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1.
Microorganisms ; 9(9)2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34576892

RESUMO

Treatment of Shiga toxin-producing Escherichia coli O157 (O157) diarrhea with antimicrobials might alter the risk of hemolytic uremic syndrome (HUS). However, full characterization of which antimicrobials might affect risk is lacking, particularly among adults. To inform clinical management, we conducted a case-control study of residents of the FoodNet surveillance areas with O157 diarrhea during a 4-year period to assess antimicrobial class-specific associations with HUS among persons with O157 diarrhea. We collected data from medical records and patient interviews. We measured associations between treatment with agents in specific antimicrobial classes during the first week of diarrhea and development of HUS, adjusting for age and illness severity. We enrolled 1308 patients; 102 (7.8%) developed confirmed HUS. Antimicrobial treatment varied by age: <5 years (12.6%), 5-14 (11.5%), 15-39 (45.4%), ≥40 (53.4%). Persons treated with a ß-lactam had higher odds of developing HUS (OR 2.80, CI 1.14-6.89). None of the few persons treated with a macrolide developed HUS, but the protective association was not statistically significant. Exposure to "any antimicrobial" was not associated with increased odds of HUS. Our findings confirm the risk of ß-lactams among children with O157 diarrhea and extends it to adults. We observed a high frequency of inappropriate antimicrobial treatment among adults. Our data suggest that antimicrobial classes differ in the magnitude of risk for persons with O157 diarrhea.

2.
Open Forum Infect Dis ; 5(7): ofy148, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30568988

RESUMO

Background: The relationship between socioeconomic status and Shiga toxin-producing Escherichia coli (STEC) is not well understood. However, recent studies in Connecticut and New York City found that as census tract poverty (CTP) decreased, rates of STEC increased. To explore this nationally, we analyzed surveillance data from laboratory-confirmed cases of STEC from 2010-2014 for all Foodborne Disease Active Surveillance Network (FoodNet) sites, population 47.9 million. Methods: Case residential data were geocoded and linked to CTP level (2010-2014 American Community Survey). Relative rates were calculated comparing incidence in census tracts with <20% of residents below poverty with those with ≥20%. Relative rates of age-adjusted 5-year incidence per 100 000 population were determined for all STEC, hospitalized only and hemolytic-uremic syndrome (HUS) cases overall, by demographic features, FoodNet site, and surveillance year. Results: There were 5234 cases of STEC; 26.3% were hospitalized, and 5.9% had HUS. Five-year incidence was 10.9/100 000 population. Relative STEC rates for the <20% compared with the ≥20% CTP group were >1.0 for each age group, FoodNet site, surveillance year, and race/ethnic group except Asian. Relative hospitalization and HUS rates tended to be higher than their respective STEC relative rates. Conclusions: Persons living in lower CTP were at higher risk of STEC than those in the highest poverty census tracts. This is unlikely to be due to health care-seeking or diagnostic bias as it applies to analysis limited to hospitalized and HUS cases. Research is needed to better understand exposure differences between people living in the lower vs highest poverty-level census tracts to help direct prevention efforts.

3.
J Pediatr ; 166(4): 1022-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25661408

RESUMO

OBJECTIVE: To assess the clinical spectrum of postdiarrheal hemolytic uremic syndrome (D(+)HUS) hospitalizations and sought predictors of in-hospital death to help identify children at risk of poor outcomes. STUDY DESIGN: We assessed clinical variables collected through population-based surveillance of D(+)HUS in children <18 years old hospitalized in 10 states during 1997-2012 as predictors of in-hospital death by using tree modeling. RESULTS: We identified 770 cases. Of children with information available, 56.5% (430 of 761) required dialysis, 92.6% (698 of 754) required a transfusion, and 2.9% (22 of 770) died; few had a persistent dialysis requirement (52 [7.3%] of 716) at discharge. The tree model partitioned children into 5 groups on the basis of 3 predictors (highest leukocyte count and lowest hematocrit value during the 7 days before to 3 days after the diagnosis of hemolytic uremic syndrome, and presence of respiratory tract infection [RTI] within 3 weeks before diagnosis). Patients with greater leukocyte or hematocrit values or a recent RTI had a greater probability of in-hospital death. The largest group identified (n = 533) had none of these factors and had the lowest odds of death. Many children with RTI had recent antibiotic treatment for nondiarrheal indications. CONCLUSION: Most children with D(+)HUS have good hospitalization outcomes. Our findings support previous reports of increased leukocyte count and hematocrit as predictors of death. Recent RTI could be an additional predictor, or a marker of other factors such as antibiotic exposure, that may warrant further study.


