A new wave of Salmonella infections linked to backyard poultry includes cases resistant to first-line antibiotics, according to the latest investigation update from the CDC. Experts point to improper antibiotic use and poor biosecurity and handling practices that likely led to heightened risk amid increasingly common drug-resistant Salmonella cases.

As of April 23, a total of 34 cases of Salmonella across 13 states have been linked to backyard flocks based on epidemiologic, traceback, and lab data, according to the CDC. No deaths have been reported to date, but 13 hospitalizations have been documented. The number of infections is likely higher than currently reported, as many infected individuals recover without being tested or receiving medical care.

The current outbreak appears to be having a greater impact on children, based on the current data. The median age of the 34 cases to date is 12 years, and 41% were younger than 5 years.

Whole-genome sequencing of the 34 confirmed cases predicted resistance to fosfomycin, often used for extensively drug-resistant Salmonella, according to the CDC. Of these, eight samples also predicted resistance to at least one of four other antibiotics: chloramphenicol, streptomycin, sulfisoxazole, and tetracycline.

A Salmonella outbreak in September 2025 that also was traced to backyard poultry included 559 cases in 48 states, with 125 hospitalizations and two deaths according to the CDC.

The Chicken or the Egg?

Several interconnected factors might have contributed to the emergence of multidrug-resistant Salmonella in backyard poultry-linked outbreaks, including the most recent ones, according to Janak Dhakal, PhD, assistant professor of animal science at University of Maryland Eastern Shore, Princess Anne, Maryland.

The primary driver is likely contamination at the hatchery level, said Dhakal, corresponding author of a recent study on Salmonella in backyard poultry published in the Journal of Food Protection.

However, other factors include a lack of proper biosecurity in backyard poultry, such as open housing, poor sanitation, and contact with wildlife, Dhakal told Medscape Medical News. Salmonella persists in the environment, and the improper or unregulated use of antibiotics promotes the development of resistance, he said.

“Multidrug-resistant Salmonella is increasingly common, with can limit treatment options and complicate management,” said Dhakal, who noted the prevalence in a 2025 study. Consequently, clinicians who see patients with suspected Salmonella should expect and consider antimicrobial resistance and include a detailed exposure history, he said. Children younger than 5 years remain a high-risk group because they like to cuddle and handle backyard poultry, Dhakal noted.

In the recent outbreak, the hospitalization of 13 of 34 patients suggests a high level of severity, and some isolates showed resistance to last-line antibiotics for Gram-negative bacteria, such as colistin and fosfomycin, Dhakal said. Use culture and susceptibility testing, when possible, before recommending any antibiotic, he added.

Practice Poultry Hygiene

The CDC continues to recommend safe care and handling practices for individuals who keep backyard flocks. Clinicians should continue to advise patients that even healthy-looking ducks and chickens may carry Salmonella germs that spread easily in the birds’ environments. Handwashing with soap and water (or hand sanitizer) immediately after handling backyard poultry, their eggs, or any items in their environment is essential for infection prevention. In addition, parents and caregivers must remind children not to snuggle with backyard birds and supervise children’s handwashing after handling poultry.

Prevention Plans

Good hygiene practices are essential and foundation, but not all that is needed, Dhakal told Medscape Medical News. The popularity of backyard poultry is expected to continue to rise in the US, and so is the risk for transmission of Salmonella, resulting in recurrent multistate outbreaks and the spread of antimicrobial-resistant strains, he said. More work is needed to improve antimicrobial resistance surveillance in backyard poultry, and to integrate backyard chicken flocks into national antimicrobial resistance and pathogen surveys, Dhakal noted. A better understanding of antibiotic practices in small-scale systems and an evaluation of biosecurity interventions tailored to backyard settings also could help prevent future outbreaks, he said.

Dhakal had no financial conflicts to disclose.