid Salmonella spp. resistant to cefotaxime. J Antimicrob Chemother. 1995;36:697702. DOIPubMedGoogle Scholar

Top

Cite This Article

DOI: 10.3201/eid0501.990128

Related Links

Top

Table of Contents – Volume 5, Number 1—February 1999

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Page created: December 10, 2010
Page updated: December 10, 2010
Page reviewed: December 10, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external