High prevalence of ceftriaxone resistance among invasive Salmonella enterica serotype Choleraesuis isolates in Thailand: The emergence and increase of CTX-M-55 in ciprofloxacin-resistant S. Choleraesuis isolates.

S. Choleraesuis is a highly invasive zoonotic pathogen that causes a serious systemic infection in humans. The emergence and increase of resistance to ceftriaxone and ciprofloxacin among S. Choleraesuis has become a serious therapeutic problem. The present study demonstrated high frequency of antimicrobial resistance in Salmonella Choleraesuis among 414 nontyphoidal Salmonella isolates from bacteremic patients in Thailand. High rates of ceftriaxone (58.3%) and ciprofloxacin (19.6%) resistances were observed in S. Choleraesuis isolates. The dissemination of the self-transferable blaCTX-M-14-carrying IncFIIs, IncFII, and IncI1 plasmids and blaCMY-2-carrying IncA/C plasmid along with the clonal spread of blaCMY-2-harbouring S. Choleraesuis isolates contributed to the high frequency of resistance to extended-spectrum cephalosporins (ESCs; third- and fourth-generation cephalosporins) during 2005-2007. We reported the first occurrence of ceftazidime-hydrolysing CTX-M-55 in S. Choleraesuis isolates which dramatically increased and became the most abundant CTX-M variant among ESC-resistant S. Choleraesuis isolates during 2012-2016. The spread of clone pulsotype B3 was due to the dissemination of IncA/C plasmids carrying both blaCTX-M-55 and qnrS1 among ciprofloxacin-resistant S. Choleraesuis isolates harbouring D87G in GyrA. These isolates were apparently responsible for the high rates of co-resistance to ESCs and ciprofloxacin (51.3%) during 2012-2016. This study emphasizes the importance to have an action plan to control the dissemination of antimicrobial resistance in S. Choleraesuis since this poses a threat to global health due to travel and trade in animal food products.

Occurrence of a novel class 1 integron harboring qnrVC4 in Salmonella Rissen.

We described qnrVC4 in S. Rissen 166ANSS50, a swine isolate, which was detected in the study on quinolone resistance mechanisms of nontyphoidal Salmonella in Thailand. The isolate was found to harbor a Ì´17-kb non-conjugative plasmid carrying qnrVC4 within 8.91kb of a novel In4-like class 1 integron (In805). It contained the multi-drug resistance gene cassettes of qnrVC4-qacH4-aacA4-cmlA7-blaOXA-10-aadA1-dfrA14 and unusual 3'-CS of mobC-IS6100. This 1014-bp qnrVC4 cassette included with promoter (PqnrVC4: -35 TTGAGA and -10 TAGTCT) showed high homology with qnrVC4 in superintegron of V. cholerae O1 El Tor. The qnrVC4 recombinant plasmid resulted in 4-, 8-, and 16-fold increase in the MICs of nalidixic acid (2-8µg/mL), ciprofloxacin (0.015-0.125µg/mL), and norfloxacin (0.03-0.5µg/mL), respectively. In addition, the backbone plasmid revealed a novel replicon belonging to the MOBQ1 group from the broad-host-range mobilisable IncQ1 plasmid RFS1010 based on relaxase sequences. This is the first known report of qnrVC in Salmonella enterica. The qnrVC4 gene was co-transferred with other resistance genes via a novel plasmid-borne In805. This allowed the spread of this resistance gene to Enterobacteriaceae.

Bacterial pathogens isolated from raw meat and poultry compared with pathogens isolated from children in the same area of rural Thailand.

