Although Thanksgiving is over, one pathogen that may still linger in our bellies and cause us some trouble even after that last piece of turkey is gone is Salmonella. This motile, Gram negative bacteria can cause a variety of illnesses, ranging from mycotic and endovascular infections (especially within aneurysms and weakened blood vessel walls), osteomyelitis among individuals with defective red blood cell production, relentless diarrhea, and typhoid fever in returning travelers. Although most notoriously associated with the consumption of under-cooked bird products (including that turkey you recently ate), this bacterium can also be seen among reptiles– hence your pet lizard, snake or iguana may in fact be more dangerous than you think!

What’s also concerning is that certain subtypes of non-typhoid Salmonella have been becoming more resistant since 2011, according to the CDC.  In fact, resistance issues have been noted among Salmonella species since the 1990’s, with a sharp rise noted during the turn of the century. Of particular note, Salmonella enteriditis–the species that causes diarrhea–accounted for 36% of Salmonella infections that were resistant to nalidixic acid, the prototypical flouroquinolone drug. The flouroquinolones are often used as first line therapy for this infection, and has been critical in preventing serious complications from occurring in individuals who were unfortunate enough to develop salmonellosis. Other subtypes, including S. newport, S. dublin, D. typhimurium and S. heidelberg, accounted for the majority of Salmonella isolates that were found to be resistant to ceftriaxone, another antibiotic commonly used to treat this organism. One particular type of Salmonella, subtype:  I4, [5], 12:i:, has shown multi-drug resistance in 46% of isolates, compared to just 18% that were noted in 2011.

All this underscores the increasing trend of multidrug resistant organisms that we are seeing on a day-to-day basis, both in the U.S and worldwide. Most recently, the CDC has been tracking a multi-state outbreak of multi-drug resistant Salmonella  that appears to have spread through dairy cattle. According to this report, 21 individuals have developed resistant Salmonella infection between 8 states, resulting in 8 hospitalizations and (fortunately) no deaths as of yet.

In situations such as these, we are again reminded that the health of humans is often intrinsically linked to the health of other animals and the environment that they are in. Minimizing the antibiotic exposure we provide our livestock and keeping livestock away from the crops that we consume (so that their feces cannot contaminate them) is crucial in preventing the spread of infection and reducing the risk of multi-drug resistant bacteria. Proper handling and processing of meat, dairy, and other foods coming from these animals is also essential in preventing infections from occurring. Lastly, minimizing our own antibiotic use, and practicing responsible antibiotic stewardship as physicians (not treating that cold or sinus infection that is nearly always viral), along with minimizing nosocomial exposure whenever possible also goes a long way in preventing multidrug resistant bacteria from forming.  Small steps such as these may prove to be the best weapon in the fight against the development of drug resistant bacteria in the future.

[NS]

REFERENCES:

Su, Lin-Hui, et al. Antimicrobial Resistance in Non-typhoid  Salmonella Serotype: A Global Challenge.  Clin Infect Dise (2004), 39 (4):546-551

CDC Outbreak  Reported  November 28, 2016