Assuntos
Diarreia/complicações , Síndrome Hemolítico-Urêmica/epidemiologia , Vigilância da População/métodos , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Diarreia/terapia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/terapia , Feminino , Hidratação , Seguimentos , Síndrome Hemolítico-Urêmica/etiologia , Síndrome Hemolítico-Urêmica/terapia , Mortalidade Hospitalar/tendências , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
4.
Clin Infect Dis ; 54 Suppl 5: S396-404, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572660

RESUMO

BACKGROUND: Listeriosis can cause severe disease, especially in fetuses, neonates, older adults, and persons with certain immunocompromising and chronic conditions. We summarize US population-based surveillance data for invasive listeriosis from 2004 through 2009. METHODS: We analyzed Foodborne Diseases Active Surveillance Network (FoodNet) data for patients with Listeria monocytogenes isolated from normally sterile sites. We describe the epidemiology of listeriosis, estimate overall and specific incidence rates, and compare pregnancy-associated and nonpregnancy-associated listeriosis by age and ethnicity. RESULTS: A total of 762 listeriosis cases were identified during the 6-year reporting period, including 126 pregnancy-associated cases (17%), 234 nonpregnancy-associated cases(31%) in patients aged <65 years, and 400 nonpregnancy-associated cases (53%) in patients aged ≥ 65 years. Eighteen percent of all cases were fatal. Meningitis was diagnosed in 44% of neonates. For 2004-2009, the overall annual incidence of listeriosis varied from 0.25 to 0.32 cases per 100,000 population. Among Hispanic women, the crude incidence of pregnancy-associated listeriosis increased from 5.09 to 12.37 cases per 100,000 for the periods of 2004-2006 and 2007-2009, respectively; among non-Hispanic women, pregnancy-associated listeriosis increased from 1.74 to 2.80 cases per 100,000 for the same periods. Incidence rates of nonpregnancy-associated listeriosis in patients aged ≥ 65 years were 4-5 times greater than overall rates annually. CONCLUSIONS: Overall listeriosis incidence did not change significantly from 2004 through 2009. Further targeted prevention is needed, including food safety education and messaging (eg, avoiding Mexican-style cheese during pregnancy). Effective prevention among pregnant women, especially Hispanics, and older adults would substantially affect overall rates.


Assuntos
Doenças Transmitidas por Alimentos/epidemiologia , Educação em Saúde/métodos , Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/prevenção & controle , Humanos , Lactente , Recém-Nascido , Listeriose/microbiologia , Listeriose/prevenção & controle , Masculino , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/microbiologia , Meningites Bacterianas/prevenção & controle , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Adulto Jovem
5.
Clin Infect Dis ; 54 Suppl 5: S424-31, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572665

RESUMO

BACKGROUND: Postdiarrheal hemolytic uremic syndrome (HUS) is the most common cause of acute kidney failure among US children. The Foodborne Diseases Active Surveillance Network (FoodNet) conducts population-based surveillance of pediatric HUS to measure the incidence of disease and to validate surveillance trends in associated Shiga toxin-producing Escherichia coli (STEC) O157 infection. METHODS: We report the incidence of pediatric HUS, which is defined as HUS in children <18 years. We compare the results from provider-based surveillance and hospital discharge data review and examine the impact of different case definitions on the findings of the surveillance system. RESULTS: During 2000-2007, 627 pediatric HUS cases were reported. Fifty-two percent of cases were classified as confirmed (diarrhea, anemia, microangiopathic changes, low platelet count, and acute renal impairment). The average annual crude incidence rate for all reported cases of pediatric HUS was 0.78 per 100,000 children <18 years. Regardless of the case definition used, the year-to-year pattern of incidence appeared similar. More cases were captured by provider-based surveillance (76%) than by hospital discharge data review (68%); only 49% were identified by both methods. CONCLUSIONS: The overall incidence of pediatric HUS was affected by key characteristics of the surveillance system, including the method of ascertainment and the case definitions. However, year-to-year patterns were similar for all methods examined, suggesting that several approaches to HUS surveillance can be used to track trends.


