We’re Likely to See More Drug-Resistant Salmonella Outbreaks Like the One in California

Why? Salmonella-outbreak numbers are stable year-to-year, and drug resistance is increasing.

Salmonella species growing on X.L.D. agar.
National Journal
Brian Resnick
Oct. 9, 2013, 8:38 a.m.

Tain­ted chick­en from a Cali­for­nia-based sup­pli­er has led to sal­mon­ella in­fec­tions in 278 in­di­vidu­als across 17 states. That num­ber is likely to rise. Forty-two per­cent of those in­fec­ted have been hos­pit­al­ized, which is double the ex­pec­ted hos­pit­al­iz­a­tion rate for such an out­break, the Los Angeles Times re­ports. No deaths have been re­por­ted.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion is call­ing this a “com­plex out­break,” as four out of sev­en of the strains of bac­teria in­volved “ex­hib­ited drug res­ist­ance to one or more com­monly pre­scribed an­ti­bi­ot­ics.”

Amid a shuttered gov­ern­ment, CDC had to re­call work­ers and has lim­ited means of track­ing the out­break. Speak­ing to USA TODAY, Chris­toph­er Braden, dir­ect­or of food-borne ill­ness at the agency, said Pulsen­et, the agency’s com­pu­ter­ized sys­tem for de­tect­ing out­breaks, was shut down when the out­break oc­curred. “We were try­ing to do this without the auto­mat­ic sys­tem, and it was nearly im­possible,” Reyn­olds told the pa­per. Pulsen­et is now back on­line.

Not­with­stand­ing gov­ern­ment shut­down, it’s likely we’re go­ing to see more of these epis­odes. It’s due to a con­ver­gence of two trends.

1. Sal­mon­ella out­break num­bers are frus­trat­ingly stable.

“With sal­mon­ella, you see the num­bers just stag­nat­ing and in some years, you have seen the num­bers go up,” Eliza­beth Ha­gen, USDA’s un­der­sec­ret­ary for food safety, told me earli­er this year. She said it’s due, in part, to out­dated food-safety prac­tices.

“We’ve been do­ing things largely the same way since the 1950s,” she ex­plained. “We have an enorm­ous pro­por­tion of our re­sources fo­cused on look­ing at visu­al de­fects on the birds that don’t ac­tu­ally cor­rel­ate with food-safety risk.”

2. An­ti­bi­ot­ic res­ist­ance is grow­ing in sal­mon­ella.

In Septem­ber, CDC re­leased a com­pre­hens­ive re­port on the growth of an­ti­bi­ot­ic res­ist­ance in many strains of bac­teria. Drug-res­ist­ant bac­teria now ac­count for 2 mil­lion in­fec­tions and 23,000 deaths per year. Res­ist­ance is grow­ing in dis­eases that are only found in hos­pit­als, like the “night­mare bac­teria” CRE, but also in dis­eases that are found in every­day loc­a­tions, such as food pack­aging. “About 5 per­cent of non-typhoid­al sal­mon­ella tested by CDC are res­ist­ant to five or more types of drugs,” the agency found. But these per­cent­ages have been grow­ing since at least 1996, when it was al­most nonex­ist­ent.

(CDC)

CDC de­scribes the dis­ease in aw­ful terms: “Most per­sons in­fec­ted with sal­mon­ella bac­teria de­vel­op diarrhea, fever, and ab­dom­in­al cramps 12 to 72 hours after in­fec­tion. The ill­ness usu­ally lasts 4 to 7 days, and most per­sons re­cov­er without treat­ment.” And those with the drug-res­ist­ant vari­ety are more likely to end up in the hos­pit­al. In all, the CDC es­tim­ates, drug-res­ist­ant sal­mon­ella costs $365 mil­lion a year to treat.

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