A Hospital Outbreak of Multiresistant Salmonella typhimurium Belonging to Phage Type 193

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Abstract
An outbreak of nosocomial infection was caused by strains of Salmonella typhimurium phage type 193 that were resistant to ampicillin, chloramphenicol, neomycin-kanamycin, streptomycin, spectinomycin, sulfonamides, tetracyclines, trimethoprim, and nalidixic acid. Resistances to drugs other than nalidixic acid were specified by plasmids, and, on the basis of phage typing and plasmid characterization studies, the multiresistant phage type 193 strains were determined to be clonal. In a two-year period, 488 patients infected with these bacteria were identified. An investigation in a pediatric surgical ward, where the outbreak was particularly severe, showed that patients exposed to antibiotics were more likely to be colonized with the epidemic strain and that young debilitated patients were more liable to show clinical signs of infection. Epidemiologic studies suggested that cross infection via the hands of the ward staff was the likely means of propagation of the epidemic.