Abstract
BackgroundNontyphoidal Salmonella (NTS) is an important foodborne pathogen worldwide. We investigated a 2018 outbreak of highly antimicrobial-resistant Salmonella enterica serotype Goldcoast in northern Taiwan.MethodsWe collected 30 clinical isolates and 2 meat isolates from this outbreak in New Taipei and Taoyuan, Taiwan in 2018. The clinical manifestations and the treatment of the patients were reviewed. To trace the source, we examined NTS isolated from food samples collected from the markets in northern Taiwan. All of the isolates along with an additional human isolate from China were sequenced and compared with the sequences of Salmonella Goldcoast reported by other countries.ResultsThe outbreak involved 14 pediatric patients (<5 years old) and 16 adults (36 to 83 years old). Nine patients with invasive or severe disease required carbapenem treatment. The MIC90 of ceftriaxone and ciprofloxacin for the outbreak isolates was >256 μg/mL and 1 μg/mL, respectively, and a conjugative 278-kilobase plasmid harboring blaCTX-M-55 and qnrS1 contributed towards the resistance. Whole-genome sequencing revealed a clonal relationship among the outbreak isolates and the 2 collected from the retail meats. The outbreak clone was phylogenetically close to that of Salmonella Goldcoast reported in the United Kingdom, Poland, and China, whereas similar resistance plasmids were found in China and Cambodia.ConclusionsThe clinical spectrum of the high-level cephalosporin-resistant Salmonella Goldcoast is similar to that of other NTS serotypes, but severe cases required carbapenem treatment. The study confirmed the emergence of a highly antimicrobial-resistant clone of Salmonella Goldcoast, highlighting the importance of surveillance for food safety.
Highlights
MethodsWe collected 30 clinical isolates and 2 meat isolates from this outbreak in New Taipei and Taoyuan, Taiwan in 2018
The clinical spectrum of the high-level cephalosporin-resistant Salmonella Goldcoast is similar to that of other Nontyphoidal Salmonella (NTS) serotypes, but severe cases required carbapenem treatment
It has been estimated that there are more than 90 million cases of gastroenteritis due to NTS globally each year, with 85% of those cases being linked to foods consumed [3]
Summary
We collected 30 clinical isolates and 2 meat isolates from this outbreak in New Taipei and Taoyuan, Taiwan in 2018. We examined NTS isolated from food samples collected from the markets in northern Taiwan. Chang Gung Memorial Hospital (CGMH) is a main referral hospital for cities in northern Taiwan, including Taipei, New Taipei, and Taoyuan. The population in this region is approximately 7 million. In 2018, 30 culture-confirmed infections were found to have been caused by Salmonella Goldcoast (Figure 1A; Supplementary Table 1). An outbreak investigation was conducted, including an analysis of the following: clinical manifestations, treatments, and patient outcomes; bacterial source tracing; and microbiological and genomic examinations of all isolates of Salmonella Goldcoast. All statistical analyses were 2-sided, and significance was set at P < .05
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