Significance and Sources of Antimicrobial-Resistant Nontyphoidal Salmonella Infections in Humans in the United States

Abstract

Human Salmonella infections are common; most infections are self-limiting but severe disease may occur. Antimicrobial agents, while not essential for the treatment of Salmonella gastroenteritis, are essential for the treatment of thousands of patients each year with invasive infections. Fluoroquinolones and third-generation cephalosporins are the drugs-of-choice for invasive Salmonella infections in humans; alternative antimicrobial choices are limited by increasing antimicrobial resistance and less desirable pharmacodynamic properties. Little correlation is noted between the antimicrobial resistance patterns of isolates collected from persons with Salmonella infections and antimicrobial agents used for the treatment of Salmonella infections in humans. Direct evidence is available which demonstrates that antimicrobial resistant Salmonella result from the use of antimicrobial agents in food animals and these antimicrobial resistant Salmonella are subsequently transmitted to humans, usually through the food supply. Because of the adverse health consequences in humans and animals associated with the increasing prevalence of antimicrobial resistant Salmonella, there is an urgent need to emphasize nonantimicrobial strategies, such as improved sanitation and hygiene, to develop guidelines for the prudent usage of antimicrobial agents, and to restrict the use of fluoroquinolones in food animals to minimize the development of antimicrobial resistance and dissemination of antimicrobial resistant pathogens.