To better understand the epidemiology of bacterial food borne pathogens in children, in relation to pathogens in meats from a market in rural Thailand, we collected 73 cultures samples from raw chicken, pork and fish at a local market where diarrheal disease surveillance was conducted. Standard methods were employed to isolate, identify and serotype enteric pathogens from children and food samples. Antibiotic susceptibility testing was performed. Ninety-seven percent of food samples were contaminated with at least one enteric pathogen. The pathogens most commonly isolated from food were Salmonella spp (84%), Arcobacter butzleri (74%) and Campylobacter spp (51%). The most common serovars of Salmonella obtained from humans with diarrhea were S. Risen, S. Stanley and S. Anatum. Most common serovars of Salmonella isolated from food were S. Anatum, S. Stanley, and S. Corvallis. Fifty-one percent and 25% of children infected with Salmonella and Campylobacter, respectively, infected with the same serotypes isolated from food samples, suggesting these pathogens are widespread in food and humans. Pulsed-field gel analysis of Salmonella spp revealed 65 pulsotypes, but no point-sources of salmonellosis were identified. Joint epidemiologic/laboratory studies are useful to describe the epidemiology of enteric pathogens in rural populations.

Serotypes and antimicrobial resistance of Salmonella enterica ssp in central Thailand, 2001-2006.

This study was carried out to elucidate the epidemiological trends and antimicrobial susceptibilities against Salmonella serovars among Thai patients and asymptomatic carriers during 2001-2006 in central Thailand. A total of 1,401 human and 260 non-human isolates from various sources were included. The isolates were characterized using serotyping and antimicrobial susceptibility testing. The most common serovars in patients submitting stool samples were S. Weltevreden, S. Stanley, S. Anatum, and S. Rissen. Significantly higher odds ratios were observed in blood samples versus stool sample for S. Choleraesuis, S. Enteritidis, S. Typhimurium, and S. Typhi. Children under five years old suffered the most frequently from gastroenteritis. The patients most commonly infected with an invasive serovar were children and people from 26 to 55 years of age. Antimicrobial susceptibility data revealed that S. Schwarzengrund, S. Choleraesuis, S. Anatum, S. Stanley, S. Rissen, and S. Typhimurium were the most resistant serovars observed. The invasive serovar, S. Choleraesuis was resistant to cefotaxime and norfloxacin. Antimicrobial resistance to cefotaxime, was observed in S. Agona, S. Rissen, S. Typhimurium, S. Anatum, and S. Weltevreden. An alarmingly high frequency of resistance to third generation cephalosporins was observed. We recommend Thai authorities take action in order to prevent spread of resistant S. Choleraesuis and other serovars among animals and humans by enforcing a more strict policy on the use of antimicrobials in food animals.

Molecular characterization of extended-spectrum cephalosporinase-producing Salmonella enterica serovar Choleraesuis isolates from patients in Thailand and Denmark.

The objective of this study was to characterize extended-spectrum cephalosporinase (ESC)-producing isolates of Salmonella enterica serovar Choleraesuis recovered from patients in Thailand and Denmark. Twenty-four blood culture isolates from 22 patients were included in the study, of which 23 isolates were recovered from 21 Thai patients during 2003, 2007, or 2008 and one isolate was recovered from a Danish traveler to Thailand. ESC production was confirmed in 13 out of the 24 isolates by MIC testing. Microarray and plasmid profiling (replicon typing and restriction fragment length polymorphism [RFLP]) were used to characterize the genetic mechanisms of antimicrobial resistance in the 13 ESC-producing isolates. Pulsed-field gel electrophoresis (PFGE) and MIC testing were used to compare the clonality between the 13 ESC-producing isolates and the 11 non-ESC-producing isolates. Based on susceptibility patterns, the ESC-producing isolates were more closely related than non-ESC-producing isolates. Microarray, PCR, plasmid profiling, and replicon typing revealed that the 13 ESC-producing isolates harbored either bla(CMY-2) containing incA/C or bla(CTX-M-14) containing incFIIA, incFrepB, and an unknown replicon located on plasmids ranging in size from 75 to 200 kb. The RFLP and replicon typing clustered the isolates into four distinct groups. PFGE revealed 16 unique patterns and five clusters; each cluster contained two or three of the 24 isolates. The isolate from the Danish patient was indistinguishable from two Thai clinical isolates by PFGE. This study revealed the emergence of the bla(CTX-M-14) gene among several clones of Salmonella serovar Choleraesuis. Numerous plasmids were identified containing up to two different ESC genes and four distinct replicons. A "travel-associated" spread was confirmed. Overall, a high degree of clonal diversity between isolates resistant and susceptible to cephalosporins was observed. The findings represent a serious threat to public health for the Thai people and tourists.

