Multistate Outbreak of Multidrug-Resistant CampylobacterInfections Linked to Contact with Pet Store Puppies

Outbreak Advisory

67
Cases

15
States

17
Hospitalizations

0
Deaths

CDC, several states, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (USDA-APHIS) are investigating a multistate outbreak of multidrug-resistant Campylobacter infections.

Campylobacter bacteria isolated from clinical samples from people sickened in this outbreak were found to be resistant to commonly recommended, first-line antibiotics. This antibiotic resistance means it may be difficult to treat infections with the outbreak strain with the antibiotics usually prescribed for Campylobacterinfections.

Since the last update on October 3, 2017, 12 more ill people have been reported from 8 states. The most recent illness began on October 14, 2017.

As of October 23, 2017, a total of 67 people with laboratory-confirmed infections or symptoms consistent with Campylobacter infection have been linked to this outbreak. Illnesses have been reported from 15 states.

Of 62 ill people with available information, 17 (27%) have been hospitalized. No deaths have been reported.

Illnesses started on dates ranging from September 15, 2016 to October 14, 2017.

Epidemiologic and laboratory investigations linked this outbreak to contact with pet store puppies.

Of the 67 ill people in this outbreak, 62 (93%) have an epidemiological link to puppies at or from a Petland store.

Eighteen patients were Petland employees.

Forty- four people either recently purchased a puppy from Petland, visited a Petland store, or live in or visited a home with a puppy sold by Petland before their illness began.

Of the other five ill people, four reported contact with puppies from other sources and one had a laboratory-confirmed infection and did not report any puppy exposure.

Whole genome sequencing (WGS) showed that the Campylobacter isolates from ill people and from puppies were closely related genetically.

WGS provides additional evidence that the source of human illness in this outbreak is contact with puppies from Petland.

Antibiotic resistance may be associated with increased risk of hospitalization, development of a bloodstream infection, or treatment failure in patients.

WGS has identified multiple antimicrobial resistance genes and mutations in outbreak-associated isolates from 13 ill people and 8 puppies. This finding matches results from standard antibiotic resistance testingmethods used by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory on 10 clinical isolates from 4 ill people and 6 puppies in this outbreak.

The 10 isolates tested by standard methods were resistant to azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline. In addition, 8 of these isolates were resistant to gentamicin, and 2 of these isolates were resistant to florfenicol.

Follow these steps to prevent illness when handling puppies or dogs:

Always wash your hands thoroughly with soap and water right after touching puppies or picking up their poop.

Work with your veterinarian to keep your animals healthy and prevent diseases.

This investigation is ongoing and we will provide updates as more information becomes available.