Assuntos
Diarreia/epidemiologia , Infecções por Escherichia coli/epidemiologia , Doenças Transmitidas por Alimentos/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Vigilância da População/métodos , Escherichia coli Shiga Toxigênica/isolamento & purificação , Adolescente , Fatores Etários , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Diarreia/complicações , Diarreia/mortalidade , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/mortalidade , Doenças Transmitidas por Alimentos/microbiologia , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Incidência , Lactente , Estados Unidos/epidemiologia
6.
Clin Infect Dis ; 54 Suppl 5: S453-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572669

RESUMO

BACKGROUND: This analysis used data from the most recent Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey (May 2006 through April 2007) to examine differences in the consumption of various types of foods between men and women. METHODS: Participants were surveyed by telephone and asked whether or not they had consumed certain foods in the past 7 days, including the following "high-risk" foods commonly associated with foodborne illness: pink hamburger, raw oysters, unpasteurized milk, cheese made from unpasteurized milk, runny eggs, and alfalfa sprouts. Data were weighted to adjust for survey design and to reflect the age and sex distribution of the population under FoodNet surveillance. RESULTS: A total of 14 878 persons ≥ 18 years were interviewed, of whom 5688 (38%) were men. A higher proportion of men reported eating meat and certain types of poultry than women, whereas a higher proportion of women ate fruits and vegetables. A higher proportion of men than women reported consuming runny eggs (12% versus 8%), pink hamburger (7% versus 4%), and raw oysters (2% versus 0.4%). A higher proportion of women than men ate alfalfa sprouts (3% versus 2%). No differences by sex were observed for consumption of unpasteurized milk or cheese. CONCLUSIONS: Data from the FoodNet Population Surveys can be useful in efforts to design targeted interventions regarding consumption of high-risk foods. Moreover, understanding the background rates of food consumption, stratified by sex, may help investigators identify the kinds of foods likely to be associated with outbreaks in which a preponderance of cases occur among members of one sex.


Assuntos
Dieta , Comportamento Alimentar , Alimentos , Doenças Transmitidas por Alimentos/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Fatores Sexuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention, U.S. , Feminino , Manipulação de Alimentos/métodos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Adulto Jovem
7.
Clin Infect Dis ; 54 Suppl 5: S458-63, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572670

RESUMO

BACKGROUND: Treatment of shigellosis with appropriate antimicrobial agents shortens duration of illness and bacterial shedding, but resistance to commonly used agents is increasing. METHODS: We describe resistance patterns among Shigella isolates in the United States with use of linked data from the Foodborne Diseases Active Surveillance Network (FoodNet) and National Antimicrobial Resistance Monitoring System (NARMS). FoodNet sites send every 20th Shigella isolate to the NARMS laboratory for susceptibility testing. RESULTS: During 2000-2010, the NARMS laboratory tested 1376 Shigella isolates from FoodNet sites. Of 1118 isolates (81%) linked to FoodNet, 826 (74%) were resistant to ampicillin, 649 (58%) to streptomycin, 402 (36%) to trimethoprim-sulfamethoxazole (TMP-SMX), 355 (32%) to sulfamethoxazole-sulfisoxazole, 312 (28%) to tetracycline, 19 (2%) to nalidixic acid, and 6 (0.5%) to ciprofloxacin. The proportion of Shigella isolates with resistance to TMP-SMX was 40% among white persons, 58% among Hispanic persons, and 75% among persons with a history of international travel. Resistance to at least TMP-SMX and ampicillin was present in 25% of isolate, and 5% were resistant to ampicillin, TMP-SMX, and chloramphenicol. Overall, 5% of isolates showed multidrug resistance to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole-sulfisoxazole, and tetracycline, including 49 Shigella flexneri (33%) and 3 Shigella sonnei (0.3%) isolates. Male individuals were more likely than female individuals to be infected with a multidrug-resistant strain (7% versus 3%; P < .01). CONCLUSIONS: Antimicrobial resistance differed by race, ethnicity, age, travel, and species. Resistance to commonly used antibiotics is high; therefore, it is important to look at the susceptibility pattern before starting treatment.


