|
|
Letter
Salmonella Typhimurium
Veterinary Clinic Outbreak
John F. Prescott*
*University of Guelph, Guelph, Ontario, Canada
Suggested
citation for this article
To the Editor: The Emerging Infectious Diseases 2004 issue on
zoonotic diseases (volume 10, number 12) included a careful and comprehensive
description of a Salmonella enterica serovar Typhimurium outbreak
associated with a veterinary clinic in New York (1).
In the outbreak, 2 cats and 1 dog had dental procedures performed, and
the 3 owners, 2 clinic technicians, and a friend of an affected owner
all contracted salmonellosis caused by the same strain. An isolate was
obtained from an animal, but a source for the Salmonella outbreak
was not identified.
I get 1 or 2 phone calls each year from veterinarians in Canada regarding
recurrent problems of salmonellosis in their clinics, though rarely with
human infections. The advice I give the veterinarians, which stops the
problem, is to stop using clindamycin as a routine prophylactic agent
when carrying out dental procedures. The marked disruption of the colonic
anaerobic microflora by oral clindamycin will reduce the number of Salmonella
organisms required to establish infection to very few. In veterinary journals,
advertising for clindamycin focuses on its use in prophylaxis of infections
after dental procures such as cleaning, scaling, and extractions. Veterinary
practitioners typically respond to my advice with initial disbelief because
it challenges use of a procedure that is seen as standard in veterinary
practice.
That "all 3 animal patients were treated after the [dental] procedure
with a prophylactic course of clindamycin" is the most meaningful
factor in this outbreak, but this point was not commented on by the authors.
The apparently increasing use in North American dogs and cats of biologically
appropriate raw foods diets, in other words raw meat, may be exacerbating
the problem since most such diets are contaminated with Salmonella
spp. (2). In addition, Clostridium difficile infection
is increasingly recognized as a common cause of diarrhea in dogs (3)
and might also develop in some animals treated with clindamycin, just
as it does in humans.
A number of antimicrobial drugs are likely to be as effective as clindamycin
for dental prophylaxis, if indeed any antimicrobial drug is truly needed,
and these are considerably less likely to produce what is probably the
side effect described in this report. Moreover, a canine dentistry text
states, "Most routine dental cleaning procedures do not require antibiotic
administration. The American Dental Association, the American Academy
of Oral Medicine, and the Council on Scientific Affairs advise against
the routine use of antibiotics for dental cleaning procedures" (4).
The case reported by Cherry et al. probably supports this recommendation.
References
- Cherry B, Burns A, Johnson GS, Pfeiffer H, Dumas N,
Barrett D, et al. Salmonella
Typhimurium outbreak associated with veterinary clinic. Emerg Infect
Dis. 2004;10:2249–51.
- Joffe DJ, Schlesinger DP. Preliminary
assessment of the risk of Salmonella infection in dogs fed raw
chicken diets. Can Vet J. 2002;43:441–2.
- Weese JS, Staempfli HR, Prescott JF, Kruth SA, Greenwood SJ, Weese
HE. The
roles of Clostridium difficile and enterotoxigenic Clostridium
perfringens in diarrhea in dogs. J Vet Intern Med. 2001;15:374–8.
- DuPont GA. Prevention of periodontal disease. Canine
dentistry. Vet Clin North Am Small Anim Pract. 1998;28:1129–45.
Suggested citation
for this article:
Prescott JF. Salmonella
Typhimurium veterinary clinic outbreak [letter]. Emerg Infect Dis [serial
on the Internet]. 2005 Dec [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol11no12/04-1295.htm
|
