Risk Factors for Non-O157 Shiga Toxin-Producing Escherichia coli Infections, United States.

Shiga toxin-producing Escherichia coli (STEC) causes acute diarrheal illness. To determine risk factors for non-O157 STEC infection, we enrolled 939 patients and 2,464 healthy controls in a case-control study conducted in 10 US sites. The highest population-attributable fractions for domestically acquired infections were for eating lettuce (39%), tomatoes (21%), or at a fast-food restaurant (23%). Exposures with 10%-19% population attributable fractions included eating at a table service restaurant, eating watermelon, eating chicken, pork, beef, or iceberg lettuce prepared in a restaurant, eating exotic fruit, taking acid-reducing medication, and living or working on or visiting a farm. Significant exposures with high individual-level risk (odds ratio >10) among those >1 year of age who did not travel internationally were all from farm animal environments. To markedly decrease the number of STEC-related illnesses, prevention measures should focus on decreasing contamination of produce and improving the safety of foods prepared in restaurants.

Predicting Food Sources of Listeria monocytogenes Based on Genomic Profiling Using Random Forest Model.

Listeria monocytogenes can cause severe foodborne illness, including miscarriage during pregnancy or death in newborn infants. When outbreaks of L. monocytogenes illness occur, it may be possible to determine the food source of the outbreak. However, most reported L. monocytogenes illnesses do not occur as part of a recognized outbreak and most of the time the food source of sporadic L. monocytogenes illness in people cannot be determined. In the United States, L. monocytogenes isolates from patients, foods, and environments are routinely sequenced and analyzed by whole genome multilocus sequence typing (wgMLST) for outbreak detection by PulseNet, the national molecular surveillance system for foodborne illnesses. We investigated whether machine learning approaches applied to wgMLST allele call data could assist in attribution analysis of food source of L. monocytogenes isolates. We compiled isolates with a known source from five food categories (dairy, fruit, meat, seafood, and vegetable) using the metadata of L. monocytogenes isolates in PulseNet, deduplicated closely genetically related isolates, and developed random forest models to predict the food sources of isolates. Prediction accuracy of the final model varied across the food categories; it was highest for meat (65%), followed by fruit (45%), vegetable (45%), dairy (44%), and seafood (37%); overall accuracy was 49%, compared with the naive prediction accuracy of 28%. Our results show that random forest can be used to capture genetically complex features of high-resolution wgMLST for attribution of isolates to their sources.

Salmonella Serotypes Associated with Illnesses after Thanksgiving Holiday, United States, 1998-2018.

We sought to determine which Salmonella serotypes cause illness related to the Thanksgiving holiday in the United States and to foods disproportionately eaten then (e.g., turkey). Using routine surveillance for 1998-2018 and a case-crossover design, we found serotype Reading to be most strongly associated with Thanksgiving.

Nearest-Neighbors Matching for Case-Control Study Analyses: Better Risk Factor Identification From a Study of Sporadic Campylobacteriosis in the United States.

BACKGROUND: Case-control studies are commonly used to explore factors associated with enteric bacterial diseases. Control of confounding is challenging due to a large number of exposures of interest and the low frequencies of many of them. METHODS: We evaluated nearest-neighbors matching in a case-control study (originally 1:1 matched, published in 2004) of sporadic Campylobacter infections that included information on 433 exposures in 2632 subjects during 1998-1999. We performed multiple imputations of missing data (m = 100) and calculated Gower distances between cases and controls using all possible confounders for each exposure in each dataset. We matched each case with ≤20 controls within a data-determined distance. We calculated odds ratios and population attributable fractions (PAFs). RESULTS: Examination of pairwise correlation between exposures found very strong associations for 1046 pairs of exposures. More than 100 exposures were associated with campylobacteriosis, including nearly all risk factors identified using the previously published approach that included only 16 exposures and some less studied, rare exposures such as consumption of chicken liver and raw clams. Consumption of chicken and nonpoultry meat had the highest PAFs (62% and 59%, respectively). CONCLUSIONS: Nearest-neighbors matching appear to provide an improved ability to examine rare exposures and better control for numerous highly associated confounders.

Seasonal monitoring of Cryptosporidium species and their genetic diversity in neonatal calves on two large-scale farms in Xinjiang, China.

