Re‐emergence of the Progenitors of a Multidrug‐Resistant Outbreak Strain ofMycobacterium tuberculosisamong the Post‐Outbreak Case Patients

SUMMARYOn 23 May 2011, CDC identified a multistate cluster of Salmonella Heidelberg infections and two multidrug-resistant (MDR) isolates from ground turkey retail samples with indistinguishable pulsed-field gel electrophoresis patterns. We defined cases as isolation of outbreak strains in persons with illness onset between 27 February 2011 and 10 November 2011. Investigators collected hypothesis-generating questionnaires and shopper-card information. Food samples from homes and retail outlets were collected and cultured. We identified 136 cases of S. Heidelberg infection in 34 states. Shopper-card information, leftover ground turkey from a patient's home containing the outbreak strain and identical antimicrobial resistance profiles of clinical and retail samples pointed to plant A as the source. On 3 August, plant A recalled 36 million pounds of ground turkey. This outbreak increased consumer interest in MDR Salmonella infections acquired through United States-produced poultry and played a vital role in strengthening food safety policies related to Salmonella and raw ground poultry.

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An outbreak of multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium, DT104L linked to dried anchovy in Singapore

Epidemiology and Infection ◽

10.1017/s0950268801006367 ◽

2002 ◽

Vol 128 (1) ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

M. L. LING ◽

K. T. GOH ◽

G. C. Y. WANG ◽

K. S. NEO ◽

T. CHUA

Keyword(s):

Salmonella Enterica ◽

Multidrug Resistant ◽

Common Source ◽

Stepwise Logistic Regression ◽

Reference Laboratory ◽

Outbreak Strain ◽

Source Of Infection ◽

Confounding Variables ◽

Control Study ◽

Structured Questionnaire

Multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium DT104L was first reported in Singapore from mid-July to mid-October 2000. Salmonella strains isolated from clinical laboratories were submitted to a reference laboratory for serotyping, phage-typing and pulsed-field gel electrophoresis (PFGE) using XbaI restriction endonuclease. An epidemiological investigation was conducted to determine the source of infection and mode of transmission using a structured questionnaire. A total of 33 cases involving mainly infants and toddlers were detected in the 3-month long outbreak. The outbreak strain was of the R-type ACGSTSu, i.e. resistant to ampicillin, chloramphenicol, gentamicin, streptomycin, tetracycline and sulphonamide. PFGE showed all isolates had an indistinguishable pattern, indicating a common source of infection. Consumption of imported dried anchovy was found to be the vehicle of transmission after adjusting for all confounding variables in the case-control study using stepwise logistic regression (OR 25·6; 95% CI 3·9–167·9; P = 0·001). Imported dried seafood should be properly processed, packed, labelled, and thoroughly cooked to prevent transmission of multidrug-resistant S. Typhimurium.

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Utility of whole-genome sequencing during an investigation of multiple foodborne outbreaks of Shigella sonnei

Epidemiology and Infection ◽

10.1017/s0950268821000509 ◽

2021 ◽

Vol 149 ◽

Author(s):

Amy F. W. Mikhail ◽

Monique Pereboom ◽

Lara Utsi ◽

Jeremy Hawker ◽

Jonathan Lighthill ◽

...

Keyword(s):

Whole Genome Sequencing ◽

Genome Sequencing ◽

Middle Eastern ◽

Epidemiological Data ◽

Multidrug Resistant ◽

Food Samples ◽

Shigella Sonnei ◽

Whole Genome ◽

Contributing Factors ◽

Outbreak Strain

Abstract In April 2018, Public Health England was notified of cases of Shigella sonnei who had eaten food from three different catering outlets in England. The outbreaks were initially investigated as separate events, but whole-genome sequencing (WGS) showed they were caused by the same strain. The investigation included analyses of epidemiological data, the food chain and microbiological examination of food samples. WGS was used to determine the phylogenetic relatedness and antimicrobial resistance profile of the outbreak strain. Ultimately, 33 cases were linked to this outbreak; the majority had eaten food from seven outlets specialising in Indian or Middle Eastern cuisine. Five outlets were linked to two or more cases, all of which used fresh coriander although a shared supplier was not identified. An investigation at one of the venues recorded that 86% of cases reported eating dishes with coriander as an ingredient or garnish. Four cases were admitted to hospital and one had evidence of treatment failure with ciprofloxacin. Phylogenetic analysis showed that the outbreak strain was part of a wider multidrug-resistant clade associated with travel to Pakistan. Poor hygiene practices during cultivation, distribution or preparation of fresh produce are likely contributing factors.

