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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.
MMWR Morb Mortal Wkly Rep ; 70(38): 1332-1336, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34555002

RESUMO

Foodborne illnesses are a substantial and largely preventable public health problem; before 2020 the incidence of most infections transmitted commonly through food had not declined for many years. To evaluate progress toward prevention of foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food reported by 10 U.S. sites.* FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration. This report summarizes preliminary 2020 data and describes changes in incidence with those during 2017-2019. During 2020, observed incidences of infections caused by enteric pathogens decreased 26% compared with 2017-2019; infections associated with international travel decreased markedly. The extent to which these reductions reflect actual decreases in illness or decreases in case detection is unknown. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. After the declaration, state and local officials implemented stay-at-home orders, restaurant closures, school and child care center closures, and other public health interventions to slow the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Federal travel restrictions were declared (1). These widespread interventions as well as other changes to daily life and hygiene behaviors, including increased handwashing, have likely changed exposures to foodborne pathogens. Other factors, such as changes in health care delivery, health care-seeking behaviors, and laboratory testing practices, might have decreased the detection of enteric infections. As the pandemic continues, surveillance of illness combined with data from other sources might help to elucidate the factors that led to the large changes in 2020; this understanding could lead to improved strategies to prevent illness. To reduce the incidence of these infections concerted efforts are needed, from farm to processing plant to restaurants and homes. Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations.


Assuntos
COVID-19/epidemiologia , Microbiologia de Alimentos/estatística & dados numéricos , Parasitologia de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Pandemias , Conduta Expectante , Adolescente , Criança , Pré-Escolar , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Lactente , Estados Unidos/epidemiologia
3.
J Infect Dis ; 217(6): 1000-1010, 2018 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-29216383

RESUMO

Background: Postdiarrheal hemolytic-uremic syndrome (D+HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is a serious condition lacking specific treatment. Host immune dysregulation and genetic susceptibility to complement hyperactivation are implicated in non-STEC-related HUS. However, genetic susceptibility to D+HUS remains largely uncharacterized. Methods: Patients with culture-confirmed STEC diarrhea, identified through the Centers for Disease Control and Prevention FoodNet surveillance system (2007-2012), were serotyped and classified by laboratory and/or clinical criteria as having suspected, probable, or confirmed D+HUS or as controls and underwent genotyping at 200 loci linked to nondiarrheal HUS or similar pathologies. Genetic associations with D+HUS were explored by multivariable regression, with adjustment for known risk factors. Results: Of 641 enrollees with STEC O157:H7, 80 had suspected D+HUS (41 with probable and 32 with confirmed D+HUS). Twelve genes related to cytokine signaling, complement pathways, platelet function, pathogen recognition, iron transport, and endothelial function were associated with D+HUS in multivariable-adjusted analyses (P ≤ .05). Of 12 significant single-nucleotide polymorphisms (SNPs), 5 were associated with all levels of D+HUS (intergenic SNP rs10874639, TFRC rs3804141, EDN1 rs5370, GP1BA rs121908064, and B2M rs16966334), and 7 SNPs (6 non-complement related) were associated with confirmed D+HUS (all P < .05). Conclusions: Polymorphisms in many non-complement-related genes may contribute to D+HUS susceptibility. These results require replication, but they suggest novel therapeutic targets in patients with D+HUS.


Assuntos
Centers for Disease Control and Prevention, U.S. , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Predisposição Genética para Doença , Síndrome Hemolítico-Urêmica/genética , Escherichia coli Shiga Toxigênica/patogenicidade , Adolescente , Criança , Pré-Escolar , Diarreia/complicações , Diarreia/microbiologia , Feminino , Síndrome Hemolítico-Urêmica/patologia , Humanos , Masculino , Fatores de Risco , Estados Unidos
4.
Emerg Infect Dis ; 20(9): 1520-3, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25148394

RESUMO

During 2003-2009, we identified 544 cases of Cronobacter spp. infection from 6 US states. The highest percentage of invasive infections occurred among children <5 years of age; urine isolates predominated among adults. Rates of invasive infections among infants approximate earlier estimates. Overall incidence of 0.66 cases/100,000 population was higher than anticipated.


Assuntos
Cronobacter , Infecções por Bactérias Gram-Negativas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Cronobacter/isolamento & purificação , Infecções por Bactérias Gram-Negativas/história , Infecções por Bactérias Gram-Negativas/prevenção & controle , História do Século XXI , Humanos , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Vigilância da População , Estados Unidos , Adulto Jovem
5.
Am J Public Health ; 104(7): e108-14, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24832415

RESUMO

OBJECTIVES: The objective of this study was to determine the role international travel plays in US Campylobacter epidemiology and antimicrobial resistance. METHODS: In this study, epidemiological and antimicrobial resistance data, encompassing the years 2005 to 2011, from 10 sites participating in the Foodborne Diseases Active Surveillance Network were linked. The 10 sites are represented by 7 states that conducted surveillance on a statewide level, and 3 states which conducted county-level surveillance. Cases of Campylobacter among persons with history of international travel in the week prior to illness were compared with cases among individuals with no international travel. RESULTS: Approximately 18% of Campylobacter infections were estimated to be associated with international travel, and 60% of international travel-associated infections had a quinolone-resistant Campylobacter isolate. CONCLUSIONS: We confirm that international travel plays a significant role in campylobacteriosis diagnosed in the United States. Recognizing this is important to both medical management decisions and understanding burden and attribution estimates of US campylobacteriosis and antibiotic-resistant campylobacteriosis.