To find out whether and how the prevalence and genetic diversity of Cryptosporidium in neonatal calves vary with the season, 380 fecal samples from neonatal calves on two large-scale farms in Xinjiang (Alar and Wensu) were studied using molecular biology techniques. Cryptosporidium was detected in 48.7% (185/380) of the samples and was most frequent in summer (56.8%), followed by spring (50.0%), winter (46.8%), and autumn (41.7%; p > 0.05). Calves with diarrhea seem to be more likely infected by Cryptosporidium than those without diarrhea (p < 0.01). We also found that C. parvum (n = 173), C. bovis (n = 7), and C. ryanae (n = 3) were the Cryptosporidium species detected in this study, and co-infections of these three species (n = 2) were also identified. Two subtypes (IIdA14G1 and IIdA15G1) of C. parvum were identified, and both can infect human. These results also show that neonatal calves commonly suffer diarrhea caused by C. parvum throughout the year.

The structure of exopolyphosphatase (PPX) from Porphyromonas gingivalis in complex with substrate analogs and magnesium ions reveals the basis for polyphosphate processivity.

The enzymes exopolyphosphatase/guanosine pentaphosphate phosphohydrolase (PPX/GppA) play important roles in the bacterial stringent response. PPX degrades inorganic polyphosphate (polyP), a polymer composed of a few to hundreds of phosphate residues supporting cell survival in the stationary phase. The crystal structure of PPX from Porphyromonas gingivalis (PgPPX) in complex with catalytic magnesium ions and several sulfate ions was solved. PgPPX contained two domains and represented a "closed" configuration. Four sulfate ions forming a linear dispersed chain were observed in the aqueduct of the PPX dimer, which the long polyP chain most likely occupied. The side chain of R255 stretched into the cavity where polyP could be located, obstructing the entrance of larger substrates such as NTP and NDP. This study provided the first view into the structure of the PPX/GppA homolog in complex with magnesium ions and substrate analogs and explained how PgPPX implemented its functionality.

Food recalls associated with foodborne disease outbreaks, United States, 2006-2016.

About 800 foodborne disease outbreaks are reported in the United States annually. Few are associated with food recalls. We compared 226 outbreaks associated with food recalls with those not associated with recalls during 2006-2016. Recall-associated outbreaks had, on average, more illnesses per outbreak and higher proportions of hospitalisations and deaths than non-recall-associated outbreaks. The top confirmed aetiology for recall-associated outbreaks was Salmonella. Pasteurised and unpasteurised dairy products, beef and molluscs were the most frequently implicated foods. The most common pathogen-food pairs for outbreaks with recalls were Escherichia coli-beef and norovirus-molluscs; the top pairs for non-recall-associated outbreaks were scombrotoxin-fish and ciguatoxin-fish. For outbreaks with recalls, 48% of the recalls occurred after the outbreak, 27% during the outbreak, 3% before the outbreak, and 22% were inconclusive or had unknown recall timing. Fifty per cent of recall-associated outbreaks were multistate, compared with 2% of non-recall-associated outbreaks. The differences between recall-associated outbreaks and non-recall-associated outbreaks help define the types of outbreaks and food vehicles that are likely to have a recall. Improved outbreak vehicle identification and traceability of rarely recalled foods could lead to more recalls of these products, resulting in fewer illnesses and deaths.

Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021.

INTRODUCTION: Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness. METHODS: We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions. RESULTS: Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27-1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25-1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24-1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41-1.67) for patients with 1 condition to 3.82 (95% CI, 3.45-4.23) for patients with more than 10 conditions (compared with patients with no conditions). CONCLUSION: Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.

Establishment of clinical diagnosis model of Graves' disease and Hashimoto's thyroiditis.

