International Salmonella Typhimurium DT104 infections, 1992-2001

Abstract

The incidence of multidrug-resistant (MDR) Salmonella Typhimurium infections in humans, and in particular MDR definitive phage type 104 (DT104), has increased substantially in many countries in the last 2 decades, often associated with increased illness. To examine the magnitude of this problem, a survey was conducted among countries with available antimicrobial resistance or phage typing surveillance data. A total of 29, primarily industrialized, countries participated in the survey, which covered the years 1992-2001. Overall, the incidence of MDR S. Typhimurium and DT104 increased continuously during this period, although the problem affected primarily Europe and North America. The increase appeared to have peaked in the United Kingdom but not in other countries. Also, the incidence of quinolone-resistant S. Typhimurium was increasing. This survey implies that MDR S. Typhimurium constitutes an increasing public health problem in large parts of the world and emphasizes the importance of surveillance and control programs.

Figure 1

Participating countries in the survey of multidrug-resistant Salmonella enterica serotype Typhimurium, 1992–2001, internationally (A) and in Europe (B).

Figure 2

Salmonella enterica serovar Typhimurium DT104 as percentage of all S. Typhimurium in 8 world regions, 1992–2001. Only countries that had data available for 2 or more 2-year periods are included: United Kingdom and Ireland: England and Wales, Scotland, Ireland; Scandinavia: Denmark, Finland, Norway, Sweden; Western Europe: Austria, Germany, and the Netherlands; Eastern Europe: Czech Republic and Hungary; Southern Europe: Spain and Israel; North America: Canada, United States; Eastern Asia: the Republic of Korea; Oceania: Australia and New Zealand.

Figure 3

Multidrug-resistant Salmonella enterica serovar Typhimurium as a percentage of all S. Typhimurium in 9 world regions, 1992–2001. Only countries that had data available for 2 or more 2-year periods are included: United Kingdom and Ireland: Scotland and Ireland; Scandinavia and the Baltics: Denmark, Finland, Norway, and Latvia; Western Europe: Austria, Germany, Luxembourg, and the Netherlands; Eastern Europe: Czech Republic and Hungary; Southern Europe: Greece, Malta, and Spain; North America: Canada, United States; South America: Brazil; Eastern Asia: the Republic of Korea; Oceania: Australia.

Figure 4

Proportion of multidrug-resistant Salmonella enterica serovar Typhimurium with additional resistance to quinolones, cephalosporin, or trimethoprim, 1992–2001.