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

*Excludes 12 patients for whom dog exposure questions were unknown.

Authors and Disclosures

Martha P. Montgomery, MD^1,2, Scott Robertson, DVM^2,3, Lia Koski, MPH^3,4, Ellen Salehi, MPH¹, Lauren M. Stevenson, MHS^3,5, Rachel Silver, MPH^3,4, Preethi Sundararaman, MPH^3,6, Amber Singh, DVM¹, Lavin A. Joseph, MS³, Mary Beth Weisner⁷, Eric Brandt¹, Melanie Prarat, MS⁷, Rick Bokanyi, PhD¹, Jessica C. Chen, PhD^3,8, Jason P. Folster, PhD³, Christy T. Bennett^3,8, Louise K. Francois Watkins, MD³, Rachael D. Aubert, PhD³, Alvina Chu, MHS⁹, Jennifer Jackson, MPH⁹, Jason Blanton, PhD¹⁰, Amber Ginn¹⁰, Kirtana Ramadugu, MPH¹⁰, Danielle Stanek, DVM¹⁰, Jamie DeMent, MNS¹⁰, Jing Cui, DVM⁷, Yan Zhang, DVM, PhD⁷, Colin Basler, DVM³, Cindy R. Friedman, MD³, Aimee L. Geissler, PhD³, Samuel J. Crowe, PhD³, Natasha Dowell, MPH^3,8, Staci Dixon, MA³, Laura Whitlock, MPH³, Ian Williams, PhD³, Michael A. Jhung, MD³, Megin C. Nichols, DVM³, Sietske de Fijter, MS¹ and Mark E. Laughlin, DVM<sup>3

1</sup>Ohio Department of Health; ²Epidemic Intelligence Service, CDC; ³Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; ⁴Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee; ⁵Caitta, Inc., Herndon, Virginia; ⁶Atlanta Research and Education Foundation, Atlanta, Georgia; ⁷Ohio Department of Agriculture; ⁸IHRC, Inc., Atlanta, Georgia; ⁹Florida Department of Health in Orange County; ¹⁰Florida Department of Health.

Corresponding author
Martha P. Montgomery, MMontgomery4@cdc.gov, 404–718-7126.

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Sidebar 1

Summary

What is already known about this topic?

Dogs, especially puppies, are a known source of sporadic Campylobacter infections in humans, but are uncommonly reported to cause outbreaks.

What is added by this report?

Investigation of a multistate, multidrug-resistant outbreak of Campylobacter jejuni infections implicated puppies from breeders and distributors sold through pet stores as the outbreak source. Outbreak strains were resistant to all antibiotics commonly used to treat Campylobacter infections.

What are the implications for public health practice?

Consumers, employees, and clinicians should be aware of the risk for disease transmission from puppies, including the possibility of exposure to multidrug-resistant pathogens. Greater adherence to implementation of antibiotic stewardship practices in the commercial dog industry might be needed.

Sidebar 2

Box. Case definition for multidrug-resistant Campylobacter jejuni outbreak linked to puppy exposure — United States, 2016–2018*

Confirmed case

Campylobacteriosis in a patient with onset during January 1, 2016–February 28, 2018, who had either

• A clinical isolate closely related* to the outbreak strains by whole-genome sequencing (WGS), or

• Other laboratory evidence (culture or culture-independent diagnostic testing) of Campylobacter infection and worked in, visited, or had contact with a puppy from a pet store within 7 days before illness onset.

Probable case

An illness compatible with Campylobacter infection in a patient who had worked in, visited, or had contact with a puppy from a pet store within 7 days before illness onset, but without laboratory confirmation of Campylobacter infection.

Exclusion criteria

Exposure criteria met, but isolate unrelated to the outbreak strains by WGS.

*Relatedness of outbreak strains was determined by whole-genome multilocus sequence typing (wgMLST). Because no published wgMLST cutoff values exist, genetic relatedness was determined based on epidemiologic concordance and comparison with background Campylobacter jejuni isolates.