BACKGROUND: A clinical diagnosis model include thyroid functions, thyroid antibodies and radioactive iodine uptake (RAIU) of patients with hyperthyroidism were established and as new evaluation indicators for the differentiation of the Graves' disease (GD) and Hashimoto's thyroiditis (HT). METHODS: Clinical data of patients with newly diagnosed hyperthyroidism including gender, age, thyroid function, thyroid antibodies (FT3, FT4, TSH, TPOAb, TGAb, TRAb), RAIU (2 h, 6 h, 24 h) were collected. A stepwise regression analysis was performed to establish a model based on these variables. RESULTS: Model 1 was subjected to stepwise regression analysis. After screening, the variables that entered the model included FT3, TGAb, TPOAb, TRAb, 2-h RAIU, 24-h RAIU and gender, in which the variables FT3, TGAb, TRAb, 2-h RAIU, 24-h RAIU, and gender were significantly different. Model 2 without RAIU was also subjected to stepwise regression analysis. After screening, the variables that entered the model included FT4, TGAb, TPOAb, TRAb and gender were statistical significant. The larger value of each variable in the two models indicated the higher probability to diagnose GD. The area under the receiver operating characteristic (ROC) curve of model 1 was 0.843 (95% CI 0.779-0.894), and the area under the ROC curve of model 2 was 0.806 (95% CI 0.685-0.824), which showed good differential diagnostic value. CONCLUSIONS: GD and HT diagnosis model was established according to the variables including gender, FT3, TGAb, TRAb, the 2-h RAIU, the 24-h RAIU in the model 1, and the variables FT4, TGAb, TPOAb, TRAb and gender in the model 2 that did not include RAIU. These models had high value to differentiate GD and HT for patients with early hyperthyroidism.

Molecular epidemiology of Cryptosporidium spp. in dairy cattle in Guangdong Province, South China.

To determine the prevalence of Cryptosporidium in dairy cattle in Guangdong Province, South China, 1440 fecal samples were collected from 10 farms and screened for Cryptosporidium with PCR. The overall prevalence of Cryptosporidium was 4.38% (63/1440), and the infection rates in preweaned calves, postweaned calves, heifers and adults were 6.4% (19/297), 6.19% (33/533), 1.48% (4/271) and 2.06% (7/339), respectively. Three Cryptosporidium species, Cryptosporidium andersoni (n = 33), Cryptosporidium bovis (n = 22) and Cryptosporidium ryanae (n = 8) were detected by DNA sequence analysis of the 63 positive samples, and C. andersoni was identified as the most common species on the dairy cattle farms. In preweaned calves, C. bovis was the most prevalent species (9/19, 47.4%). In contrast, C. andersoni was the predominant species (19/33, 57.6%) in postweaned calves and the only species found in heifers and adults. The zoonotic species Cryptosporidium parvum was not detected in this study. Twenty-four C. andersoni isolates were successfully classified into three multilocus sequence typing (MLST) subtypes. MLST subtype A4,A4,A4,A1 was the predominant subtype, and MLST subtype A2,A5,A2,A1, previously found in sheep, was detected in cattle for the first time. A linkage disequilibrium analysis showed that the C. andersoni isolates had a clonal genetic population structure. However, further molecular studies are required to better understand the epidemiology of Cryptosporidium in Guangdong.

A canine model of experimental infection with Cryptosporidium canis.

Cryptosporidium is a genus of protozoal parasites that affects the gastrointestinal epithelium of a variety of hosts. Several models of experimental infection have been described to study the susceptibility, infectivity and pathogenicity among different Cryptosporidium species and isolates. This study aimed to establish an experimental infection of Cryptodporidium canis in canids. Infectivity and pathogenicity have been measured by evaluating the clinical status, pattern of oocyst excretion and histological examination. Results showed that C. canis was not infective for immunocompetent dogs or mice with severe combined immunodeficiency syndrome (SCID). Oocysts were first detected in the feces of immunosuppressed dogs on day 3 post-infection (p.i.), with levels peaking twice on days 10 and 17 p.i. during the patent period. cryptosporidial developmental stages were found in the duodenum and jejunum of dogs in histological sections stained with hematoxylin and eosin (H & E) and using scanning electron microscopy (SEM). Histopathological changes in the intestinal tract of infected dogs were characterized by epithelial metaplasia and dilatation; the integrity of intestinal mucosal epithelial cells was distinctly damaged with whole sheets of cilia sloughed away. Ultrastructural observation data were consistent with histological observations. Based on these findings, the canine model described in this work will be useful to evaluate clinical, parasitological and histological aspects of C. canis infection and will be useful for the further understanding of cryptosporidiosis, drug development, and vaccine development.

The efficacy of steroid injection in total knee or hip arthroplasty.