Assuntos
Anti-Infecciosos/farmacologia , Farmacorresistência Bacteriana Múltipla , Disenteria Bacilar/microbiologia , Doenças Transmitidas por Alimentos/microbiologia , Shigella/efeitos dos fármacos , Shigella/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Disenteria Bacilar/etnologia , Feminino , Doenças Transmitidas por Alimentos/etnologia , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Viagem , Estados Unidos , Adulto Jovem
8.
Clin Infect Dis ; 54 Suppl 5: S480-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572673

RESUMO

BACKGROUND: Approximately 40% of US travelers to less developed countries experience diarrheal illness. Using data from the Foodborne Diseases Active Surveillance Network (FoodNet), we describe travel-associated enteric infections during 2004-2009, characterizing the patients, pathogens, and destinations involved. METHODS: FoodNet conducts active surveillance at 10 US sites for laboratory-confirmed infections with 9 pathogens transmitted commonly through food. Travel-associated infections are infections diagnosed in the United States but likely acquired abroad based on a pathogen-specific time window between return from international travel to diagnosis. We compare the demographic, clinical, and exposure-related characteristics of travelers with those of nontravelers and estimate the risk of travel-associated infections by destination, using US Department of Commerce data. RESULTS: Of 64,039 enteric infections reported to FoodNet with information about travel, 8270 (13%) were travel associated. The pathogens identified most commonly in travelers were Campylobacter (42%), nontyphoidal Salmonella (32%), and Shigella (13%). The most common travel destinations were Mexico, India, Peru, Dominican Republic, and Jamaica. Most travel-associated infections occurred in travelers returning from Latin America and the Caribbean (LAC). Risk was greatest after travel to Africa (75.9 cases per 100,000 population), followed by Asia (22.7 cases per 100,000), and LAC (20.0 cases per 100,000). CONCLUSIONS: The Latin America and Caribbean region accounts for most travel-associated enteric infections diagnosed in the United States, although travel to Africa carries the greatest risk. Although FoodNet surveillance does not cover enterotoxigenic Escherichia coli, a common travel-associated infection, this information about other key enteric pathogens can be used by travelers and clinicians in pre- and posttravel consultations.


Assuntos
Diarreia/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/isolamento & purificação , Doenças Transmitidas por Alimentos/epidemiologia , Viagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Diarreia/microbiologia , Infecções por Enterobacteriaceae/transmissão , Exposição Ambiental , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
9.
Emerg Infect Dis ; 17(8): 1553-5, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21801649

RESUMO

We evaluated data from gastroenteritis outbreaks in Oregon to assess sensitivity of stool testing for norovirus and determine number of specimens needed to confirm norovirus as the cause. Norovirus can be readily confirmed if 3-6 specimens are collected any time ≤7 days after onset of diarrhea and for almost that long after symptoms resolve.


Assuntos
Surtos de Doenças , Fezes/virologia , Gastroenterite/diagnóstico , Norovirus/isolamento & purificação , Manejo de Espécimes/métodos , Infecções por Caliciviridae/diagnóstico , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Norovirus/genética , Oregon/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Manejo de Espécimes/estatística & dados numéricos
11.
Foodborne Pathog Dis ; 7(7): 741-7, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20113209

RESUMO

BACKGROUND: An estimated 450,000 cases of shigellosis occur annually in the United States. Outbreaks have been associated with food, water, child daycare centers, and men who have sex with men. However, for sporadic infections, which account for the majority of cases, risk exposures are poorly characterized. METHODS: Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, laboratory-based shigellosis surveillance in 10 US sites. We interviewed cases with illness onset during 2005 about exposures during the week before symptom onset using a standardized questionnaire. The proportion of patients who denied nonfood risks was used to estimate the burden attributable to foodborne transmission. RESULTS: Overall, 1494 cases were identified. The approximate incidence was 3.9/100,000, with the highest rates among children aged 1-4 years (16.4) and Hispanics (8.4). Of the 929 cases interviewed, 223 (24%) reported international travel in the week before symptom onset. Of the 626 nontraveling cases with complete risk factor information, 298 (48%) reported exposure to daycare or a household member with diarrhea; 99 (16%) reported drinking untreated water or recreational exposure to water; and 16 (3%) reported sexual contact with a person with diarrhea. Two hundred and fifty-nine (41%) denied all nonfood exposures examined. CONCLUSIONS: Sporadic shigellosis is most common among young children and Hispanics. Common exposures include international travel and contact with ill persons or daycare. However, more than one-third of US shigellosis cases annually might be due to food consumed in the United States.


Assuntos
Disenteria Bacilar/epidemiologia , Vigilância da População , Distribuição por Idade , Centers for Disease Control and Prevention, U.S. , Disenteria Bacilar/microbiologia , Disenteria Bacilar/transmissão , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Incidência , Fatores de Risco , Shigella/isolamento & purificação , Viagem , Estados Unidos/epidemiologia
12.
Clin Infect Dis ; 49(10): 1480-5, 2009 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-19827953

RESUMO

BACKGROUND: Hemolytic uremic syndrome (HUS) is a life-threatening illness usually caused by infection with Shiga toxin-producing Escherichia coli O157 (STEC O157). We evaluated the age-specific rate of HUS and death among persons with STEC O157 infection and the risk factors associated with developing HUS. METHODS: STEC O157 infections and HUS cases were reported from 8 sites participating in the Foodborne Diseases Active Surveillance Network during 2000-2006. For each case of STEC O157 infection and HUS, demographic and clinical outcomes were reported. The proportion of STEC O157 infections resulting in HUS was determined. RESULTS: A total of 3464 STEC O157 infections were ascertained; 218 persons (6.3%) developed HUS. The highest proportion of HUS cases (15.3%) occurred among children aged <5 years. Death occurred in 0.6% of all patients with STEC O157 infection and in 4.6% of those with HUS. With or without HUS, persons aged 60 years had the highest rate of death due to STEC O157 infection. Twelve (3.1%) of 390 persons aged 60 years died, including 5 (33.3%) of 15 persons with HUS and 7 (1.9%) of 375 without. Among children aged <5 years, death occurred in 4 (3.0%) of those with HUS and 2 (0.3%) of those without. CONCLUSIONS: Young children and females had an increased risk of HUS after STEC O157 infection. With or without HUS, elderly persons had the highest proportion of deaths associated with STEC O157 infection. These data support recommendations for aggressive supportive care of young children and the elderly early during illness due to STEC O157.


Assuntos
Escherichia coli O157/isolamento & purificação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Morte , Escherichia coli , Infecções por Escherichia coli , Feminino , Doenças Transmitidas por Alimentos , Síndrome Hemolítico-Urêmica , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Antimicrob Agents Chemother ; 52(4): 1278-84, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18212096

RESUMO

Patients with typhoid fever due to Salmonella enterica serotype Typhi strains for which fluoroquinolones MICs are elevated yet that are classified as susceptible by the current interpretive criteria of the Clinical and Laboratory Standards Institute may not respond adequately to fluoroquinolone therapy. Patients from seven U.S. states with invasive Salmonella serotype Typhi infection between 1999 and 2002 were enrolled in a multicenter retrospective cohort study. Patients infected with Salmonella serotype Typhi isolates with ciprofloxacin MICs of 0.12 to 1 microg/ml (decreased ciprofloxacin susceptibility but not resistant to ciprofloxacin [DCS]) were compared with patients infected with isolates with ciprofloxacin MICs <0.12 microg/ml for fever clearance time and treatment failure. Of 71 patients, 30 (43%) were female and 24 (34%) were infected with Salmonella serotype Typhi with DCS; the median age was 14 years (range, 1 to 51 years). Twenty-one (88%) of 24 isolates with DCS were resistant to nalidixic acid. The median antimicrobial-related fever clearance times in the DCS and non-DCS groups were 92 h (range, 21 to 373 h) and 72 h (range, 19 to 264 h) (P = 0.010), respectively, and the fluoroquinolone-related fever clearance times in the DCS and non-DCS groups were 90 h (range, 9 to 373 h) and 64 h (range, 34 to 204 h) (P = 0.153), respectively. Four (17%) of 24 patients in the DCS group and 2 (4%) of 46 patients in the non-DCS group (relative risk, 2.5; 95% confidence interval, 1.2 to 5.1) experienced treatment failure. Associations persisted after adjustment for potential confounders. We demonstrate that patients infected with Salmonella serotype Typhi isolates with DCS show evidence of a longer time to fever clearance and more frequent treatment failure. Nalidixic acid screening does not detect all isolates with DCS.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Fluoroquinolonas/farmacologia , Salmonella typhi/efeitos dos fármacos , Febre Tifoide/tratamento farmacológico , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Ciprofloxacina/farmacologia , Ciprofloxacina/uso terapêutico , Estudos de Coortes , Feminino , Fluoroquinolonas/uso terapêutico , Doenças Transmitidas por Alimentos/epidemiologia , Hospitalização , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana/normas , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Resultado do Tratamento , Febre Tifoide/microbiologia , Estados Unidos
14.
Pediatr Infect Dis J ; 26(1): 19-24, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17195700

