At least 65 people in 9 states have been sickened with the same strain of Salmonella enteritidis linked to tainted eggs, according to an update today from the Centers for Disease Control and Prevention (CDC).

Most sick people are from Wisconsin (42) or Illinois (11). Other states included in the outbreak are Michigan, California, Colorado, Iowa, Minnesota, Utah, and Virginia.

24 people hospitalized 

Of the 65 people sickened, 24 have required hospitalization, and none have died. Patients range in age from 2 to 88 years, with a median age of 55. 

"Data show that eggs supplied by Milo's Poultry Farms LLC are contaminated with Salmonella and are making people sick," the CDC said. Late last week, Milo's Poultry Farms LLC recalled eggs sold to stores and restaurants in Illinois, Michigan, and Wisconsin and labeled with "Milo's Poultry Farms" or "Tony's Fresh Market." All egg types, sizes, and expiration dates are recalled. 

"Several sick people reported eating at the same restaurants before getting sick," the CDC said. "The Wisconsin Department of Health Services identified four illness clusters at restaurants where eggs were served.”

The Wisconsin Department of Health Services identified four illness clusters at restaurants where eggs were served.

The Salmonella strain implicated in the outbreak is resistant to nalidixic acid and ciprofloxacin, which the CDC said may make the illness difficult to treat with some commonly recommended antibiotics.

More than half of respondents to a survey on non-prescription antibiotic use said they would use leftover antibiotics in the future if they were feeling sick, researchers reported today in Antimicrobial Stewardship & Hospital Epidemiology.

The survey, developed by researchers at the Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, was conducted from January 2020 through June 2021 in the waiting rooms of six public, safety-net primary care clinics and two private emergency departments in Texas. To assess patients' endorsement of non-prescription antibiotic use, interviewers asked respondents, "If you were feeling sick, would you take antibiotics in the following situations without contacting a doctor/nurse/dentist/clinic?" and then presented them with 13 predefined situations. 

The researchers grouped patient answers into three situational summary factors: barriers to a doctor visit, accessibility of non-prescription antibiotics, and previous symptom relief with antibiotics. They also analyzed patient demographics.

Leftover antibiotics, previous symptom relief are significant factors

Among the 546 patients surveyed (72% female, 47% Hispanic, 33% Black), the most common situations that would trigger patients to use non-prescription antibiotics were having leftover antibiotics (50.4%), experiencing symptom relief with prior use of antibiotics (47.5%), and perceived high cost of a doctor visit (29.8%). Overall, accessibility of non-prescribed antibiotics (54%) was the most commonly cited situational summary factor, followed by previous symptom relief with antibiotics (53%) and reported barriers to a doctor's visit (37%).

Multivariate regression analysis revealed that younger patients and patients attending the safety-net clinics had higher intended use of non-prescription antibiotics for all three summary factors.

The study authors say the findings highlight the ongoing, systemic problem of overprescribing, and the need for additional education on appropriate antibiotic use.

"Future stewardship interventions should consider the types of situations that drive patients’ decisions to use antibiotics without a prescription," they concluded. "Interventions aimed at reducing barriers to health care (eg, high costs and long waits associated with doctor appointments) and educating individuals on medically appropriate, nonantibiotic treatment options may reduce antibiotic use and antimicrobial resistance."