Health

Salmonella outbreaks linked to hospitals; doctors warned

The bug has hit institutions in at least eight Northeast states, and public health officials are racing to determine the source.

By Victoria Stagg Elliott — Posted Sept. 4, 2006

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Public health officials are calling on physicians to consider the possibility of Salmonella when faced with a patient who has diarrhea and may have had recent contact with the medical system -- either as a patient, hospital visitor or health care worker, particularly in New Hampshire and elsewhere in the Northeast.

"Think about Salmonella, and test the patient," said Jose Montero, MD, state epidemiologist and chief of communicable disease control with the New Hampshire Dept. of Health and Human Services.

This advice is being given because public health officials from the Centers for Disease Control and Prevention and in New Hampshire are in the process of tracking a multistate outbreak of Salmonella oranienburg. The initial cases were detected in that Northeast state, and, at press time, officials had found 34 people throughout the region who all had contact with health care facilities and became ill. Those investigating the outbreak say it could be a national problem related to food consumed at these facilities and have initiated a case-control study to determine the cause.

"We have found eight states with cases that match this pattern, but it may grow," said Elizabeth Daly, MPH, a foodborne disease epidemiologist with the New Hampshire DHHS who is leading the investigation. "We're trying to find something that's common to all of them."

Although the source of this outbreak was unknown at press time, many experts suspect -- because it is geographically widespread -- that it may not be the result of hygiene problems at these institutions. Instead, since so many hospitals have been impacted by the same organism, it is almost certain that the contamination occurred somewhere else and then was delivered to the facilities.

But whatever the source, this incident does have many infectious disease experts worried, particularly because the pathogen puts hospital patients who are already sick at even greater risk.

"It's so rare to find Salmonella in the hospital. And, when outbreaks do occur, they're devastating," said Thomas Fekete, MD, professor of medicine and chief of infectious diseases at Temple University School of Medicine in Philadelphia.

According to CDC data, the various types of Salmonella infect millions and kill more than 500 annually. Those who are very young, very old or otherwise frail are considered most likely to die or develop severe disease.

Antibiotic discussion

Experts also say this incident should add to the discussion of the importance of the judicious use of antibiotics and the debate regarding acid suppression in hospital settings.

Antibiotic use long has been linked to the development of resistant organisms, but it can also change the normal gut flora that can provide some protection against various foodborne pathogens. More recently, proton pump inhibitors and H2 blockers in this environment have been linked to a higher risk of Clostridium difficile. Some wonder whether such practices are factors in these Salmonella cases.

"Patients might be more susceptible because their protective mechanisms, such as acid in the stomach, may be suppressed," said Donald J. Kennedy, MD, professor of internal medicine and infectious diseases at Saint Louis University.

Those who work with infectious disease also say this incident further sends home the message that Salmonella is an important pathogen that demands as much respect, if not more, than infectious agents that make headlines.

"We ought to be worried about [Salmonella], not mad cow disease or bird flu," said Marc Siegel, MD, associate professor of medicine at New York University School of Medicine and the author of False Alarm: The Truth About the Epidemic of Fear.

Suspected cases should be reported via e-mail to David Blossom in the CDC's Division of Healthcare Quality Promotion ([email protected]" target="_blank">link).

Back to top


External links

ProMED-mail, the International Society for Infectious Diseases' Program for Monitoring Emerging Diseases, for the Aug. 12 Salmonella oranienburg alert, archive number 20060812.2259. (link)

"Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians and Other Health Care Professionals," product of the American Medical Association, American Nurses Assn., Centers for Disease Control and Prevention, Food and Drug Administration and U.S. Dept. of Agriculture (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn