1
|
Oxendine A, Walsh AA, Young T, Dixon B, Hoke A, Rogers EE, Lee MD, Maurer JJ. Conditions Necessary for the Transfer of Antimicrobial Resistance in Poultry Litter. Antibiotics (Basel) 2023; 12:1006. [PMID: 37370325 DOI: 10.3390/antibiotics12061006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Animal manures contain a large and diverse reservoir of antimicrobial resistance (AMR) genes that could potentially spillover into the general population through transfer of AMR to antibiotic-susceptible pathogens. The ability of poultry litter microbiota to transmit AMR was examined in this study. Abundance of phenotypic AMR was assessed for litter microbiota to the antibiotics: ampicillin (Ap; 25 μg/mL), chloramphenicol (Cm; 25 μg/mL), streptomycin (Sm; 100 μg/mL), and tetracycline (Tc; 25 μg/mL). qPCR was used to estimate gene load of streptomycin-resistance and sulfonamide-resistance genes aadA1 and sul1, respectively, in the poultry litter community. AMR gene load was determined relative to total bacterial abundance using 16S rRNA qPCR. Poultry litter contained 108 CFU/g, with Gram-negative enterics representing a minor population (<104 CFU/g). There was high abundance of resistance to Sm (106 to 107 CFU/g) and Tc (106 to 107 CFU/g) and a sizeable antimicrobial-resistance gene load in regards to gene copies per bacterial genome (aadA1: 0.0001-0.0060 and sul1: 0.0355-0.2455). While plasmid transfer was observed from Escherichia coli R100, as an F-plasmid donor control, to the Salmonella recipient in vitro, no AMR Salmonella were detected in a poultry litter microcosm with the inclusion of E. coli R100. Confirmatory experiments showed that isolated poultry litter bacteria were not interfering with plasmid transfer in filter matings. As no R100 transfer was observed at 25 °C, conjugative plasmid pRSA was chosen for its high plasmid transfer frequency (10-4 to 10-5) at 25 °C. While E. coli strain background influenced the persistence of pRSA in poultry litter, no plasmid transfer to Salmonella was ever observed. Although poultry litter microbiota contains a significant AMR gene load, potential to transmit resistance is low under conditions commonly used to assess plasmid conjugation.
Collapse
Affiliation(s)
- Aaron Oxendine
- School of Animal Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Allison A Walsh
- School of Animal Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Tamesha Young
- School of Animal Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Brandan Dixon
- School of Animal Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Alexa Hoke
- School of Animal Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Eda Erdogan Rogers
- Department of Biomedical Science and Pathobiology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Margie D Lee
- Department of Biomedical Science and Pathobiology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - John J Maurer
- School of Animal Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| |
Collapse
|
2
|
Zhang H, Liu Z, Fang H, Chang S, Ren G, Cheng X, Pan Y, Wu R, Liu H, Wu J. Construction of Probiotic Double-Layered Multinucleated Microcapsules Based on Sulfhydryl-Modified Carboxymethyl Cellulose Sodium for Increased Intestinal Adhesion of Probiotics and Therapy for Intestinal Inflammation Induced by Escherichia coli O157:H7. ACS APPLIED MATERIALS & INTERFACES 2023; 15:18569-18589. [PMID: 37037009 DOI: 10.1021/acsami.2c20437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The decreased number of viable bacteria and the ability of Bifidobacterium to adhere to and colonize the gut in the gastrointestinal environment greatly limit their efficacy. To solve this problem, thiolated carboxymethyl cellulose sodium (CMC) probiotic double-layered multinucleated microcapsules with Bifidobacterium adolescentis FS2-3 in the inner layer and Bacillus subtilis SN15-2 embedded in the outer layers were designed. First, the viable counts and release rates of microcapsules were examined by in vitro simulated digestion assays, and it was found that microcapsules were better protected from gastrointestinal digestion than the controls. Compared with free Bifidobacterium strains, double-layered multinucleated microcapsules have higher viable bacterial survival rates and storage stability. Second, through in vitro rheology, tensile tests, isotherm titration calorimetry, and adhesion tests, it was observed that thiolated CMC could enhance the strong interaction of Bifidobacterium with intestinal mucus and significantly promote the proliferation and growth of probiotics. Finally, double-layered multinucleated microcapsules containing B. adolescentis FS2-3 and B. subtilis SN15-2 modified with sulfhydryl-modified CMC were studied in the intestine. Alleviation of Escherichia coli O157:H7 induced intestinal inflammation. The results showed that microencapsulation could significantly increase the colon content of Bifidobacterium, relieve intestinal inflammation symptoms in mice with bacterial enteritis, and repair the intestinal microbiota disorder caused by inflammation. The probiotic double-layered multinucleated microcapsules prepared in this study can improve the survival rate of probiotics and promote proliferation, adhesion, and colonization of probiotics.
Collapse
Affiliation(s)
- Henan Zhang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Zhili Liu
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Haitian Fang
- Ningxia Key Laboratory for Food Microbial-Applications Technology and Safety Control, School of Food and Wine, Ningxia University, Yinchuan 750021, P.R. China
| | - Shihan Chang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Key Laboratory of Microbial Fermentation Technology Innovation, Shenyang, Liaoning, 110866, P.R. China
| | - Guangyu Ren
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Xinyu Cheng
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Yue Pan
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Rina Wu
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Huiyan Liu
- Ningxia Key Laboratory for Food Microbial-Applications Technology and Safety Control, School of Food and Wine, Ningxia University, Yinchuan 750021, P.R. China
| | - Junrui Wu
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Key Laboratory of Microbial Fermentation Technology Innovation, Shenyang, Liaoning, 110866, P.R. China
| |
Collapse
|
3
|
Addition of a protected complex of biofactors and antioxidants to breeder hen diets confers transgenerational protection against Salmonella enterica serovar Enteritidis in progeny chicks. Poult Sci 2023; 102:102531. [PMID: 36805406 PMCID: PMC9958073 DOI: 10.1016/j.psj.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Addition of vitamins and antioxidants has been long associated with increased immunity and are commonly used in the poultry industry; however, less is known regarding their use in broiler breeder hens. The objective of this study was to determine if feeding a complex of protected biofactors and antioxidants composed of vitamins and fermentation extracts to broiler breeder hens conferred resistance against Salmonella enterica serovar Enteritidis (S. Enteritidis) in the progeny chicks. Three-day-old chicks from control- and supplement-fed hens were challenged with S. Enteritidis and necropsied 4- and 11-days postchallenge (dpc) to determine if there were differences in invasion and colonization. Serum and jejunum were evaluated for various cytokine and chemokine production. Fewer (P = 0.002) chicks from supplement-fed hens had detectable S. Enteritidis in the ceca (32.6%) compared to chicks from control-fed hens (64%). By 11 dpc, significantly (P < 0.001) fewer chicks from supplement-fed hens were positive for S. Enteritidis (liver [36%]; ceca [16%]) compared to chicks from the control hens (liver [76%]; ceca [76%]). The recoverable S. Enteritidis in the cecal content was also lower (P = 0.01) at 11 dpc. In additional to the differences in invasion and colonization, cytokine and chemokine production were distinct between the 2 groups of chicks. Chicks from supplement-fed hens had increased production of IL-16, IL-6, MIP-3α, and RANTES in the jejunum while IL-16 and MIP-1β were higher in the serum of chicks from the control-fed hens. By 11 dpc, production of IFN-γ was decreased in the jejunum of chicks from supplement-fed hens. Collectively, these data demonstrate adding a protected complex of biofactors and antioxidants to the diet of broiler breeder hens offers a measure of transgenerational protection to the progeny against S. Enteritidis infection and reduces colonization that is mediated, in part, by a robust and distinct cytokine and chemokine response locally at the intestine and systemically in the blood.
Collapse
|
4
|
Patterns of enteric infections in a population-wide cohort study of sequelae, British Columbia, Canada. Epidemiol Infect 2022; 151:e7. [PMID: 36515015 PMCID: PMC9990383 DOI: 10.1017/s0950268822001911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We assessed patterns of enteric infections caused by 14 pathogens, in a longitudinal cohort study of sequelae in British Columbia (BC) Canada, 2005-2014. Our population cohort of 5.8 million individuals was followed for an average of 7.5 years/person; during this time, 40 523 individuals experienced 42 308 incident laboratory-confirmed, provincially reported enteric infections (96.4 incident infections per 100 000 person-years). Most individuals (38 882/40 523; 96%) had only one, but 4% had multiple concurrent infections or more than one infection across the study. Among individuals with more than one infection, the pathogens and combinations occurring most frequently per individual matched the pathogens occurring most frequently in the BC population. An additional 298 557 new fee-for-service physician visits and hospitalisations for enteric infections, that did not coincide with a reported enteric infection, also occurred, and some may be potentially unreported enteric infections. Our findings demonstrate that sequelae risk analyses should explore the possible impacts of multiple infections, and that estimating risk for individuals who may have had a potentially unreported enteric infection is warranted.
Collapse
|
5
|
Antibiotic prescribing for acute gastroenteritis during ambulatory care visits-United States, 2006-2015. Infect Control Hosp Epidemiol 2022; 43:1880-1889. [PMID: 36017721 PMCID: PMC9753066 DOI: 10.1017/ice.2021.522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To describe national antibiotic prescribing for acute gastroenteritis (AGE). SETTING Ambulatory care. METHODS We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006-2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen. RESULTS We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%-15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%-36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%-26.4%), and penicillins (18.9%; 99% CI, 11.6%-26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%-12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%-13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%-71.9%), Campylobacter (44.8%; 95% CI, 41.5%-48.1%), Shigella (39.7%; 95% CI, 35.9%-43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%-38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%-33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%-13.0%) of visits for viral gastroenteritis. CONCLUSIONS Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.
Collapse
|
6
|
Whitham HK, Gilliland AE, Collier SA, Walter ES, Hoffmann S. Direct Outpatient Health Care Costs Among Commercially Insured Persons for Common Foodborne Pathogens and Acute Gastroenteritis, 2012-2015. Foodborne Pathog Dis 2022; 19:558-568. [PMID: 35960532 PMCID: PMC10941978 DOI: 10.1089/fpd.2021.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Foodborne illness is common in the United States with most, but not all, foodborne pathogens causing symptoms of acute gastroenteritis (AGI). Outpatient care is the most frequent type of medical care sought; however, more accurate estimates of outpatient costs are needed to inform food safety policy decision. Using the U.S. MarketScan Commercial Claims and Encounters database, we quantified the per-visit cost of outpatient visits with any AGI-related diagnosis (including pathogen-specific and nonspecific or symptom-based diagnoses) and for those with a pathogen-specific diagnosis for 1 of 29 pathogens commonly transmitted through food (including pathogens that cause AGI and some that do not). Our estimates included the per-case cost of office visits and associated laboratory tests and procedures as well as the conservative estimates of prescription cost. Most AGI outpatient visits were coded using nonspecific codes (e.g., infectious gastroenteritis), rather than pathogen-specific codes (e.g., Salmonella). From 2012 to 2015, we identified more than 3.4 million initial outpatient visits with any AGI diagnosis and 45,077 with a foodborne pathogen-specific diagnosis. As is typical of treatment cost data, severe cases of illness drove mean costs above median. The mean cost of an outpatient visit with any AGI was $696 compared with the median of $162. The mean costs of visits with pathogen-specific diagnoses ranged from $254 (median $131; interquartile range [IQR]: $98-184) for Streptococcus spp. Group A (n = 22,059) to $1761 (median $161; IQR: $104-$1101) for Clostridium perfringens (n = 30). Visits with two of the most common causes of foodborne illness, nontyphoidal Salmonella and norovirus, listed as a diagnosis, had mean costs of $841 and $509, respectively. Overall, the median per-case costs of outpatient visits increased with age, with some variation by pathogen. More empirically based estimates of outpatient costs for AGI and specific pathogens can enhance estimates of the economic cost of foodborne illness used to guide food policy and focus prevention efforts.
Collapse
Affiliation(s)
- Hilary K. Whitham
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubrey E. Gilliland
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A. Collier
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elaine Scallan Walter
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Sandra Hoffmann
- Food Economics Division, Economic Research Service, U.S. Department of Agriculture, Washington, District of Columbia, USA
| |
Collapse
|
7
|
Quist AJL, Holcomb DA, Fliss MD, Delamater PL, Richardson DB, Engel LS. Exposure to industrial hog operations and gastrointestinal illness in North Carolina, USA. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 830:154823. [PMID: 35341848 PMCID: PMC9133154 DOI: 10.1016/j.scitotenv.2022.154823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
With 9 million hogs, North Carolina (NC) is the second leading hog producer in the United States. Most hogs are housed at concentrated animal feeding operations (CAFOs), where millions of tons of hog waste can pollute air and water with fecal pathogens that can cause diarrhea, vomiting, and/or nausea (known as acute gastrointestinal illness (AGI)). We used NC's ZIP code-level emergency department (ED) data to calculate rates of AGI ED visits (2016-2019) and swine permit data to estimate hog exposure. Case exposure was estimated as the inverse distances from each hog CAFO to census block centroids, weighting with Gaussian decay and by manure amount per CAFO, then aggregated to ZIP code using population weights. We compared ZIP codes in the upper quartile of hog exposure ("high hog exposed") to those without hog exposure. Using inverse probability of treatment weighting, we created a control with similar demographics to the high hog exposed population and calculated rate ratios using quasi-Poisson models. We examined effect measure modification of rurality and race using adjusted models. In high hog exposed areas compared to areas without hog exposure, we observed a 11% increase (95% CI: 1.06, 1.17) in AGI rate and 21% increase specifically in rural areas (95% CI: 0.98, 1.43). When restricted to rural areas, we found an increased AGI rate among American Indian (RR = 4.29, 95% CI: 3.69, 4.88) and Black (RR = 1.45, 95% CI: 0.98, 1.91) residents. The association was stronger during the week after heavy rain (RR = 1.41, 95% CI: 1.19, 1.62) and in areas with both poultry and swine CAFOs (RR = 1.52, 95% CI: 1.48, 1.57). Residing near CAFOs may increase rates of AGI ED visits. Hog CAFOs are disproportionally built near rural Black and American Indian communities in NC and are associated with increased AGI most strongly in these populations.
Collapse
Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - David A Holcomb
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Mike Dolan Fliss
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Chapel Hill, NC 27514, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
8
|
Quist AJL, Fliss MD, Wade TJ, Delamater PL, Richardson DB, Engel LS. Hurricane flooding and acute gastrointestinal illness in North Carolina. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 809:151108. [PMID: 34688737 PMCID: PMC8770555 DOI: 10.1016/j.scitotenv.2021.151108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 05/28/2023]
Abstract
Hurricanes often flood homes and industries, spreading pathogens. Contact with pathogen-contaminated water can result in diarrhea, vomiting, and/or nausea, known collectively as acute gastrointestinal illness (AGI). Hurricanes Matthew and Florence caused record-breaking flooding in North Carolina (NC) in October 2016 and September 2018, respectively. To examine the relationship between hurricane flooding and AGI in NC, we first calculated the percent of each ZIP code flooded after Hurricanes Matthew and Florence. Rates of all-cause AGI emergency department (ED) visits were calculated from NC's ED surveillance system data. Using controlled interrupted time series, we compared AGI ED visit rates during the three weeks after each hurricane in ZIP codes with a third or more of their area flooded to the predicted rates had these hurricanes not occurred, based on AGI 2016-2019 ED trends, and controlling for AGI ED visit rates in unflooded areas. We examined alternative case definitions (bacterial AGI) and effect measure modification by race and age. We observed an 11% increase (rate ratio (RR): 1.11, 95% CI: 1.00, 1.23) in AGI ED visit rates after Hurricanes Matthew and Florence. This effect was particularly strong among American Indian patients and patients aged 65 years and older after Florence and elevated among Black patients for both hurricanes. Florence's effect was more consistent than Matthew's effect, possibly because little rain preceded Florence and heavy rain preceded Matthew. When restricted to bacterial AGI, we found an 85% (RR: 1.85, 95% CI: 1.37, 2.34) increase in AGI ED visit rate after Florence, but no increase after Matthew. Hurricane flooding is associated with an increase in AGI ED visit rate, although the strength of effect may depend on total storm rainfall or antecedent rainfall. American Indians and Black people-historically pushed to less desirable, flood-prone land-may be at higher risk for AGI after storms.
