Multidrug-Resistant Campylobacter Jejuni Outbreak Linked to Puppy Exposure — United States, 2016–2018

Martha P. Montgomery, MD; Scott Robertson, DVM; Lia Koski, MPH; Ellen Salehi, MPH; Lauren M. Stevenson, MHS; Rachel Silver, MPH; Preethi Sundararaman, MPH; Amber Singh, DVM; Lavin A. Joseph, MS; Mary Beth Weisner; Eric Brandt; Melanie Prarat, MS; Rick Bokanyi, PhD; Jessica C. Chen, PhD; Jason P. Folster, PhD; Christy T. Bennett; Louise K. Francois Watkins, MD; Rachael D. Aubert, PhD; Alvina Chu, MHS; Jennifer Jackson, MPH; Jason Blanton, PhD; Amber Ginn; Kirtana Ramadugu, MPH; Danielle Stanek, DVM; Jamie DeMent, MNS; Jing Cui, DVM; Yan Zhang, DVM, PhD; Colin Basler, DVM; Cindy R. Friedman, MD; Aimee L. Geissler, PhD; Samuel J. Crowe, PhD; Natasha Dowell, MPH; Staci Dixon, MA; Laura Whitlock, MPH; Ian Williams, PhD; Michael A. Jhung, MD; Megin C. Nichols, DVM; Sietske de Fijter, MS; Mark E. Laughlin, DVM


Morbidity and Mortality Weekly Report. 2018;67(37):1032-1035. 

In This Article

Epidemiologic Investigation

Campylobacteriosis became a nationally notifiable condition in 2015, and many states routinely interview patients with campylobacteriosis.* For this investigation, a standardized, supplemental questionnaire was used by state and local health departments to collect dog exposure information from persons with Campylobacter infection who reported recent dog or pet store exposure during routine interview. A case definition relevant to this outbreak (Box) was developed to aid in case finding and characterization.

By February 28, 2018, a total of 118 persons meeting the case definition for Campylobacter infection, including 29 pet store employees, were reported from 18 states. Age was available for 115 persons and ranged from <1 year to 85 years (median = 26 years); 74 of 115 (63%) infected persons were female. Among 107 persons for whom hospitalization information was available, 26 (24%) were hospitalized; no deaths occurred. In total, 105 of 106 (99%) infected persons reported dog exposure, including 101 (95%) who had contact with a pet store puppy (Table). Eight patients reported buying or having contact with puppies from five pet store companies other than company A (companies B–F), indicating that puppies became infected with Campylobacter before reaching pet stores.

State and local health and agriculture departments in four states (Kentucky, Ohio, Pennsylvania, and Wisconsin) visited 20 pet stores and collected antibiotic administration records for 154 puppies. Among 149 puppies with available information, 142 (95%) received one or more antibiotic courses before arriving or while at the store. Among 142 puppies that received antibiotics, treatment indication was available for 134 (94%); 78 (55%) treated puppies received antibiotics for prophylaxis only, 54 (38%) for prophylaxis and treatment, and two (1%) for treatment only. Median antibiotic treatment duration was 15 days (range = 2–67 days). Four antibiotics (metronidazole, sulfadimethoxine, doxycycline, and azithromycin) accounted for 81% of all antibiotics administered (Figure). Use of broad-spectrum antibiotics also was noted, including tetracyclines, quinolones, aminoglycosides, and chloramphenicol.


Number of days of antibiotics administered to 149 pet store puppies* assessed during a multidrug-resistant Campylobacter jejuni outbreak, by type of antibiotic — United States, 2016–2018
Abbreviation: SMX-TMP = sulfamethoxazole-trimethoprim.
*Excludes five puppies with missing information on number of days treated.

Connecticut (two patients), Florida (20), Georgia (five), Illinois (11), Kansas (seven), Massachusetts (two), Maryland (five), Michigan (one), Missouri (two), New Hampshire (two), New York (two), Ohio (34), Oklahoma (one), Pennsylvania (six), Tennessee (two), Utah (four), Wisconsin (nine), and Wyoming (three).