Multistate Outbreak of Multidrug-Resistant Salmonella Heidelberg Infections Linked to Contact with Dairy Calves

PUBLISHED: Nov 17, 2017
Relevant to: Ambulatory Care, Critical Access Hospitals, Hospitals, Medical Office/Clinic

The US Centers for Disease Control and Prevention (CDC) and the U.S. Department of Agriculture's Animal and Plant Inspection Service (USDA) are investigating a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections linked to contact with dairy calves. A total of 54 people have been reported from 15 states.

According to the CDC, clinicians should consider multidrug-resistant (MDR) Salmonella Heidelberg infection in the differential diagnosis of patients with exposure to cattle, farms, or farm workers and symptoms compatible with salmonellosis (e.g., diarrhea, fever, and abdominal cramps).

Guidance for clinicians whose patients have suspected or confirmed Salmonella Heidelberg infection related to this outbreak:

  • Testing
    • Obtain a culture (stool or blood, as indicated by symptoms and signs).
    • Request antimicrobial susceptibility testing.
  • Treatment
    • Most patients with nontyphoidal Salmonella do not require antibiotic treatment (exceptions may include patients <6 months, >50 years, and those who are immunocompromised or severely ill.
    • If treatment is indicated and MDR Salmonella Heidelberg infection is suspected, clinicians should begin treatment with azithromycin until susceptibility results of the patient’s isolate are available.
  • Follow up
    • Obtain follow-up stool cultures for patients who have culture-confirmed MDR Salmonella Heidelberg and who are:
      • Food handlers
      • Health care workers
      • Childcare workers or attendees
  • Patient counseling
    • Counsel patients to follow prevention practices. Key messages for counseling patients with salmonellosis:
      • Wash hands carefully with soap after going to the bathroom.
      • Don’t prepare food for others while ill. After you recover, wash hands carefully with soap before preparing food for others.
      • Before returning to work or childcare, these patients should have two consecutive negative stool cultures taken at least 24 hours apart and at least 48 hours after resolution of symptoms.

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