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ARTICLE |

Massive Outbreak of Antimicrobial-Resistant Salmonellosis Traced to Pasteurized Milk FREE

Caroline A. Ryan, MD; Mary K. Nickels, MS; Nancy T. Hargrett-Bean, PhD; Morris E. Potter, DVM; Tomy Endo, DrPH; Leonard Mayer, PhD; Carl W. Langkop, MSPH; Carol Gibson; Robert C. McDonald, MD; Richard T. Kenney, MD; Nancy D. Puhr; Paul J. McDonnell; Russell J. Martin, DVM, MPH; Mitchell L. Cohen, MD; Paul A. Blake, MD, MPH
[+] Author Affiliations

Reprint requests to Enteric Diseases Branch 1-5428, Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333 (Dr Ryan).


JAMA. 1987;258(22):3269-3274. doi:10.1001/jama.1987.03400220069039
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Two waves of antimicrobial-resistant Salmonella typhimurium infections in Illinois totaling over 16000 culture-confirmed cases were traced to two brands of pasteurized 2% milk produced by a single dairy plant. Salmonellosis was associated with taking antimicrobials before onset of illness. Two surveys to determine the number of persons who were actually affected yielded estimates of 168791 and 197581 persons, making this the largest outbreak of salmonellosis ever identified in the United States. The epidemic strain was easily identified because it had a rare antimicrobial resistance pattern and a highly unusual plasmid profile; study of stored isolates showed it had caused clusters of salmonellosis during the previous ten months that may have been related to the same plant, suggesting that the strain had persisted in the plant and repeatedly contaminated milk after pasteurization.

(JAMA 1987;258:3269-3274)

REFERENCES

Lederberg J, Lederberg EM:  Replica plating and indirect selection of bacterial mutants . J Bacteriol 1952;;63:399-406.
Bauer A, Kirby WMM, Sherris JC, et al:  Antibiotic susceptibility testing by standard single disk method . Am J Clin Pathol 1966;;45:493-496.
Birnboim HC, Doly J:  A rapid alkaline extraction procedure for screening recombinant plasmid DNA . Nucleic Acids Res 1979;;7:1513-1523.
Meyers JA, Sanchez D, Elwell LP, et al:  Simple agarose gel electrophoretic method for the identification and characterization of plasmid deoxyribonucleic acid . J Bacteriol 1976;;127:1529-1537.
Spika JS, Waterman SH, Soo Hoo G, et al:  Chloramphenicol-resistant Salmonella newport traced through hamburger to dairy farms: A major persisting source of human salmonellosis in California . N Engl J Med 1987;;316:565-570.
Holmberg SD, Osterholm MT, Senger KA, et al:  Drug-resistant Salmonella from animals fed antimicrobials . N Engl J Med 1984;;311:617.
Holmberg SD, Wells JG, Cohen ML:  Animal-to-man transmission of antimicrobial-resistant Salmonella: Investigation of US outbreaks, 1971-1983 . Science 1984;;225:833.
Tacket CO, Dominguez LB, Fisher HJ, et al:  An outbreak of multiple-drug-resistant Salmonella enteritis from raw milk . JAMA 1985;;253:2058.
Riley LW, Cohen ML, Seals JE, et al:  Importance of host factors in human salmonellosis caused by multiresistant strains of Salmonella . J Infect Dis 1984;;149:878.
Aserkoff B, Schroeder SA, Brachman PS:  Salmonellosis in the United States—a five-year review . Am J Epidemiol 1970;;92:13.

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Lederberg J, Lederberg EM:  Replica plating and indirect selection of bacterial mutants . J Bacteriol 1952;;63:399-406.
Bauer A, Kirby WMM, Sherris JC, et al:  Antibiotic susceptibility testing by standard single disk method . Am J Clin Pathol 1966;;45:493-496.
Birnboim HC, Doly J:  A rapid alkaline extraction procedure for screening recombinant plasmid DNA . Nucleic Acids Res 1979;;7:1513-1523.
Meyers JA, Sanchez D, Elwell LP, et al:  Simple agarose gel electrophoretic method for the identification and characterization of plasmid deoxyribonucleic acid . J Bacteriol 1976;;127:1529-1537.
Spika JS, Waterman SH, Soo Hoo G, et al:  Chloramphenicol-resistant Salmonella newport traced through hamburger to dairy farms: A major persisting source of human salmonellosis in California . N Engl J Med 1987;;316:565-570.
Holmberg SD, Osterholm MT, Senger KA, et al:  Drug-resistant Salmonella from animals fed antimicrobials . N Engl J Med 1984;;311:617.
Holmberg SD, Wells JG, Cohen ML:  Animal-to-man transmission of antimicrobial-resistant Salmonella: Investigation of US outbreaks, 1971-1983 . Science 1984;;225:833.
Tacket CO, Dominguez LB, Fisher HJ, et al:  An outbreak of multiple-drug-resistant Salmonella enteritis from raw milk . JAMA 1985;;253:2058.
Riley LW, Cohen ML, Seals JE, et al:  Importance of host factors in human salmonellosis caused by multiresistant strains of Salmonella . J Infect Dis 1984;;149:878.
Aserkoff B, Schroeder SA, Brachman PS:  Salmonellosis in the United States—a five-year review . Am J Epidemiol 1970;;92:13.
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