PURPOSE: A systematic review and meta-analysis based on randomized controlled trials (RCTs) was conducted to evaluate the efficacy and safety of steroid injection in total knee or hip arthroplasty (TKA/THA). METHODS: A systematical electronic search identified the relevant RCTs in the databases of PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials. Two reviewers independently completed data collection and assessment of methodological quality. Meta-analysis was performed for the outcomes of visual analogue pain score, range of motion (ROM), postoperative nausea and vomiting (PONV), morphine consumption, length of stay and complications. RESULTS: A total of 863 participants were enrolled. Patients who received steroid injection had a significant reduction in the incidence of PONV and improvement in short-term pain score, and ROM (p < 0.05). Regarding morphine consumption and hospitalization time, the steroid group showed a significant reduction in TKA but no statistically significant difference in THA. In addition, there were no significant differences in complications (n.s.). CONCLUSIONS: The current evidence suggests that steroid injection in TKA/THA provides short-term advantages in pain relief and antiemetic effects. The optimal dose and long-term effects of steroid injection still require numerous studies. LEVEL OF EVIDENCE: II.

Prevalence, molecular characterization and zoonotic potential of Cryptosporidium spp. in goats in Henan and Chongqing, China.

To estimate the prevalence and public health significance of cryptosporidiosis in goats in China, 1265 fecal samples from seven farms in Henan province and Chongqing city were examined for Cryptosporidium oocysts. The overall infection rate of Cryptosporidium spp. was 3.48% (44/1256). Significant difference was observed among age groups, with the post weaned kids having the highest infection rate (4.58%; ρ<0.01). Cryptosporidium spp. were characterized by PCR-restriction fragment length polymorphism (RFLP) analysis and DNA sequence analysis of the small subunit (SSU) rRNA gene. The SSU rRNA-based PCR identified three Cryptosporidium species, including Cryptosporidium ubiquitum (24/44) in Henan and Chongqing, and Cryptosporidium andersoni (16/44) and Cryptosporidium xiaoi (4/44) in Henan. Among which, the C. ubiquitum and C. andersoni were first identified in goats thus far and were found in all age groups except no C. andersoni being found in the postparturition nannies, whereas the C. xiaoi was detected in pre-weaned kids and pregnant nannies. Subtyping C. ubiquitum by DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene suggested the isolates identified all belonged to zoonotic XIIa subtype 2. Thus, the dominant C. ubiquitum found in this study and the XIIa subtype 2 has been found in humans indicated goats are a potential source for zoonotic infections with the C. ubiquitum. More studies are needed for better understanding of differences in the transmission and public health significance of cryptosporidiosis in goats.

Periarticular multimodal drug injection in total knee arthroplasty.

PURPOSE: A systematic review and meta-analysis based on randomized controlled trials (RCTs) were conducted to evaluate the efficiency and safety of periarticular multimodal drug injection in total knee arthroplasty (TKA). METHODS: Periarticular injection with the use of multimodal drugs is an efficient alternative for postoperative analgesia in TKA. A systematical electronic search was performed to identify the eligible RCTs in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Literature Database. Two independent reviewers completed data collection and assessment of methodological quality. The quality of evidence of outcomes was judged using GRADE criteria. Meta-analysis was performed for the outcomes of pain, straight leg raise, operating time, hospital stay and complications. RESULTS: Ten RCTs including eight studies with 1,216 TKAs in 835 patients met the inclusion criteria. Periarticular injection with multimodal drugs in TKA was associated with short-term benefits in terms of pain relief, straight leg raise, narcotic consumption, and the rates of nausea, vomiting, rash and pruritus. There were no statistically significant differences in operating time, hospital stay, wound complications and deep vein thrombosis between both groups. CONCLUSIONS: The current evidence suggests that periarticular multimodal drug injection in TKA provides short-term advantages in pain relief, straight leg raise and postoperative complications.

Structure of the exopolyphosphatase (PPX) from Zymomonas mobilis reveals a two-magnesium-ions PPX.

Rapid adaptation of metabolic capabilities is crucial for bacterial survival in habitats with fluctuating nutrient availability. In such conditions, the bacterial stringent response is a central regulatory mechanism activated by nutrient starvation or other stressors. This response is primarily controlled by exopolyphosphatase/guanosine pentaphosphate phosphohydrolase (PPX/GPPA) enzymes. To gain further insight into these enzymes, the high-resolution crystal structure of PPX from Zymomonas mobilis (ZmPPX) was determined at 1.8 Å. The phosphatase activity of PPX was strictly dependent on the presence of divalent metal cations. Notably, the structure of ZmPPX revealed the presence of two magnesium ions in the active site center, which is atypical compared to other PPX structures where only one divalent ion is observed. ZmPPX exists as a dimer in solution and belongs to the "long" PPX group consisting of four domains. Remarkably, the dimer configuration exhibits a substantial and deep aqueduct with positive potential along its interface. This aqueduct appears to extend towards the active site region, suggesting that this positively charged aqueduct could potentially serve as a binding site for polyP.