RESUMO

BACKGROUND: Campylobacter is an important cause of foodborne illness in infants (younger than 1 year of age), but little is known about the sources of infection in this age group. METHODS: Eight sites in the Foodborne Diseases Active Surveillance Network (FoodNet) participated in a 24-month population-based case-control study conducted in 2002-2004. Cases were infants with laboratory-confirmed Campylobacter infection ascertained through active laboratory surveillance, and controls were infants in the community. RESULTS: We enrolled 123 cases and 928 controls. Infants 0-6 months of age with Campylobacter infection were less likely to be breast-fed than controls [odds ratio (OR); 0.2; 95% confidence interval (CI), 0.1-0.6]. Risk factors for infants 0-6 months of age included drinking well water (OR 4.4; CI, 1.4-14) and riding in a shopping cart next to meat or poultry (OR 4.0; CI, 1.2-13.0). Risk factors for infants 7-11 months of age included visiting or living on a farm (OR 6.2; CI, 2.2-17), having a pet with diarrhea in the home (OR 7.6; CI, 2.1-28) and eating fruits and vegetables prepared in the home (OR 2.5, CI 1.2-4.9). Campylobacter infection was associated with travel outside the United States at all ages (OR 19.3; CI, 4.5-82.1). CONCLUSIONS: Several unique protective and risk factors were identified among infants, and these risk factors vary by age, suggesting that prevention measures be targeted accordingly. Breast-feeding was protective for the youngest infants and should continue to be encouraged.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter/isolamento & purificação , Infecções por Campylobacter/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Masculino , Vigilância da População , Fatores de Risco
15.
Clin Infect Dis ; 44(4): 513-20, 2007 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-17243053

RESUMO

BACKGROUND: Listeriosis is a leading cause of death among patients with foodborne diseases in the United States. Monitoring disease incidence is an important element of listeriosis surveillance and control. METHOD: We conducted population-based surveillance for Listeria monocytogenes isolates obtained from normally sterile sites at all clinical diagnostic laboratories in the Foodborne Diseases Active Surveillance Network from 1996 through 2003. RESULTS: The incidence of laboratory-confirmed invasive listeriosis decreased by 24% from 1996 through 2003; pregnancy-associated disease decreased by 37%, compared with a decrease of 23% for patients > or =50 years old. The highest incidence was reported among Hispanic persons from 1997 through 2001. Differences in incidence by age group and ethnicity may be explained by dietary preferences. CONCLUSION: The marked decrease in the incidence of listeriosis may be related to the decrease in the prevalence of L. monocytogenes contamination of ready-to-eat foods since 1996. The crude incidence in 2003 of 3.1 cases per 1 million population approaches the government's Healthy People objective of 2.5 cases per 1 million population by 2005. Further decreases in listeriosis incidence will require continued efforts of industry and government to reduce contamination of food and continued efforts to educate consumers and clinicians.


Assuntos
Bacteriemia/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Bacteriemia/diagnóstico , Criança , Pré-Escolar , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Incidência , Lactente , Listeriose/diagnóstico , Masculino , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Taxa de Sobrevida , Estados Unidos/epidemiologia
16.
Clin Infect Dis ; 44(4): 521-8, 2007 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-17243054

