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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1442-1446

EXPERIENCE AND REASON

Transmission of Salmonella enterica Serotype Typhimurium DT104 to Infants Through Mother’s Breast Milk

Salah S. Qutaishat, PhD, Mary E. Stemper, MS, Susan K. Spencer, BS, Mark A. Borchardt, PhD, James C. Opitz, MD, Timothy A. Monson, MS, Jennifer L. Anderson, BS and Jay L. E. Ellingson, PhD

Saint Joseph’s Hospital, Marshfield, WI 54449
Marshfield Laboratories, Marshfield Clinic, Marshfield, WI 54449
Marshfield Medical Research Foundation, Marshfield, WI 54449
Department of Pediatrics, Marshfield Clinic, Marshfield, WI 54449
Communicable Disease Division, Wisconsin State Laboratory of Hygiene, Madison, WI 53706
Food Safety Services, Marshfield Clinic, Marshfield, WI 54449

This study documents the first reported transmission of Salmonella enterica serotype Typhimurium definitive type 104 (DT104) to premature fraternal twins via their mother’s breast milk. When premature twin neonates developed severe enteritis in the neonatal intensive care unit (NICU), stool samples and the mother’s breast milk were cultured for the presence of Salmonella. Antibacterial susceptibility patterns were determined. Semiquantitative organism abundance data were retrospectively gathered on 54 stored breast milk samples collected on 34 different days using a rapid, real-time polymerase chain reaction (PCR) methodology (LightCycler PCR). Fecal samples from other infants in the NICU at that time were also tested. Pulsed-field gel electrophoresis (PFGE) was used to assess the genetic composition of the isolated organisms. The twins’ neonatal stools and mother’s breast milk cultures revealed a resistance pattern (R-type) to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline. LightCycler PCR analysis of sequential breast milk samples confirmed this to be the likely source of transmission. In the subsequent outbreak investigation, none of the NICU surveillance fecal samples proved positive for this organism. The genetic composition of organisms isolated from the maternal breast milk was indistinguishable from those isolated from neonatal specimens as determined by PFGE. Antibiotic susceptibility tests coupled with PFGE patterns suggested that these Salmonella isolates were DT104. Because the prevalence of DT104 infections is rising in the United States, neonatologists should be aware of breast milk as a potential mode of transmission.

Key Words: Salmonella enterica serotype Typhimurium DT104 • breast milk • neonatal infection • antibacterial susceptibility • real-time PCR • LightCycler • pulsed-field gel electrophoresis • outbreak

Abbreviations: NICU, neonatal intensive care unit • DT104, definitive type 104 • PCR, polymerase chain reaction • ACSSuT, ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline • PFGE, pulsed-field gel electrophoresis

Received for publication Sep 9, 2002; Accepted Dec 12, 2002.




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