Risk factors and epidemiology of the ten most common Salmonella serovars from patients in Thailand: 2002-2007.

We conducted a retrospective observational study to assess epidemiological trends and risk factors associated with the 10 most common Salmonella serovars isolated from humans in Thailand between 2002 and 2007. A total of 11,656 Salmonella isolates covering all 6 years were included in the study. The top 10 Salmonella serovars identified during the course of this study were Enteritidis, Stanley, Weltevreden, Rissen, I [1],4,[5],12:i:-, Choleraesuis, Anatum, Typhimurium, Corvallis, and Panama, which accounted for 8108 (69.6%) of the isolates. Most isolates were from patients <5 years (33%), were isolated during June (13%), and were recovered from stool (82%) and from patients in Bangkok (27%). Statistical analysis revealed that S. Enteritidis and S. Choleraesuis were recovered from blood with a higher frequency than other nontyphoidal serovars. While both serovars tended to be isolated from patients >5 years; S. Choleraesuis was recovered with a higher frequency from patients in Bangkok and the central region, whereas S. Enteritidis was recovered predominantly from patients in the southern region. This study also indicates a shift in prevalence of the most common Salmonella serovars responsible for human infections in Thailand compared to previous studies. Notably, there was an increase in human infections with S. Stanley, S. Corvallis, and S. Choleraesuis, three serovars that have previously been associated with swine, and a decrease in infections due to S. Weltevreden and S. Anatum. The study also revealed differences in the epidemiology among the different serovars, suggesting that serovar-specific interventions are needed. We recommend initiating targeted interventions for the two serovars associated with a high odds ratio for submitted blood samples, S. Enteritidis and S. Choleraesuis. The authors also recommend additional epidemiologic studies to investigate the observed increase in swine associated serovars (S. Stanley, S. Corvallis, and S. Choleraesuis) and determine interventions to reduce the burden of disease from these serovars.

Shigella species and serotypes among clinical isolates in Thailand from 2001 to 2005.

OBJECTIVE: To study the species and the serotypes of the clinical isolates of Shigella obtained from patients in Thailand. MATERIAL AND METHOD: The World Health Organization National Salmonella and Shigella Center Thailand, had confirmed the species and performed serotype identification of 1,913 clinical isolates of Shigella collected from the laboratory network of Department of Medical Sciences and the collaborated hospitals across Thailand from 2001 to 2005. RESULTS: Between the year 2001 and 2005, 728, 481, 160, 247, 297 clinical isolates were tested, respectively. There were 5 isolates of S. dysenteriae (group A), 416 isolates of S. flexneri (group B), 4 isolates of S. boydii (group C) and 1,488 isolates of S. sonnei (group D). A total of 21 Shigella serotypes were identified and there were 3 serotypes in group A, 11 serotypes in group B, 4 serotypes in group C, and 3 serotypes in group D. Throughout these five years, the five common serotypes were S. sonnei Phases I and II, 28.6% (548 isolates); S. sonnei Phase I, 24.6% (470 isolates); S. sonnei Phase II, 24.6% (470 isolates); S. flexneri Type 2a, 10.9% (208 isolates), and S. flexneri Type 3a, 6.3% (121 isolates), respectively. CONCLUSION: At the national scale in Thailand from 2001 to 2005, S. sonnei was the most frequent Shigella spp. isolated from patients in Thailand. In addition, S. dysenteriae and S. boydii were extremely uncommon. These findings are important in future vaccine development.

