Antimicrobial Drug-resistant Salmonella Typhimurium (Reply to Helms)

In Reply to Helms: In the article by Helms et al., Helms concludes that infections with Salmonella Typhimurium strains resistant to ampicillin, chloramphenicol, streptomycin, sulfonamide, and tetracycline (hereafter referred to as penta-resistant) were associated with higher death rates than infections with non–penta-resistant S. Typhimurium. Helms also concluded that infections with quinolone-resistant (nalidixine-resistant) S. Typhimurium were associated with higher death rates than quinolone-susceptible S. Typhimurium (1). Table 2 in Helms’ article provides information that enables close scrutiny of this conclusion and comparison of the excess mortality associated with penta-resistant, quinolone-susceptible S. Typhimurium with the excess mortality of non–penta-resistant S. Typhimurium (1). In this letter, the Table is based on the original table. However, two additional comparisons have been added: the p values, which are not based on the data but are approximations based on the parameters in the table. The conclusion is that only quinolone resistance is associated with excess mortality compared with nonresistant isolates. Penta-resistant, quinolone-susceptible S. Typhimurium has a risk ratio of 2.9 (1.1 to 7.9) compared to the ratio of non–penta-resistant isolates 2.1 (1.5 to 2.9). When these figures are compared, the approximate p value is 0.55, which, of course, is far from being significant. Thus, on the basis of the article by Helms, penta resistance may not pose a greater threat to human health than non–penta resistance. However, the measured effect of penta resistance is achieved by the inclusion of quinolone-resistant S. Typhimurium in the group.