Collapse
Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Mike Dolan Fliss
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Timothy J Wade
- Public Health and Environmental Systems Division, United States Environmental Protection Agency, Chapel Hill, NC 27514, USA
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Chapel Hill, NC 27514, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
9
|
Dhaliwal S, Hoffmann S, White A, Ahn JW, McQueen RB, Scallan Walter E. Cost of Hospitalizations for Leading Foodborne Pathogens in the United States: Identification by International Classification of Disease Coding and Variation by Pathogen. Foodborne Pathog Dis 2021; 18:812-821. [PMID: 34591654 DOI: 10.1089/fpd.2021.0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Foodborne illness is a continuing public health problem in the United States. Seven pathogens-Campylobacter, Clostridium perfringens, Shiga toxin-producing Escherichia coli O157, Listeria monocytogenes, nontyphoidal Salmonella, norovirus, and Toxoplasma gondii-are estimated to cause >90% of the foodborne illnesses, hospitalizations, and deaths attributed to 31 known pathogens. The purpose of this article was to inform estimates of the cost of hospitalizations associated with these pathogens using National Inpatient Survey data from January 2012 through September 2015. The article explored two methodological issues. First, is it more appropriate to use hospitalizations identified using principal or all diagnosis codes when estimating cost? Second, should pathogen-specific or overall mean cost estimates be used? After excluding C. perfringens because of low sample size, the remaining six pathogens included in the analysis were associated with 17,102 hospital discharge records. Of these 55% have the pathogen listed as a principal diagnosis (FBP-PD), ranging from 6% for T. gondii to 68% for nontyphoidal Salmonella. The mean per-case cost of records with the pathogen listed as a secondary diagnosis (FBP-SD) was 2.7 times higher than FBP-PD. FBP-SD were also more severe than FBP-PD with longer lengths of stay, increasing loss of function, and increasing risk of mortality. Severity was the main driver of cost. We also found severity of illness and cost of hospitalizations vary by pathogen. Based on identifying cases with a pathogen in either FBP-PD or FBP-SD, we found mean per-case hospitalization cost across the six pathogens included in this study was $17,515, ranging from $11,552 for Campylobacter to $34,206 for norovirus. In summary, if only FBP-PD cases were used to estimate cost, estimates would likely underestimate hospitalization costs among those cases with a pathogen-specific diagnosis. Because these foodborne pathogens varied in severity of illness, the mean cost of hospitalizations also varied significantly by pathogen.
Collapse
Affiliation(s)
| | - Sandra Hoffmann
- U.S. Department of Agriculture, Economic Research Service, Washington, District of Columbia, USA
| | - Alice White
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jae-Wan Ahn
- U.S. Department of Agriculture, Economic Research Service, Kansas City, Kansas, USA
| | | | | |
Collapse
|
10
|
Collier SA, Deng L, Adam EA, Benedict KM, Beshearse EM, Blackstock AJ, Bruce BB, Derado G, Edens C, Fullerton KE, Gargano JW, Geissler AL, Hall AJ, Havelaar AH, Hill VR, Hoekstra RM, Reddy SC, Scallan E, Stokes EK, Yoder JS, Beach MJ. Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerg Infect Dis 2021; 27:140-149. [PMID: 33350905 PMCID: PMC7774540 DOI: 10.3201/eid2701.190676] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million–12.0 million), results in 601,000 ED visits (95% CrI 364,000–866,000), 118,000 hospitalizations (95% CrI 86,800–150,000), and 6,630 deaths (95% CrI 4,520–8,870) and incurring US $3.33 billion (95% CrI 1.37 billion–8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.