Assuntos
Infecções por Campylobacter/epidemiologia , Farmacorresistência Bacteriana , Doenças Transmitidas por Alimentos/epidemiologia , Viagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Feminino , Fluoroquinolonas/farmacologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
6.
Foodborne Pathog Dis ; 10(5): 453-60, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23560425

RESUMO

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of postdiarrheal hemolytic uremic syndrome. Non-O157 STEC infections are being recognized with greater frequency because of changing laboratory practices. METHODS: Foodborne Diseases Active Surveillance Network (FoodNet) site staff conducted active, population-based surveillance for laboratory-confirmed STEC infections. We assessed frequency and incidence of STEC infections by serogroup and examined and compared demographic factors, clinical characteristics, and frequency of international travel among patients. RESULTS: During 2000-2010, FoodNet sites reported 2006 cases of non-O157 STEC infection and 5688 cases of O157 STEC infections. The number of reported non-O157 STEC infections increased from an incidence of 0.12 per 100,000 population in 2000 to 0.95 per 100,000 in 2010; while the rate of O157 STEC infections decreased from 2.17 to 0.95 per 100,000. Among non-O157 STEC, six serogroups were most commonly reported: O26 (26%), O103 (22%), O111 (19%), O121 (6%), O45 (5%), and O145 (4%). Non-O157 STEC infections were more common among Hispanics, and infections were less severe than those caused by O157 STEC, but this varied by serogroup. Fewer non-O157 STEC infections were associated with outbreaks (7% versus 20% for O157), while more were associated with international travel (14% versus 3% for O157). CONCLUSIONS: Improved understanding of the epidemiologic features of non-O157 STEC infections can inform food safety and other prevention efforts. To detect both O157 and non-O157 STEC infections, clinical laboratories should routinely and simultaneously test all stool specimens submitted for diagnosis of acute community-acquired diarrhea for O157 STEC and for Shiga toxin and ensure that isolates are sent to a public health laboratory for serotyping and subtyping.


Assuntos
Infecções por Escherichia coli/epidemiologia , Escherichia coli O157/isolamento & purificação , Doenças Transmitidas por Alimentos/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Vigilância da População , Escherichia coli Shiga Toxigênica/isolamento & purificação , Adolescente , Adulto , Criança , Demografia , Diarreia , Surtos de Doenças , Infecções por Escherichia coli/microbiologia , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Incidência , Masculino , Antígenos O/imunologia , Sorotipagem , Toxina Shiga/metabolismo , Escherichia coli Shiga Toxigênica/classificação , Viagem , Estados Unidos/epidemiologia , Adulto Jovem
7.
Clin Infect Dis ; 54 Suppl 5: S421-3, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572664

RESUMO

Accurate information about deaths is important when determining the human health and economic burden of foodborne diseases. We reviewed death certificate data to assess the accuracy of deaths reported to the Foodborne Diseases Active Surveillance Network (FoodNet). Data were highly accurate, and few deaths were missed through active surveillance.


Assuntos
Infecções Bacterianas/mortalidade , Centers for Disease Control and Prevention, U.S./normas , Atestado de Óbito , Doenças Transmitidas por Alimentos/mortalidade , Doenças Parasitárias/mortalidade , Vigilância da População , Sistema de Registros/normas , Infecções Bacterianas/epidemiologia , Causas de Morte , Humanos , Doenças Parasitárias/epidemiologia , Estados Unidos/epidemiologia
8.
Clin Infect Dis ; 54 Suppl 5: S440-5, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22572667

RESUMO

BACKGROUND: Campylobacter is a leading cause of foodborne illness in the United States. Understanding laboratory practices is essential to interpreting incidence and trends in reported campylobacteriosis over time and provides a baseline for evaluating the increasing use of culture-independent diagnostic methods for Campylobacter infection. METHODS: The Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance for laboratory-confirmed Campylobacter infections. In 2005, FoodNet conducted a survey of clinical laboratories to describe routine practices used for isolation and identification of Campylobacter. A profile was assigned to laboratories based on complete responses to key survey questions that could impact the recovery and isolation of Campylobacter from stool specimens. RESULTS: Of 411 laboratories testing on-site for Campylobacter, 97% used only culture methods. Among those responding to the individual questions, nearly all used transport medium (97%) and incubated at 42°C (94%); however, most deviated from existing guidelines in other areas: 68% held specimens in transport medium at room temperature before plating, 51% used Campy blood agar plate medium, 52% read plates at <72 hours of incubation, and 14% batched plates before placing them in a microaerobic environment. In all, there were 106 testing algorithms among 214 laboratories with a complete profile; only 16 laboratories were fully adherent to existing guidelines. CONCLUSIONS: Although most laboratories used culture-based methods, procedures differed widely and most did not adhere to existing guidelines, likely resulting in underdiagnosis. Given the availability of new culture-independent testing methods, these data highlight a clear need to develop best practice recommendations for Campylobacter infection diagnostic testing.


