Two outbreaks of multidrug-resistant Salmonella serotype Typhimurium DT104 infections linked to raw-milk cheese in northern California
Two outbreaks of multidrug-resistant Salmonella serotype Typhimurium DT104 infections linked to raw-milk cheese in northern California
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DOI：
10.1001/jama.281.19.1805
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发表时间：
1999-05-19
影响因子：
120.7
通讯作者：
Vugia, DJ
中科院分区：
文献类型：
--
作者：
Cody, SH;Abbott, SL;Vugia, DJ
背景鼠伤寒沙门氏菌血清型104(DT104)对5种药物(氨苄西林、氯霉素、链霉素、磺胺和四环素)具有耐药性，已成为美国最常见的多重耐药沙门氏菌菌株，然而，该菌株引起的疾病尚未与美国的来源确定相关。目的确定两次鼠伤寒沙门氏菌暴发的来源。环境和实验室调查。背景和参与者这项病例对照研究包括加利福尼亚州北部2个邻近县的居民，他们感染了哥本哈根鼠伤寒沙门氏菌暴发株，并与年龄匹配的对照组。为了加强监测，将1例病例定义为接触新鲜墨西哥式奶酪的人感染了鼠伤寒沙门氏菌。主要结果衡量了感染的危险因素和涉案食物的来源。结果1次暴发于1997年2月达到高峰；31例患者经培养证实‘感染了哥本哈根沙门氏菌变种，其分离株显示脉冲场凝胶电泳(PFGE)图谱难以区分。暴发株为噬菌体DT104，耐药模式为5-型。16个病例和25个对照被纳入病例对照研究；16个哥本哈根变种沙门氏菌病例中有15个病例报告食用了未经巴氏灭菌的墨西哥式奶酪，而24个匹配对照中有14个病例报告食用了未经巴氏灭菌的墨西哥风味奶酪(匹配优势比为7.9%，95%可信区间为1.1-354.9)。加强监测发现了第二次疫情，疫情在1997年4月达到高峰，由一种非哥本哈根变种的鼠伤寒沙门氏菌引起。在第二次暴发期间，从79名食用街头小贩新鲜墨西哥式奶酪的人以及奶酪样品和生奶中分离出鼠伤寒沙门氏菌。牛奶分离株的PFGE图谱符合从患者身上回收的3种图谱中的1种，所有菌株均为噬菌体DT104b型，并具有5种耐药图谱。结论原料奶产品存在多重耐药鼠伤寒沙门氏菌DT104感染的风险。
Context Salmonella serotype Typhimurium definitive type 104 (DT104), with resistance to 5 drugs (ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline), has emerged as the most common multidrug-resistant Salmonella strain in the United States, However, illnesses resulting from this strain have not been associated definitively with a source in this country.Objective To determine the source of 2 outbreaks of Salmonella Typhimurium DT104.Design Matched case-control study conducted between March 24 and April 5, 1997 (outbreak 1), enhanced surveillance for new cases dating from February 1, 1997 (outbreak 2), and environmental and laboratory investigations.Setting and Participants The case-control study included residents of 2 adjacent counties in northern California infected with the outbreak strain of Salmonella Typhimurium var Copenhagen and age-matched controls. For enhanced surveillance, a case was defined as Salmonella Typhimurium infection in a person exposed to fresh Mexican-style cheese.Main Outcome Measures Risk factors for infection and source of implicated food.Results Outbreak 1 peaked in February 1997; 31 patients were confirmed by culture as' having Salmonella Typhimurium var Copenhagen infection, isolates of which showed indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. The outbreak strain was phage type DT104 with the 5-drug resistance pattern. Sixteen cases and 25 controls were enrolled in the case-control study; 15 of 16 Salmonella Typhimurium var Copenhagen cases compared with 14 of 24 matched controls reported eating unpasteurized Mexican-style cheese, (matched odds ratio, 7.9; 95% confidence interval, 1.1-354.9). Enhanced surveillance uncovered outbreak 2, which peaked in April 1997 and was caused by a non-Copenhagen variant of Salmonella Typhimurium. During outbreak 2, Salmonella Typhimurium was isolated from 79 persons who ate fresh Mexican-style cheese from street vendors and from cheese samples and raw milk. The PFGE pattern of the milk isolate matched 1 of the 3 patterns recovered from patients; all strains were phage type DT104b with the 5-drug resistance pattern.Conclusion Raw-milk products pose a risk for multidrug-resistant Salmonella Typhimurium DT104 infections.