RESUMO

BACKGROUND: Listeria monocytogenes has been estimated to cause >2500 illnesses and 500 deaths annually in the United States. Efforts to reduce foodborne listeriosis have focused on foods frequently implicated in outbreaks. Potential sources for L. monocytogenes infection not associated with outbreaks remain poorly understood. METHODS: The Foodborne Diseases Active Surveillance Network conducts surveillance for culture-confirmed listeriosis at clinical laboratories in 9 states. After excluding outbreak-associated cases, we attempted to enroll eligible case patients with L. monocytogenes infection in a case-control study from 2000 through 2003. Control subjects were recruited through health care providers and were matched to case patients by state, age, and immunosuppression status. Data were collected about exposures occurring in the 4 weeks before specimen collection from the case patients. RESULTS: Of the 249 case patients with L. monocytogenes infection, only 12 (5%) had cases that were associated with outbreaks; 6 other patients were ineligible for other reasons. Of 231 eligible case patients, 169 (73%) were enrolled in the study. We classified 28 case patients as having pregnancy-associated cases. We enrolled 376 control subjects. In multivariable analysis, L. monocytogenes infection was associated with eating melons at a commercial establishment (odds ratio, 2.6; 95% confidence interval, 1.4-5.0) and eating hummus prepared in a commercial establishment (odds ratio, 5.7; 95% confidence interval, 1.7-19.1). CONCLUSIONS: Most cases of L. monocytogenes infection were not associated with outbreaks. Reducing the burden of foodborne listeriosis may require interventions directed at retail environments and at foods, such as melons and hummus, that are not commonly recognized as high risk. Because of the severity of listeriosis, pregnant women and other persons at risk may wish to avoid eating these newly implicated foods.


Assuntos
Contaminação de Alimentos/estatística & dados numéricos , Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Alimentos , Manipulação de Alimentos , Conservação de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Incidência , Lactente , Listeriose/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Valores de Referência , Fatores de Risco , Distribuição por Sexo , Taxa de Sobrevida , Estados Unidos/epidemiologia
17.
Pediatrics ; 118(6): 2380-7, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17142522

RESUMO

OBJECTIVE: Rates of Salmonella infection are highest in infants, but little is known about potential sources of infection in this high-risk population. We performed a case-control study to identify dietary and environmental risk factors for sporadic salmonellosis among infants. PATIENTS AND METHODS: In 2002-2004, the Foodborne Diseases Active Surveillance Network conducted a population-based, case-control study of sporadic salmonellosis among infants <1 year of age in 8 states. Cases were identified via active laboratory-based surveillance. Healthy controls were frequency matched by age and identified through birth registries or published birth announcements. We assessed diet and environmental exposures in the 5 days before illness onset or interview. Data were analyzed by using logistic regression adjusting for age. RESULTS: The study enrolled 442 subjects and 928 controls. Compared with healthy controls, infants with Salmonella infection were less likely to have been breastfed and more likely to have had exposure to reptiles, to have ridden in a shopping cart next to meat or poultry, or to have consumed concentrated liquid infant formula during the 5-day exposure period. Travel outside the United States was associated with illness in infants 3 to 6 and >6 months of age. Attending day care with a child with diarrhea was associated with salmonellosis in infants >6 months of age. CONCLUSIONS: We identified a number of modifiable protective and risk factors for salmonellosis in infants. Attention should be directed at developing effective preventive measures for this high-risk population.


Assuntos
Infecções por Salmonella/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Masculino , Fatores de Risco
18.
J Infect Dis ; 194(2): 222-30, 2006 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-16779729

RESUMO

BACKGROUND: A new multidrug-resistant (MDR) strain of Salmonella serotype Newport, Newport-MDRAmpC, has recently emerged. We sought to identify the medical, behavioral, and dietary risk factors for laboratory-confirmed Salmonella Newport infection, including that with Newport-MDRAmpC. METHODS: A 12-month population-based case-control study was conducted during 2002-2003 in 8 sites of the Foodborne Diseases Active Surveillance Network (FoodNet), with 215 case patients with Salmonella Newport infection and 1154 healthy community control subjects. RESULTS: Case patients with Newport-MDRAmpC infection were more likely than control subjects to have taken an antimicrobial agent to which Newport-MDRAmpC is resistant during the 28 days before the onset of diarrheal illness (odds ratio [OR], 5.0 [95% confidence interval {CI}, 1.6-16]). Case patients with Newport-MDRAmpC infection were also more likely to have eaten uncooked ground beef (OR, 7.8 [95% CI, 1.4-44]) or runny scrambled eggs or omelets prepared in the home (OR, 4.9 [95% CI, 1.3-19]) during the 5 days before the onset of illness. International travel was not a risk factor for Newport-MDRAmpC infection but was a strong risk factor for pansusceptible Salmonella Newport infection (OR, 7.1 [95% CI, 2.0-24]). Case patients with pansusceptible infection were also more likely to have a frog or lizard in their household (OR, 2.9 [95% CI, 1.1-7.7]). CONCLUSIONS: Newport-MDRAmpC infection is acquired through the US food supply, most likely from bovine and, perhaps, poultry sources, particularly among persons already taking antimicrobial agents.