Assuntos
Infecções por Campylobacter/microbiologia , Campylobacter/isolamento & purificação , Doenças Transmitidas por Alimentos/microbiologia , Técnicas Bacteriológicas , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , Centers for Disease Control and Prevention, U.S. , Surtos de Doenças , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Incidência , Laboratórios , Vigilância da População , Estados Unidos/epidemiologia
9.
Foodborne Pathog Dis ; 8(4): 555-60, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21186994

RESUMO

Clinical laboratory practices affect patient care and disease surveillance. It is recommended that laboratories routinely use both culture for Escherichia coli O157 and a method that detects Shiga toxins (Stx) to identify all Stx-producing E. coli (STEC) and that labs send broths or isolates to a public health laboratory. In 2007, we surveyed laboratories serving Foodborne Diseases Active Surveillance Network sites that performed on-site enteric disease diagnostic testing to determine their culture and nonculture-based testing practices for STEC identification. Our goals were to measure changes over time in laboratory practices and to compare reported practices with published recommendations. Overall, 89% of laboratories used only culture-based methods, 7% used only Stx enzyme immunoassay (EIA), and 4% used both Stx EIA and culture-based methods. Only 2% of laboratories reported simultaneous culture for O157 STEC and use of Stx EIA. The proportion that ever used Stx EIA increased from 6% in 2003 to 11% in 2007. The proportion that routinely tested all specimens with at least one method was 66% in 2003 versus 71% in 2007. Reference laboratories were less likely than others to test all specimens routinely by one or more of these methods (48% vs. 73%, p=0.03). As of 2007, most laboratories complied with recommendations for O157 STEC testing by culture but not with recommendations for detection of non-O157 STEC. The proportion of laboratories that culture stools for O157 STEC has changed little since 2003, whereas testing for Stx has increased.


Assuntos
Técnicas de Tipagem Bacteriana , Enterite/microbiologia , Infecções por Escherichia coli/microbiologia , Vigilância de Evento Sentinela , Escherichia coli Shiga Toxigênica/classificação , Escherichia coli Shiga Toxigênica/isolamento & purificação , Técnicas de Tipagem Bacteriana/tendências , Centers for Disease Control and Prevention, U.S. , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Escherichia coli O157/classificação , Escherichia coli O157/isolamento & purificação , Escherichia coli O157/metabolismo , Fezes/microbiologia , Fidelidade a Diretrizes , Humanos , Toxina Shiga/metabolismo , Escherichia coli Shiga Toxigênica/metabolismo , Inquéritos e Questionários , Estados Unidos/epidemiologia
10.
Eur J Public Health ; 20(4): 443-8, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20034929

RESUMO

BACKGROUND: An age-matched case-control study was conducted in northeastern Spain to identify major risk factors for sporadic Campylobacter infections and their relative importance. METHODS: Cases were aged >6 months, residents of Sector Sanitario Huesca with diarrhea and confirmed culture of Campylobacter not related to outbreak. For each case <15 years of age, the patient closest in age to the case was selected from the medical records of the case's pediatrician to serve as a control. If the case was >or=15 years of age, the control was nominated by the case. RESULTS: Eighty one cases (median age 2.3 years, 79% <15 years) and 81 controls were enrolled. Three exposures, in the 7 days prior to symptom onset, were independent predictors for illness after multivariate conditional logistic regression analysis: consuming three or more times chicken [odds ratio (OR)(adjusted) = 6.1; confidence interval (CI): 2.0-18.5; population attributable fraction (PAF) = 36.1%], consuming sliced deli meat unhygienically handled at retail stores (OR(adjusted) = 4.1; CI: 1.2-13.2; PAF = 24.5%) and contact with animals (OR(adjusted) = 2.8; CI: 1.1-7.3; PAF = 19. 0%). Among cases <15 years of age, only consuming chicken >or=3 times (OR(adjusted) = 7.8; CI: 2.2-26.7; PAF = 43.6%) and contact with animals (OR(adjusted) = 3.7; CI: 1.2-11.0; PAF = 25.1%) were independent predictors for disease. Consuming sliced deli meat unhygienically handled at retail stores was significantly more frequent among <15-year age group (56.3% versus 26.6.0%, P = 0.04). CONCLUSION: A control programme for Campylobacter in the food chain and targeted food-safety education to prevent cross-contamination seem warranted to decrease the opportunity of human exposure to the pathogen in northeastern Spain.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter/isolamento & purificação , Adolescente , Adulto , Distribuição por Idade , Análise de Variância , Estudos de Casos e Controles , Criança , Pré-Escolar , Exposição Ambiental , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Lactente , Fatores de Risco , Espanha/epidemiologia
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