Identification of host protein ENO1 (alpha-enolase) interacting with Cryptosporidium parvum sporozoite surface protein, Cpgp40.

BACKGROUND: Cryptosporidium parvum is an apicomplexan zoonotic parasite causing the diarrheal illness cryptosporidiosis in humans and animals. To invade the host intestinal epithelial cells, parasitic proteins expressed on the surface of sporozoites interact with host cells to facilitate the formation of parasitophorous vacuole for the parasite to reside and develop. The gp40 of C. parvum, named Cpgp40 and located on the surface of sporozoites, was proven to participate in the process of host cell invasion. METHODS: We utilized the purified Cpgp40 as a bait to obtain host cell proteins interacting with Cpgp40 through the glutathione S-transferase (GST) pull-down method. In vitro analysis, through bimolecular fluorescence complementation assay (BiFC) and coimmunoprecipitation (Co-IP), confirmed the solid interaction between Cpgp40 and ENO1. In addition, by using protein mutation and parasite infection rate analysis, it was demonstrated that ENO1 plays an important role in the C. parvum invasion of HCT-8 cells. RESULTS: To illustrate the functional activity of Cpgp40 interacting with host cells, we identified the alpha-enolase protein (ENO1) from HCT-8 cells, which showed direct interaction with Cpgp40. The mRNA level of ENO1 gene was significantly decreased at 3 and 24 h after C. parvum infection. Antibodies and siRNA specific to ENO1 showed the ability to neutralize C. parvum infection in vitro, which indicated the participation of ENO1 during the parasite invasion of HCT-8 cells. In addition, we further demonstrated that ENO1 protein was involved in the regulation of cytoplasmic matrix of HCT-8 cells during C. parvum invasion. Functional study of the protein mutation illustrated that ENO1 was also required for the endogenous development of C. parvum. CONCLUSIONS: In this study, we utilized the purified Cpgp40 as a bait to obtain host cell proteins ENO1 interacting with Cpgp40. Functional studies illustrated that the host cell protein ENO1 was involved in the regulation of tight junction and adherent junction proteins during C. parvum invasion and was required for endogenous development of C. parvum.

The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty.

The efficacy of periarticular multimodal drug injection (PMDI) to reduce pain after total knee or hip arthroplasty (TKA or THA) still remains controversial. Our study aimed at evaluating the efficacy of PMDI after TKA or THA. A fully recursive literature search was conducted to identify relevant randomized controlled trials. Ultimately, 21 studies were included in the analysis. Pooled results showed that the PMDI group had better pain relief, less opioid consumption, larger range of motion, and lower rates of nausea and vomiting than the placebo group. No significant difference was seen in regard to the length of hospital stay between the two groups. In conclusion, PMDI should be recommended for the pain management after TKA or THA.

Comparative proteomics reveals Cryptosporidium parvum infection disrupts cellular barriers.

Cryptosporidium is a protozoan parasite capable of infecting humans and animals and is a leading cause of diarrheal disease and early childhood mortality. The molecular mechanisms underlying invasive infection and its pathogenesis remain largely unknown. To better understand the molecular mechanism of the interaction between C. parvum and host cells, we profiled the changes of host cells membrane proteins extracted using native membrane protein extraction kit between C. parvum-infected HCT-8 cells and the control group after C. parvum infected 6 h combined with quantitative Tandem Mass Tags (TMT) liquid chromatography-dual mass spectrometry proteomic analysis. Among the 4844 quantifiable proteins identified, the expression levels of 625 were upregulated, and those of 116 were downregulated at 6 h post-infection compared with controls (1.5-fold difference in abundance, p < 0.05). Enrichment analysis of the function, protein domain and Kyoto Encyclopedia of Genes and Genomes pathway of the differentially expressed proteins revealed that the differentially expressed proteins were mainly related to biological functions related to the cytoskeleton and cytoplasmic matrix. We also found that infection with C. parvum may destroy HCT-8 intercellular space adhesion. Six proteins were further verified using quantitative real-time reverse transcription polymerase chain reaction and western blotting. Through systematic analysis of proteomics related to HCT-8 cell membranes infected by C. parvum, we found many host membrane proteins that can serve as potential receptors in C. parvum adhesion or invasion. C. parvum infection destroyed host cell barrier function and caused extensive changes in host cytoskeleton proteins, providing a deeper understanding of the molecules and their functions involved in the host-C. parvum interaction. SIGNIFICANCE: There is a lack of systematic research on the molecular mechanisms underlying the interaction of C. parvum with host cells. Changes of host cell membrane proteins after C. parvum infection may be used to examine the host cell receptors for parasite adhesion and invasion, and how the parasite interacts with these receptors. It is of great significance that host cells undergo membrane fusion to mediate invasion. Through proteomic studies on the host cell membrane after infection with HCT-8 cells by C. parvum, we observed disruption of the host cell cellular barrier function and widespread alteration of host cytoskeletal proteins caused by C. parvum infection, providing a deeper understanding of the molecules and their functions involved in host-C. parvum interaction.

