Interim guidance on management of infections with a multidrug-resistant strain of Salmonella Newport

An Advisory Committee Statement (ACS)
Committee to Advise on Tropical Medicine and Travel (CATMAT)

Table of contents

Preamble

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides the Public Health Agency of Canada with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. The Agency acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices, and is disseminating this document for information purposes to both travellers and the medical community caring for travellers.

Persons administering or using drugs, vaccines, or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use.

Key points

Objective

This statement provides guidance to health care providers for the management of patients with known or suspected MDR Salmonella Newport infection after travel to or from Mexico. CATMAT also aims to remind clinicians of management practices that apply to travellers' diarrhea more generally.

The recommendations made on this page are based on expert opinion. A formal evidence appraisal, such as Grading of Recommendations, Assessment, Development and Evaluation (GRADE), was not done.

For recommendations related to the prevention of travellers' diarrhea see the CATMAT statement on prevention of travellers' diarrhea.

Patient management recommendations

Consider MDR Salmonella Newport infection in the differential diagnosis of patients with symptoms compatible with salmonellosis (such as, diarrhea, fever, and abdominal cramps) and who have returned from Mexico in the 7 days preceding illness onset.

For most patients with Salmonella and other travel-related diarrheal illnesses, including MDR Salmonella Newport, treatment with antibiotics is of limited clinical value and may cause antibiotic-related harms, including prolonged asymptomatic Salmonella carriage, disturbance of the microbiome and selection for/colonization with drug resistant bacteria. Overuse of antibiotics is also considered one of the major global public health hazardsFootnote 1.

Routine use of antibiotics for treatment of travellers' diarrhea, including for patients potentially infected with MDR Salmonella Newport, should be avoided.

Antibiotic treatment is indicated for patients who are considered at greatest risk for poor outcomes, including people:

Unfortunately, the relative risk of infection-associated complications in these groups remains poorly defined. However, we believe early antibiotic therapy in these populations is likely to reduce the risk for such complications.

Most MDR Salmonella Newport isolates from this travel-associated strain are not susceptible in vitro to antibiotics generally recommended for oral treatment.

If you're considering antibiotic treatment for a patient with known or suspected MDR Salmonella Newport infection following (within the last 7 days) travel to Mexico, we suggest the following approach be applied:

Diagnosis

Treatment

Patient education recommendations

Advise patients that they can take steps to prevent the spread of disease. People with diarrhea should:

Advise travellers that vaccination against Salmonella Typhi (that is, typhoid vaccine) does not protect against infection with Salmonella Newport or other similar strains. Travellers should always eat and drink safely abroad.

These habits can help protect travellers against other travel-associated illnesses, including travellers' diarrhea, typhoid, and paratyphoid fever.

Additional resources and useful links

Acknowledgements

This statement was prepared by the MDR Salmonella (Newport) Working Group: Libman M (Chair), Bui Y, Lagacé-Wiens P, Schofield S, and the CATMAT Secretariat and was approved by CATMAT.

CATMAT would like to thank Dr. Cédric Yansouni (external consultant) for his contribution to the statement. CATMAT also acknowledges the technical and administrative support from the Centre for Border and Travel Health at the Public Health Agency of Canada for the development of this statement.

CATMAT members: Libman M (Chair), Acharya A, Bogoch I, Bui Y, Greenaway C, Khatib A, Lagacé-Wiens P, Lee J, Plewes K, Vaughan S.

Liaison members: Angelo K (Centers for Disease Control and Prevention), Pernica J (Association of Medical Microbiology and Infectious Disease Canada), Viel-Thériault I (Canadian Paediatric Society).

Ex officio members: Marion D (Department of National Defence), Rossi C (Department of National Defence), Schofield S (Department of National Defence), and Zimmer R (Biologics and Radiopharmaceutical Drugs Directorate, Health Canada).

Conflict of Interest

None declared.

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: