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. 2021 Oct 4:1:60-64.
doi: 10.1016/j.ijregi.2021.09.006. eCollection 2021 Dec.

Outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi-Tiruchirappalli, Tamil Nadu, India, June 2018

Kevisetuo A Dzeyie  1 , Sankara Dhanapaul  2 , Polani Rubeshkumar  3 , SaravanaKumar Desing  3 , M S Vignesh  4 , I Raveendran  4 , Prem Kumar  4 , Shallu Kathuria  5 , Sushma Choudhary  6 , Ekta Saroha  7 , Valan Siromany  7 , Mohankumar Raju  8 , Parasuraman Ganeshkumar  3 , Manickam Ponnaiah  3 , Samir V Sodha  7 , Kayla Laserson  7 , Tarun Bhatnagar  3 , Lata Kapoor  5 , Arti Bahl  5 , Sudhir K Jain  5 , Sunil Gupta  5 , Manoj V Murhekar  3 , Sujeet K Singh  5
Affiliations

Outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi-Tiruchirappalli, Tamil Nadu, India, June 2018

Kevisetuo A Dzeyie et al. IJID Reg. .

Abstract

Objectives: In May 2018, a laboratory network for antimicrobial resistance (AMR) surveillance in Tamil Nadu, India, detected a cluster of Salmonella enterica serotype Typhi (S. Typhi) isolates resistant to ceftriaxone. We investigated to describe the epidemiology and identify risk factors for the outbreak.

Methods: We conducted unmatched case-control studies. We defined a case as illness (fever with abdominal pain, diarrhea or vomiting) in a person with blood culture-confirmed ceftriaxone-resistant S. Typhi isolated between January 1 and July 4, 2018 in Tiruchirappalli, Tamil Nadu. We interviewed cases using a semi-structured questionnaire to identify common exposures to food, water and places visited.

Results: We identified 7 cases (5 men) during March 25-June 8, 2018, median age 23 years (range: 12-42); all were hospitalized, none died. Eating at Restaurant A (odds ratio [OR]=22) and chicken gravy (OR=16) was associated with illness. Of the 10 workers at Restaurant A, stool culture from 8 did not detect S. Typhi; 2 did not consent to provide samples. Five water samples around the restaurant showed low or no residual chlorine content.

Conclusions: The investigation highlights the value of AMR surveillance in detecting emerging pathogens and the need for timely investigations, along with strengthening food safety.

Keywords: Ceftriaxone; India; Salmonella Typhi; antimicrobial resistance; disease outbreak.

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Figures

Figure 1:
Figure 1
Distribution of Ceftriaxone-resistant S. Typhi Cases by Illness Onset Date, Tiruchirappalli, Tamil Nadu, India, March-June 2018 (n=7) Description: The black vertical lines represents the cases that ate in Restaurant A and the grey vertical lines represents cases that did not ate in Restaurant
See this image and copyright information in PMC

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