Collapse
|
11
|
Moffatt CRM, Kennedy KJ, Selvey L, Kirk MD. Campylobacter-associated hospitalisations in an Australian provincial setting. BMC Infect Dis 2021; 21:10. [PMID: 33407203 PMCID: PMC7788795 DOI: 10.1186/s12879-020-05694-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Campylobacter spp. infections are a globally important cause of enterocolitis, causing substantial morbidity. Capturing accurate information on hospitalisations is challenging and limited population-level data exist to describe the clinico-epidemiological characteristics of hospitalised cases. METHODS Hospital administrative and laboratory datasets were linked to identify Campylobacter-associated hospitalisations between 2004 and 2013. Accuracy of morbidity coding was assessed using laboratory diagnosis as a gold standard, with health department surveillance data used to calculate population-based rates. Additional patient-level data were collected via review of medical records. Descriptive statistics were used to assess changes in rates and proportions and to assess relationships between key variables including age, length of stay, comorbidity and complications. RESULTS In total 685 Campylobacter-associated hospital admissions were identified, with the sensitivity of morbidity coding 52.8% (95% CI 48.9-56.7%). The mean annual rate of hospitalisation was 13.6%. Hospitalisation rates were higher for females across most age-groups, while for both genders marked increases were observed for those aged ≥60 years. Median admission age was 39.5 years, with an average length of stay of 3.5 days. Comorbidities were present in 34.5% (237/685) of admissions, with these patients more likely to develop electrolyte disturbances, hypotension, renal impairment or acute confusion (all p < 0.001). Bacteraemia and acute kidney injury were observed in 4.1% (28/685) and 3.6% (23/685) of admissions, respectively. Inpatient mortality was low (0.15%). CONCLUSION Under reporting of Campylobacter-associated hospitalisations is substantial but can be improved through data linkage. We observed demographic differences among those hospitalised but further work is needed to determine risk factors and predictors for hospitalisation.
Collapse
Affiliation(s)
- Cameron R M Moffatt
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 2602, Australia.
| | - Karina J Kennedy
- Department of Microbiology, Canberra Hospital and Health Services, Canberra, ACT, Australia
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 2602, Australia
| |
Collapse
|
12
|
Pindyck T, Hall AJ, Tate JE, Cardemil CV, Kambhampati AK, Wikswo ME, Payne DC, Grytdal S, Boom JA, Englund JA, Klein EJ, Halasa N, Selvarangan R, Staat MA, Weinberg GA, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan C, Marconi VC, Rodriguez-Barradas MC, Parashar U. Validation of Acute Gastroenteritis-related International Classification of Diseases, Clinical Modification Codes in Pediatric and Adult US Populations. Clin Infect Dis 2020; 70:2423-2427. [PMID: 31626687 PMCID: PMC7390357 DOI: 10.1093/cid/ciz846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/22/2019] [Indexed: 11/14/2022] Open
Abstract
International Classification of Diseases diagnostic codes are used to estimate acute gastroenteritis (AGE) disease burden. We validated AGE-related codes in pediatric and adult populations using 2 multiregional active surveillance platforms. The sensitivity of AGE codes was similar (54% and 58%) in both populations and increased with addition of vomiting-specific codes.
