Multiresistant Salmonella enterica serovar 4,[5],12:i:- in Europe: a new pandemic strain?

K L Hopkins,S A Granier,E J Threlfall,C Lucarelli,D J Mevius,M C Porrero,B Guerra,A Jakubczak,M Kirchner

doi:10.2807/ese.15.22.19580-en

K L Hopkins, S A Granier + Show 7 more

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A marked increase in the prevalence of S. enterica serovar 4,[5],12:i:- with resistance to ampicillin, streptomycin, sulphonamides and tetracyclines (R-type ASSuT) has been noted in food-borne infections and in pigs/pig meat in several European countries in the last ten years. One hundred and sixteen strains of S. enterica serovar 4,[5],12:i:- from humans, pigs and pig meat isolated in England and Wales, France, Germany, Italy, Poland, Spain and the Netherlands were further subtyped by phage typing, pulsed-field gel electrophoresis and multilocus variable number tandem repeat analysis to investigate the genetic relationship among strains. PCR was performed to identify the fljB flagellar gene and the genes encoding resistance to ampicillin, streptomycin, sulphonamides and tetracyclines. Class 1 and 2 integrase genes were also sought. Results indicate that genetically related serovar 4,[5],12:i:- strains of definitive phage types DT193 and DT120 with ampicillin, streptomycin, sulphonamide and tetracycline resistance encoded by blaTEM, strA-strB, sul2 and tet(B) have emerged in several European countries, with pigs the likely reservoir of infection. Control measures are urgently needed to reduce spread of infection to humans via the food chain and thereby prevent the possible pandemic spread of serovar 4,[5],12:i:- of R-type ASSuT as occurred with S. Typhimurium DT104 during the 1990s.

Highlights

Infections with Salmonella enterica account for the second largest burden of bacterial gastrointestinal disease in the European Union (EU) [1]
In recent years there has been an overall decline in the level of resistance in serovar Typhimurium in several European countries as a result of a reduction in the number of isolates of penta-resistant DT104 [14]
All isolates belonged to phage type U302. These isolates were classed as monophasic variants of serovar Typhimurium due to presence of an IS2000 fragment located in a Typhimurium-specific location within the fliB-fliA intergenic region and amplification of a Typhimurium DT104- and U302-specific region [3]

Summary

Introduction

Infections with Salmonella enterica account for the second largest burden of bacterial gastrointestinal disease in the European Union (EU) [1]. The majority of Salmonella infections result in mild, self-limited illness and may not require treatment with antimicrobials. Treatment with an appropriate antimicrobial can be life-saving in immunocompromised patients and in invasive disease, such as Salmonella bacteraemia and meningitis. Despite identification of more than 2,500 different serovars, the majority of cases of human infection are caused by a limited number of serovars. Most serovars are biphasic and express two distinct flagellar antigens encoded by fliC (phase-1 flagellin) and fljB (phase-2 flagellin). Some serovars fail to express either the phase-1 or phase-2 flagellar antigen, are classed as monophasic

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