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Eurosurveillance, Volume 7, Issue 27, 03 July 2003
Articles

Citation style for this article: Espié E, Weill FX. Outbreak of multidrug resistant Salmonella Newport due to the consumption of horsemeat in France. Euro Surveill. 2003;7(27):pii=2252. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2252

Outbreak of multidrug resistant Salmonella Newport due to the consumption of horsemeat in France

Emmanuelle Espié (e.espie@invs.sante.fr). Institut de Veille Sanitaire, and François-Xavier Weill (fxweill@pasteur.fr), Reference Centre for Salmonella, Institut Pasteur, France, on behalf of the investigation team (Reference Centre for Salmonella and the Veterinary and Food Administration Institut de Veille Sanitaire, Saint-Maurice, France).

From May to June 2003, a total of 14 human cases of multidrug-resistant Salmonella enterica subsp. enterica serotype Newport were reported in a localised geographical area in the north of France (figures 1 and 2). The serotype was resistant to beta-lactams (ampicillin, ticarcillin, piperacillin, 1st, 2nd and 3rd generation cephalosporins except cefepime and imipenem), streptomycin, sulfonamide, tetracycline, and chloramphenicol. Both sexes (sex-ratio = 1) and all age groups (9 children, 5 adults) were affected (mean age =24 years). All patients presented with diarrhoea, which was bloody in seven patients (50%). Eleven patients were hospitalised (79%). No death has been recorded.

Figure 1. Cases by day of onset. S. Newport outbreak, France, May-June 2003.


Figure 2. Cases by place of residence. S. Newport outbreak, France, May-June 2003.


All cases reported having eaten horsemeat consumed as ground meat (11 cases, and consumed raw by at least 6 cases) or steak (3 cases). Cases had purchased their horsemeat from butchers (7 cases) and markets (7 cases) in different towns. Among the different suppliers of the retail outlets, one wholesaler, located in the north of France, was shown to have supplied all fourteen outlets. The wholesaler purchases its horsemeat from 6 different countries outside France, predominantly in South and North America, but also in Europe and Oceania.

So far, no single vehicle of infection (common carcass or common supplier abroad) has been identified. Since the origin of the horsemeat is not recorded after purchase by the wholesaler, it may prove impossible to determine the exact origin of the contaminated meat.

Fourteen isolates were tested for the presence of blaCMY gene by PCR. All the isolates were positive in a CMY-specific PCR assay. Sequencing of PCR products showed a beta-lactamase gene identical to cmy-2.

Data from routine Salmonella surveillance on humans and domestic animals (primarily poultry, pigs and cattle) and foods showed that S. Newport isolates with the current outbreak resistance profile are very unusual in France. Four isolates have been identified in humans 2000 (n=3) and 2002 (n=1) and none in animals aand foods.

The CMY-2 gene is a AmpC-like beta lactamase plasmid mediated gene, inducing resistance to cephamycin and extended- spectrum cephlosporins. The CMY-2 plasmid can undergo transfer between different bacterial species (E. coli, Klebsiella sp, Salmonella sp, etc) and be transmitted between food, animals and humans (1-3). In the United States, the incidence of S. Newport human illness increased markedly in the late 1990s (4). The increase in S. Newport illness in human has been driven by an increase in the highly resistant strain S. Newport MDR-AmpC (4). Illness due to S. Newport MDR-AmpC is also emerging in cattle. Risk factors for human illness include contact with cattle and consumption of bovine products.

References:
  1. Zhao S, White DG, McDermott PF, Friedman S, English L, Ayers S, et al. Identification and expression of cephamycinase bla(CMY) genes in Escherichia coli and Salmonella isolates from food animals and ground meat. Antimicrob Agents Chemother 2001; 45: 3647-50. (http://aac.asm.org/cgi/reprint/45/12/3647) [accessed 3 July 2003]
  2. Carattoli A, Tosini F, Giles WP, Rupp ME, Hinrichs SH, Angulo FJ, et al. Characterization of plasmids carrying CMY-2 from expanded-spectrum cephalosporin-resistant Salmonella strains isolated in the United States between 1996 and 1998. Antimicrob Agents Chemother 2002; 46:1269-72. (http://aac.asm.org/cgi/reprint/46/5/1269.pdf) [accessed 3 July 2003]
  3. Rankin SC, Aceto H, Cassidy J, Holt J, Young S, Love B, et al. Molecular characterization of cephalosporin-resistant Salmonella enterica serotype Newport isolates from animals in Pennsylvania. J Clin Microbiol 2002; 40: 4679-84. (http://jcm.asm.org/cgi/reprint/40/12/4679.pdf) [accessed 2 July 2003]
  4. Griffin PM. Emergence of multidrug-resistant Salmonella Newport, United States. [slide presentation] CTSE Annual Meeting, June 2002. (http://www.cdc.gov/narms/whatsnew/CSTE_presentation.pdf) [accessed 3 July 2003]

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