Collapse
Affiliation(s)
- Talia Pindyck
- Epidemic Intelligence Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC, Inc, Atlanta, Georgia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Grytdal
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mary Allen Staat
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David O Beenhouwer
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Holodniy
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California, USA
| | - Cynthia Lucero-Obusan
- Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California, USA
| | - Vince C Marconi
- Atlanta VA Medical Center, Decatur, Georgia, USA
- Rollins School of Public Health at Emory University, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Infectious Diseases Section, Baylor College of Medicine, Houston, Texas, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
13
|
Scallan Walter EJ, McLean HQ, Griffin PM. Hospital Discharge Data Underascertain Enteric Bacterial Infections Among Children. Foodborne Pathog Dis 2020; 17:530-532. [PMID: 32091947 DOI: 10.1089/fpd.2019.2773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many enteric pathogens disproportionately infect children. Hospital discharge data can provide information on severe infections, including cost. However, the diagnosis must be recorded on the discharge record and coded accurately. We estimated the rate of underascertainment in hospital discharge data among children with culture-confirmed Campylobacter, Salmonella, and Escherichia coli O157 infections using linked laboratory and hospital discharge data from an integrated health care organization. We reviewed the International Classification of Diseases, 9th and 10th Revisions, Clinical Modification (ICD-9/10-CM) diagnosis codes on each patient's discharge record. We determined the percentage of patients who had a pathogen-specific diagnosis code (for Campylobacter, Salmonella, or E. coli O157) or nonspecific gastroenteritis code. We included the first admission or positive test and calculated the number of days between specimen submission (outpatient ≤7 days before admission or inpatient) and hospital discharge. Of 65 hospitalized children with culture-confirmed Campylobacter (n = 30), Salmonella (n = 24), or E. coli O157 (n = 11) infections, 55% had that pathogen-specific diagnosis code listed on the discharge record (79% Salmonella, 54% E. coli O157, 37% Campylobacter). The discharge records of the 35 children with a specimen submitted for culture ≥3 days before discharge were 16 times more likely to have a pathogen-specific diagnosis than the records of the 30 children with a specimen submitted <3 days before discharge (83% vs. 23%; odds ratio 15.9, 95% confidence interval: 4.7-53.8). Overall, 34% of records of children with culture-confirmed infection had ≥1 nonspecific gastroenteritis code (Campylobacter 43%, Salmonella 29%, E. coli O157 18%), including 59% of those for children without a pathogen-specific diagnosis (Campylobacter 63%; Salmonella 60%; E. coli O157 40%). This study showed that hospital discharge data under-ascertain enteric illnesses in children even when the infections are culture confirmed, especially for infections that usually have a short length of stay.
Collapse
Affiliation(s)
- Elaine J Scallan Walter
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Patricia M Griffin
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
14
|
Bythwood TN, Soni V, Lyons K, Hurley-Bacon A, Lee MD, Hofacre C, Sanchez S, Maurer JJ. Antimicrobial Resistant Salmonella enterica Typhimurium Colonizing Chickens: The Impact of Plasmids, Genotype, Bacterial Communities, and Antibiotic Administration on Resistance. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2019. [DOI: 10.3389/fsufs.2019.00020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
15
|
Swaggerty CL, Callaway TR, Kogut MH, Piva A, Grilli E. Modulation of the Immune Response to Improve Health and Reduce Foodborne Pathogens in Poultry. Microorganisms 2019; 7:E65. [PMID: 30823445 PMCID: PMC6462950 DOI: 10.3390/microorganisms7030065] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022] Open
Abstract
Salmonella and Campylobacter are the two leading causes of bacterial-induced foodborne illness in the US. Food production animals including cattle, swine, and chickens are transmission sources for both pathogens. The number of Salmonella outbreaks attributed to poultry has decreased. However, the same cannot be said for Campylobacter where 50⁻70% of human cases result from poultry products. The poultry industry selects heavily on performance traits which adversely affects immune competence. Despite increasing demand for poultry, regulations and public outcry resulted in the ban of antibiotic growth promoters, pressuring the industry to find alternatives to manage flock health. One approach is to incorporate a program that naturally enhances/modulates the bird's immune response. Immunomodulation of the immune system can be achieved using a targeted dietary supplementation and/or feed additive to alter immune function. Science-based modulation of the immune system targets ways to reduce inflammation, boost a weakened response, manage gut health, and provide an alternative approach to prevent disease and control foodborne pathogens when conventional methods are not efficacious or not available. The role of immunomodulation is just one aspect of an integrated, coordinated approach to produce healthy birds that are also safe and wholesome products for consumers.
Collapse
Affiliation(s)
- Christina L Swaggerty
- United States Department of Agriculture/ARS, 2881 F and B Road, College Station, TX 77845, USA.
| | - Todd R Callaway
- Department of Animal and Dairy Science, University of Georgia, 425 River Road, Athens, GA 30602, USA.
| | - Michael H Kogut
- United States Department of Agriculture/ARS, 2881 F and B Road, College Station, TX 77845, USA.
| | - Andrea Piva
- Vetagro S.p.A., Via Porro 2, 42124, Reggio Emilia, Italy.
| | - Ester Grilli
- Vetagro S.p.A., Via Porro 2, 42124, Reggio Emilia, Italy.
| |
Collapse
|