Shigella from humans in Thailand during 1993 to 2006: spatial-time trends in species and serotype distribution.

In Thailand during 1993-2006, a total of 9063 Shigella isolates from different medical centers were serotyped and trends over time and spatial clustering analyzed. Of 3583 cases with age information, 1315 (37%) cases were from children between 0 and 4 years and 684 (19%) from children between 5 and 8 years. Most infections were recorded during 1993-1994 (> 1500 per year), decreasing to < 200 in 2006. The relative species distribution also changed. During 1993-1994, Shigella flexneri accounted for 2241 (65%) of 3474 isolations. This proportion decreased to 64 (36%) of 176 infections in 2006. Most infections occurred during July and August, and fewest in December. S. flexneri clustered around Bangkok, and Shigella sonnei in southern Thailand. Most S. flexneri infections were caused by serotype 2a (1590 of 4035) followed by serotype var X (1249). For both serotypes, a pronounced decrease in the number of isolates occurred over time. A much smaller decrease was observed for serotype 3a isolates. Phase I S. sonnei was initially most common, but shifted gradually over phase I, II, to only phase II. No differences in spatial distribution were found. The three most common S. flexneri serotypes all clustered in, around, and west of Bangkok. Serotypes 2a and 3a also clustered in southern Thailand, whereas var X clustered north and northeast of Bangkok. In conclusion, looking at Shigella species, Thailand changed from being a developing country to a developed country between 1995 and 1996. In addition, major shifts in the types of S. sonnei were observed as were differences in spatial clustering of S. flexneri and S. sonnei and S. flexneri serotypes.

Antimicrobial resistance and molecular epidemiology of Salmonella Rissen from animals, food products, and patients in Thailand and Denmark.

Recently we reported increases in both the number of Salmonella infections due to Salmonella Rissen in Thailand and the isolation of this serovar from pork products in Thailand. The objectives of the present study were to determine the genetic diversity and antimicrobial resistance of Salmonella Rissen isolates recovered from humans, food products, and animals in Denmark and Thailand. Additionally, risk factors due to travel and consumption of specific food products were analyzed and evaluated. A total of 112 Salmonella Rissen isolates were included in this study from Thailand and Denmark. Thai isolates were recovered from humans, uncooked food, and ready-to-eat food. Danish isolates were obtained from humans (with and without a history of travel to Thailand prior to the infection), Danish pig or pork products, imported pig or pork products, turkeys, and animal feed. A total of 63 unique XbaI PFGE patterns were observed. The predominant pattern was shared by 22 strains. Limited antimicrobial resistance was observed in the Danish strains, and a higher degree of resistance was observed in strains originating from Thailand. Virtually all isolates were resistant to tetracycline. The tet A gene was detected in tetracycline-resistant isolates. Statistical analysis and molecular subtyping identified the combination of travel to Thailand and consumption of imported pig or pork products as well consumption of as pig or pork products produced in Denmark as risk factors for Salmonella Rissen infection among the Danish patients. The outcome of this study might be used as a supplement for future Salmonella Rissen investigations and outbreak detection.

The epidemiological relationship between Salmonella enterica serovar typhimurium and Salmonella enterica serovar 4,[5],12:i:- isolates from humans and swine in Thailand.

A total of 138 isolates of S. Typhimurium and S. 4,[5],12:i:- from humans and swine in Thailand during 2003-2006, were evaluated for antimicrobial sensitivity by the disk diffusion method against 10 antimicrobial drugs and pulsed-field gel electrophoresis (PFGE) with endonuclease Xbal to investigate the epidemiological relationship among isolates. It was found that all isolates were classified into 27 antimicrobial resistance patterns, and 80% of S. Typhimurium and 95.4% of S. 4,[5],12:i:- isolates were resistant to three or more antimicrobial agents. By PFGE testing, the 84 PFGE patterns were categorized into A to Z patterns. Eighty percent of S. Typhimurium and 71.3% of S. 4,[5],12:i:- isolates in 7 major PFGE patterns had close clonal relationships (_85% similarity). Our studies indicate the spread of genetically identical clones of S. Typhimurium and S. 4,[5],12:i:- in humans and swine in Thailand.