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Four decades of transmission of a multidrug-resistant Mycobacterium tuberculosis outbreak strain

Nature Communications ◽

10.1038/ncomms8119 ◽

2015 ◽

Vol 6 (1) ◽

Cited By ~ 110

Author(s):

Vegard Eldholm ◽

Johana Monteserin ◽

Adrien Rieux ◽

Beatriz Lopez ◽

Benjamin Sobkowiak ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Multidrug Resistant ◽

Outbreak Strain

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Differential carriage of virulence-associated loci in the New Zealand Rangipo outbreak strain ofMycobacterium tuberculosis

Infectious Diseases ◽

10.1080/23744235.2017.1330553 ◽

2017 ◽

Vol 49 (9) ◽

pp. 680-688 ◽

Cited By ~ 8

Author(s):

Sanjay S. Gautam ◽

Micheál Mac Aogáin ◽

James E. Bower ◽

Indira Basu ◽

Ronan F. O’Toole

Keyword(s):

New Zealand ◽

Outbreak Strain ◽

Ofmycobacterium Tuberculosis ◽

Strain Ofmycobacterium

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Characterization of a Multidrug-Resistant Salmonella enterica Serovar Heidelberg Outbreak Strain in Commercial Turkeys: Colonization, Transmission, and Host Transcriptional Response

Frontiers in Veterinary Science ◽

10.3389/fvets.2017.00156 ◽

2017 ◽

Vol 4 ◽

Cited By ~ 9

Author(s):

Bradley L. Bearson ◽

Shawn M. D. Bearson ◽

Torey Looft ◽

Guohong Cai ◽

Daniel C. Shippy

Keyword(s):

Salmonella Enterica ◽

Transcriptional Response ◽

Multidrug Resistant ◽

Outbreak Strain

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Control of an Outbreak of Multidrug-ResistantAcinetobacter baumannii-calcoaceticusColonization and Infection in an Intensive Care Unit (ICU) Without Closing the ICU or Placing Patients in Isolation

Infection Control and Hospital Epidemiology ◽

10.1086/507011 ◽

2006 ◽

Vol 27 (7) ◽

pp. 654-658 ◽

Cited By ~ 66

Author(s):

Mark Wilks ◽

Anne Wilson ◽

Simon Warwick ◽

Elizabeth Price ◽

Daniel Kennedy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Multidrug Resistant ◽

Control Measures ◽

Outbreak Strain ◽

Suction System ◽

Infection Control Measures ◽

Large Tertiary Care ◽

Cleaning Equipment

Objective.To describe the control of multidrug-resistantAcinetobacter baumannii-calcoaceticus(MDRABC) colonization and infection in an intensive care unit (ICU).Setting.An 18-bed ICU in a large tertiary care teaching hospital in London.Interventions.After recognition of the outbreak, a range of infection control measures were introduced over several months that were primarily aimed at reducing environmental contamination with the outbreak strain. Strategies included use of a closed tracheal suction system for all patients receiving mechanical ventilation, use of nebulized colistin for patients with evidence of mild to moderate ventilator-associated pneumonia, improved availability of alcohol for hand decontamination, and clearer designation of responsibilities and strategies for cleaning equipment and the environment in the proximity of patients colonized or infected with MDRABC.Results.The outbreak lasted from June 2001 through November 2002 and involved 136 new cases of MDRABC infection or colonization. The number of newly diagnosed cases per month reached a maximum of 15 in February 2002, and the number of new cases slowly decreased over the next 9 months.Conclusion.This outbreak was controlled by emphasizing the control of environmental reservoirs and did not require recourse to ward closure or placement of affected patients in isolation.

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Nosocomial Outbreak of Infection With Multidrug-ResistantAcinetobacter baumanniiin a Medical Center in Taiwan

Infection Control and Hospital Epidemiology ◽

10.1086/592704 ◽

2009 ◽

Vol 30 (1) ◽

pp. 34-38 ◽

Cited By ~ 33

Author(s):

Hui-Lan Chang ◽

Chih-Hsin Tang ◽

Yuan-Man Hsu ◽

Lei Wan ◽

Ya-Fen Chang ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Medical Center ◽

Random Amplified Polymorphic Dna ◽

Invasive Procedure ◽

Multidrug Resistant ◽

University Hospital ◽

Nosocomial Outbreak ◽

Outbreak Strain ◽

Rapd Fingerprinting

Objective.To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR)Acinetobacter baumanniiin the intensive care units at China Medical University Hospital in Taiwan.Design.Prospective outbreak investigation.Setting.Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.Methods.Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive procedure, were enrolled in our study. Ninety-fourA. baumanniistrains were isolated from the patients or the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006. We characterizedA. baumanniiisolates by use of repetitive extragenic palindromic–polymerase chain reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical characteristics of the source patients and the environment were noted.Results.All of the clinical isolates were determined to belong to the same epidemic strain of MDRA. baumanniiby the use of antimicrobial susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had undergone an invasive procedure. The outbreak strain was also isolated from the environment and the equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units found that both the patients and the environment harbored the same outbreak strain.Conclusion.The outbreak strain ofA. baumanniimight have been transmitted among medical staff and administration equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing recurrent outbreaks of nosocomial infection with MDRA. baumannii.

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