Assuntos
Proteínas de Bactérias/metabolismo , Farmacorresistência Bacteriana Múltipla , Microbiologia de Alimentos , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/transmissão , Salmonella/classificação , Salmonella/isolamento & purificação , beta-Lactamases/metabolismo , Animais , Antibacterianos/farmacologia , Estudos de Casos e Controles , Bovinos , Ovos/microbiologia , Humanos , Carne/microbiologia , Razão de Chances , Fatores de Risco , Salmonella/efeitos dos fármacos , Salmonella/enzimologia , Infecções por Salmonella/microbiologia , Estados Unidos/epidemiologia
19.
Pediatr Infect Dis J ; 25(2): 129-34, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16462289

RESUMO

BACKGROUND: Previous studies of bacterial enteric infections have suggested a disproportionate disease burden for children younger than 5 years of age. OBJECTIVES: This study describes population-based incidence of culture-confirmed infections with 6 bacterial enteric pathogens in children younger than 5 years of age in the Foodborne Diseases Active Surveillance Network (FoodNet), 1996-1998. METHODS: Cases were ascertained through active laboratory-based surveillance in Minnesota, Oregon and selected counties in California, Connecticut, Georgia, Maryland and New York. RESULTS: Twenty-one percent (5218 of 24,358) of infections were in children younger than 5 years of age, but this age group made up only 7% of the total person-years of observation. Among those younger than 5 years of age, the incidence (cases per 100,000 person-years) for each pathogen was: Salmonella, 55.3; Campylobacter, 43.4; Shigella, 32.7; E. coli O157, 10.3; Yersinia enterocolitica, 7.1; Listeria monocytogenes, 0.7. Incidence varied widely among the 7 FoodNet sites. CONCLUSIONS: This study confirmed a disproportionate disease burden in young children. Investigation of risk factors specific to this age group and review and enhancement of current prevention and control strategies for children younger than 5 years of age may reduce illness.


Assuntos
Infecções Bacterianas/epidemiologia , Gastroenterite/epidemiologia , Vigilância da População , Infecções Bacterianas/microbiologia , Campylobacter , Pré-Escolar , Gastroenterite/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Listeria monocytogenes/isolamento & purificação , Fatores de Risco , Estações do Ano
20.
Microb Drug Resist ; 11(4): 371-7, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16359197

RESUMO

Multidrug-resistant Salmonella Newport with decreased susceptibility to ceftriaxone (MDR-AmpC) is becoming increasingly common in its food animal reservoirs and in humans. Few data exist on rates of antimicrobial use or differences in clinical outcomes in persons infected with MDR-AmpC or other Salmonella strains. We conducted a case-comparison analysis of data from a multistate population-based case-control study to identify antimicrobial treatment choices and differences in clinical outcomes in those infected with MDRAmpC compared to pansusceptible S. Newport. Of isolates from 215 laboratory-confirmed S. Newport cases, 54 (25%) were MDR-AmpC, 146 (68%) were pansusceptible, and 15 (7%) had other resistance patterns; 146 (68%) patients with S. Newport were treated with antimicrobial agents and 66 (33%) were hospitalized. Over two-thirds of cases at low-risk for serious complications received antimicrobial therapy, most commonly with fluoroquinolones, to which this strain was susceptible. There were no significant differences in symptoms, hospitalization, duration of illness, or other outcomes between the persons infected with MDR-AmpC and pansusceptible S. Newport. Although currently prevalent MDR-AmpC S. Newport strains remains susceptible to the antimicrobial most commonly prescribed for it, continued efforts to reduce unnecessary use of antimicrobial agents in food animals and humans are critical to prevent further development of resistance to quinolones and cephalosporins, which is likely to lead to substantial adverse outcomes.


Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Infecções por Salmonella/tratamento farmacológico , Salmonella/efeitos dos fármacos , Adulto , Idoso , Estudos de Casos e Controles , Ceftriaxona/farmacologia , Pré-Escolar , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Salmonella/isolamento & purificação , Resultado do Tratamento
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