Salmonella prevalence in slaughtered buffaloes and pigs and antimicrobial susceptibility of isolates in Vientiane, Lao People's Democratic Republic.

This is the first report regarding isolation of Salmonella from cecum samples of buffaloes and pigs and characterization of the isolates in Laos. The organisms were isolated from 8% (4/50) of buffaloes and 76% (37/49) of pigs. In buffaloes, 3 animals harbored serotype 9,12: -:1,5, and 1 animal harbored both S. Derby and S. Javiana. In pigs, the most predominant serotypes were S. Derby (51%) followed by S. Anatum (45%), S. Weltevreden (15%) and S. Stanley (5%). The buffalo isolates were susceptible to the antimicrobials tested, whereas the pig isolates showed 10 resistance patterns to 1-5 antibiotics. Of the 59 pig isolates, the resistance rates to tetracycline, streptomycin, ampicillin, sulfamethoxazole-trimethoprim, chloramphenicol, amoxicillin-clavulanic acid and nalidixic acid were 24%, 22%, 14%, 5%, 2%, 2% and 2%, respectively. The results suggest that pigs and buffaloes harbor Salmonella, with a higher prevalence especially in pigs, and all the isolates showed sensitivity to cefotaxime, norfloxacin and ciprofloxacin.

International spread of multidrug-resistant Salmonella Schwarzengrund in food products.

We compared 581 Salmonella enterica serotype Schwarzengrund isolates from persons, food, and food animals in Denmark, Thailand, and the United States by antimicrobial drug susceptibility and pulsed-field gel electrophoresis (PFGE) typing. Resistance, including resistance to nalidixic acid, was frequent among isolates from persons and chickens in Thailand, persons in the United States, and food imported from Thailand to Denmark and the United States. A total of 183 PFGE patterns were observed, and 136 (23.4%) isolates had the 3 most common patterns. Seven of 14 isolates from persons in Denmark had patterns found in persons and chicken meat in Thailand; 22 of 390 human isolates from the United States had patterns found in Denmark and Thailand. This study suggests spread of multidrug-resistant S. Schwarzengrund from chickens to persons in Thailand, and from imported Thai food products to persons in Denmark and the United States.

Recovery of Salmonella using a combination of selective enrichment media and antimicrobial resistance of isolates in meat in Thailand.

From November 2004 to March 2005, 50 samples (chicken, pork and beef) of registered meat and non-registered meat were purchased from supermarkets and retail markets located in Bangkok, Thailand. Each sample was evaluated for Salmonella spp by a conventional method using combination of selective enrichment media (RV+MSRV) and compared with selective enrichment medium alone (DIASALM). Our study revealed the performance of RV+MSRV for the detection of Salmonella spp was significantly better than those of DIASALM alone since the recovery of Salmonella spp in both groups of meat was high using RV+MSRV, particularly in the registered meat. In addition, the recovery of serovars in registered meat was significantly higher than those in non-registered meat. Antimicrobial resistance of 62 Salmonella isolates in both groups of meat was determined for 10 antimicrobial drugs using the disk diffusion method. The results show that 100% of isolates from both groups were susceptible to amoxicillin/clavulanic acid, ciprofloxacin, cefotaxime and norfloxacin and 50-60% of isolates from both groups were resistant to tetracycline, streptomycin and ampicillin. Sixty percent of Salmonella isolates from meat showed multiresistance antimicrobial patterns.

Molecular characterization and occurrence of extended-spectrum beta-lactamase resistance genes among Salmonella enterica serovar Corvallis from Thailand, Bulgaria, and Denmark.

