2018 Salmonella Infections Linked to Raw Chicken Products – Advice to Clinicians
Final Update
Posted February 21, 2019 at 3:00 PM ET
This investigation is over. Illnesses could continue because this Salmonella strain appears to be widespread in the chicken industry. People can get a Salmonella infection from eating undercooked chicken or touching raw chicken, including packaged raw pet food. Always cook chicken thoroughly. Get CDC’s tips to prevent foodborne illness from chicken.
Most patients with Salmonella diarrheal illness require only supportive care, including fluid replacement. However, antibiotic treatment is needed for certain patients, such as those with severe diarrhea, extra-intestinal infection (for example, urinary tract infection), or risk factors for invasive disease (1, 2). Common first-line oral antibiotics for Salmonella infection are fluoroquinolones (for adults) and azithromycin (for children). Ceftriaxone is an alternative first-line treatment agent.
The strain of Salmonella serotype Infantis in this outbreak is multidrug-resistant. It is not susceptible to the common first-line antibiotics ciprofloxacin and ceftriaxone, and is not susceptible to some other antibiotics (see below). Many patients in this outbreak had urinary tract infections (urine cultures yielded Salmonella Infantis).
If you are considering antibiotic treatment for a patient with known or suspected Salmonella infection, keep in mind the following:
Diagnosis
- Obtain appropriate specimens and perform cultures (for example, stool, urine, blood).
- Order antimicrobial susceptibility testing of the Salmonella isolate to guide the choice of antibiotic.
- If Salmonella is identified by a culture-independent diagnostic test (CIDT), request that a culture be done on that positive specimen to obtain an isolate for antimicrobial susceptibility testing (this is called a reflex culture).
Treatment
- Choose an antibiotic based on the results of antimicrobial susceptibility testing, whenever possible.
- The strain of Salmonella Infantis in this outbreak is NOT susceptible* to first-line antibiotics, including ciprofloxacin and ceftriaxone. It is also not susceptible* to ampicillin, chloramphenicol, fosfomycin, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfisoxazole, trimethoprim-sulfamethoxazole, and tetracycline.
- Isolates tested were susceptible* to azithromycin, amoxicillin-clavulanic acid, and meropenem.
- Consider consulting an infectious disease specialist for management of patients with multidrug-resistant or complicated Salmonella infection.
- Remind patients about careful hand hygiene after using the bathroom and before preparing meals, to prevent transmission to others.
- Note that some health departments require negative stool tests before a person can return to work in a setting with higher than usual risk of transmission to others, such as food preparation, childcare, or healthcare.
Further recommendations for treatment of Salmonella infection can be found on CDC’s Salmonella website.
*The term “susceptible” is based on clinical interpretations published by the Clinical and Laboratory Standards Institute for these bacteria or other related enteric bacteria (3)
References
- 2017 IDSA Clinical Practice Guidelines for the Treatment and Management of Infectious Diarrhea
- Red Book (Report of the Committee on Infectious Diseases, American Academy of Pediatrics)
- CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020