Epidemiology and Antimicrobial Resistance of Campylobacter Infections in the United States, 2005-2018.

Background: Campylobacter is the most common cause of bacterial diarrhea in the United States; resistance to macrolides and fluoroquinolones limits treatment options. We examined the epidemiology of US Campylobacter infections and changes in resistance over time. Methods: The Foodborne Diseases Active Surveillance Network receives information on laboratory-confirmed Campylobacter cases from 10 US sites, and the National Antimicrobial Resistance Monitoring System receives a subset of isolates from these cases for antimicrobial susceptibility testing. We estimated trends in incidence of Campylobacter infection, adjusting for sex, age, and surveillance changes attributable to culture-independent diagnostic tests. We compared percentages of isolates resistant to erythromycin or ciprofloxacin during 2005-2016 with 2017-2018 and used multivariable logistic regression to examine the association of international travel with resistance. Results: Adjusted Campylobacter incidence remained stable or decreased for all groups analyzed since 2012. Among 2449 linked records in 2017-2018, the median patient age was 40.2 years (interquartile range, 21.6-57.8 years), 54.8% of patients were male, 17.2% were hospitalized, and 0.2% died. The percentage of resistant infections increased from 24.5% in 2005-2016 to 29.7% in 2017-2018 for ciprofloxacin (P < .001) and from 2.6% to 3.3% for erythromycin (P = .04). Persons with recent international travel had higher odds than nontravelers of having isolates resistant to ciprofloxacin (adjusted odds ratio [aOR] varied from 1.7 to 10.6 by race/ethnicity) and erythromycin (aOR = 1.7; 95% confidence interval, 1.3-2.1). Conclusions: Campylobacter incidence has remained stable or decreased, whereas resistance to antimicrobials recommended for treatment has increased. Recent international travel increased the risk of resistance.

Trends in dietary energy, fat, carbohydrate and protein intake in Chinese children and adolescents from 1991 to 2009.

Few studies have examined nutrition transition in children in China. Our aim, in the present study, was to examine temporal trends in dietary energy, fat, carbohydrate and protein intake in Chinese children aged 7-17 years. The analysis used individual level, consecutive 3 d dietary recall data from seven rounds of the China Health and Nutrition Surveys in 1991 (n 2714), 1993 (n 2542), 1997 (n 2516), 2000 (n 2142), 2004 (n 1341), 2006 (n 1072) and 2009 (n 996). Mixed-effect models were constructed to obtain adjusted means and to examine trends after adjusting for intra-class correlation within clusters and for covariates including age, sex, urban/rural residence and income. From 1991 to 2009, daily energy intake steadily declined from 9511·0 to 7658·2 kJ (P<0·0001). There was a steady decline in daily carbohydrate intake from 382·5 to 254·1 g (P<0·0001), and in the proportion of energy from carbohydrate from 66·7 to 56·8 % (P<0·0001). In contrast, daily fat intake steadily increased from 54·8 to 66·0 g (P<0·0001), as did the proportion of energy from fat from 21·5 to 30·0 % (P<0·0001). The proportion of children who consumed a diet with more than 30 % of energy from fat increased from 20·1 to 49·4 % (P<0·0001). The proportion of energy from protein increased from 11·8 to 13·1 % (P<0·0001), although daily protein intake dropped from 66·2 to 58·0 g (P<0·0001). Our data suggest that Chinese children have been undergoing a rapid nutrition transition to a high-fat diet.