Fifty nine Salmonella Corvallis isolates from humans and food products in Bulgaria, Denmark, and Thailand were examined for antimicrobial susceptibility and characterized by pulsed-field gel electrophoresis (PFGE). Cephalosporin-resistant isolates were examined for the presence of genes encoding beta-lactamases by PCR and sequencing. Ten different PFGE types were observed. One type (30 isolates) was recovered in all three countries; three types were found only in Bulgaria, two only in Denmark, two only in Thailand, and two both in Denmark and Thailand. Ten isolates were susceptible to all antimicrobial agents tested, whereas 41 were resistant to three or more antimicrobials. Most resistance was observed among the isolates from Bulgaria. Of the 25 isolates from Bulgaria, 20 displayed resistance to ampicillin and the cephalosporins ceftiofur and cephalothin. All 20 isolates tested negative for bla (CMY-1), bla (CMY-2), and bla (ACC), but positive for bla (SHV), of which five were sequenced to bla (SHV-2). Plasmid profiling and hybridization revealed that the bla (SHV) gene was located on plasmids of approximately 70 kb. Five plasmid profiles were found among these 20 isolates. The plasmid profiling confirmed the PFGE-type and was able to further subdivide the strains. Seventeen of these 20 isolates contained also bla (TEM), of which nine representatives were sequenced to bla (TEM-1B), or bla (TEM-1H). One isolate contained bla (CTX-M-15), bla (SHV-2), and bla (TEM-1H), with the bla (CTX-M-15), and bla (TEM-1H) genes located on a 63-kb transferable plasmid. This study showed a high frequency of resistance among S. Corvallis isolated from humans and food products in Bulgaria, with a lower frequency in Thailand and Denmark. The clonal relatedness among the isolates from three countries could indicate a recent spread of this serovar.

Salmonella lamphun: first isolation of a new Salmonella serovar in Thailand.

Two isolates of a new Salmonella serovar, Salmonella Lamphun were discovered from animal feeds in Thailand, in 2003, which belongs to group C, with antigenic formula 6,8:y: 1,2. Both isolates were susceptible to all antimicrobials tested. The pulsed field gel electrophoresis pattern of both isolates comprises 11 DNA fractions sized 48, 65, 77, 105, 110, 170, 244, 330, 337,453 and 1,135 kbp. Up to April 2005, no human or animal infection by this new Salmonella serovar was reported.

Critical control points for monitoring salmonellae reduction in thai commercial frozen broiler processing.

Since 1998, pathogen reduction regulations for poultry have been enforced through the Food Safety and Inspection Service of the U.S. Department of Agriculture and through hazard analysis critical control point evaluation. This enforcement has focused attention on pathogen control and sanitation in the United States and in other countries, including Thailand. The objective of this study was to evaluate reduction in salmonellae achieved by Thai commercial exporters of frozen broiler chickens. A total of 188 broiler samples and 56 water overflows from two chillers were collected from nine processing lines of frozen broiler exporters at four identified critical control points (CCPs): CCP1, washing; CCP2, chilling; CCP3, deboning; and CCP4, packing. Samples were screened for salmonellae by enzyme-linked immunosorbent assay, and bacterial identification was confirmed through biochemical and serological patterns. The overall prevalence of Salmonella was 24.6% (60 of 244 samples), with 12 serovars identified. Salmonella Albany was predominant (33.3%, 20 of 60 samples). Salmonella prevalence was 20.0% (6 of 30 samples) prior to CCP1 and was 12.5% (4 of 32), 22.7% (15 of 66), 33.3% (10 of 30), and 23.3% (7 of 30) after CCP1, CCP2, CCP3, and CCP4, respectively. The critical limit was 20% positive samples, and three CCPs failed to meet standards. Three corrective interventions were used at CCP2: 30 mg/liter hydrogen peroxide, 0.5% peracetic acid, and 125 mg/liter ozone. After these interventions, 65 broiler samples were collected for analysis of Salmonella prevalence. Results were compared with those obtained after chlorine was applied individually as a control. The Salmonella prevalences after intervention treatments were 16.0% (4 of 25), 5.0% (1 of 20), and 15.0% (3 of 20) after hydrogen peroxide, peracetic acid, and ozone treatments, respectively. All values were below the 20% critical limit, and the application of 0.5% peracetic acid produced significantly lower prevalences (P < 0.05). Repeated sampling after 1 to 4 months indicated that sanitation at these three plants was inconsistent (P < 0.05).

