Hospital outbreaks of severe gastroenteritis caused by multi-resistant Salmonellatyphimurium have occurred in a number of cities throughout India since 1977. The strains involved belong to phage types 66 or 122, or are untypable; the latter are derived from types 66 or 122 by acquisition of one or more of a number of temperate bacteriophages. Types 66 and 122 are closely related and react with the same phages of the S. typhimurium typing scheme.
A plasmid belonging to compatibility group FIme encoding resistance to ampicillin, chloramphenicol, kanamycin, streptomycin, sulphonamides, spectinomycin, tetracyclines, gentamicin and trimethoprim (R-type ACKSSuSpTGTm) is present in all of the multi-resistant strains. Several other plasmids have been identified including an SSu resistance determinant, a group I2, transfer factor and an R factor coding for resistance to kanamycin, streptomycin and sulphonamides which is compatible with plasmids of all the standard compatibility groups. These plasmids are only present in a proportion of the strains examined.
Examination of strains from other sources has identified a paediatric hospital outbreak in Saudi Arabia and a number of sporadic infections in Great Britain which have been caused by the same organisms. These studies show that, despite differences in phage type and plasmid content, this group of strains belongs to a single clone which has become widespread in India with some extension to other countries.