Salmonella serovars from humans and other sources in Thailand, 1993-2002.

We serotyped 44,087 Salmonella isolates from humans and 26,148 from other sources from 1993 through 2002. The most common serovar causing human salmonellosis in Thailand was Salmonella enterica Weltevreden. Serovars causing human infections in Thailand differ from those in other countries and seem to be related to Salmonella serovars in different food products and reservoirs.

Antimicrobial susceptibility and occurrence of resistance genes among Salmonella enterica serovar Weltevreden from different countries.

OBJECTIVES: This study was conducted to investigate the occurrence of antimicrobial resistance among Salmonella Weltevreden isolates from different sources in South-East Asia (Indonesia, Laos, Malaysia, Taiwan, Thailand, Vietnam), Australia, Denmark, New Zealand and the USA. METHODS: A total of 503 isolates were examined for susceptibility to antimicrobial agents, and resistant isolates were examined for the presence of selected resistance genes by PCR. RESULTS: Only 48 (9.5%) of the isolates were resistant to one or more of the antimicrobial agents tested. A low frequency of resistance was found towards ampicillin (1.8%), chloramphenicol (1.6%), florphenicol (0.4%), nalidixic acid (1.6%), neomycin (0.6%), streptomycin (4.4%), sulfamethoxazole (4.2%), tetracycline (4.0%) and trimethoprim (1.4%), whereas all isolates were susceptible to co-amoxiclav, ceftiofur, ciprofloxacin, colistin and gentamicin. All nine ampicillin-resistant isolates contained a sequence similar to the blaTEM-1b gene, one of the eight chloramphenicol-resistant isolates a sequence similar to the catA1 gene, all three neomycin-resistant isolates a sequence similar to the aphA-2 gene, 16 (73%) of the 22 streptomycin-resistant isolates a sequence similar to the aadA gene, the remaining six (27%) a sequence similar to the strA gene, and all 21 sulfamethoxazole-resistant isolates a sequence similar to the sul2 gene. Thirteen (65%) of the 20 tetracycline-resistant isolates contained the tet(A) gene, four (20%) the tet(B) gene, and one (5%) the tet(C) gene. CONCLUSIONS: This study showed a low frequency of resistance among Salmonella Weltevreden isolated from humans and other reservoirs in South-East Asia and elsewhere. There was no major difference in the occurrence of resistance between source or geographical origin.

Norfloxacin and azithromycin for treatment of nontyphoidal salmonella carriers.

There has been inadequate evaluation of an antibiotic for eradication of nontyphoidal salmonellae (NTS) in asymptomatic carriers. In a randomized, placebo-controlled trial, such efficacy was evaluated using 2 five-day regimens (norfloxacin, 400 mg twice per day, and azithromycin, 500 mg once per day) compared with placebo. The study included 265 food workers in an area of Thailand where NTS are endemic who were asymptomatic NTS carriers. The presence of NTS in stool samples was assessed on days 7, 30, 60, and 90 after start of treatment. At each assessment visit, <4% of participants in each of the 3 groups carried an initial Salmonella serotype; 16%-35% had new Salmonella serotypes detected, except on day 7 in the azithromycin group, when the rate was 4%. Sanitation was good at work but not at home. Selection of multidrug-resistant Salmonella enterica serotype Schwarzengrund was demonstrated. The study regimens were not better than placebo for treatment of asymptomatic food workers who carried NTS in an area where these organisms are endemic, and use of the regimens resulted in antimicrobial resistance.