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Andrejko KL, Gierke R, Rowlands JV, Rosen JB, Thomas A, Landis ZQ, Rosales M, Petit S, Schaffner W, Holtzman C, Barnes M, Farley MM, Harrison LH, McGee L, Chochua S, Verani JR, Cohen AL, Pilishvili T, Kobayashi M. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease among children in the United States between 2010 and 2019: An indirect cohort study. Vaccine 2024:S0264-410X(24)00499-7. [PMID: 38704263 DOI: 10.1016/j.vaccine.2024.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND A U.S. case-control study (2010-2014) demonstrated vaccine effectiveness (VE) for ≥ 1 dose of the thirteen-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) invasive pneumococcal disease (IPD) at 86 %; however, it lacked statistical power to examine VE by number of doses and against individual serotypes. METHODS We used the indirect cohort method to estimate PCV13 VE against VT-IPD among children aged < 5 years in the United States from May 1, 2010 through December 31, 2019 using cases from CDC's Active Bacterial Core surveillance, including cases enrolled in a matched case-control study (2010-2014). Cases and controls were defined as individuals with VT-IPD and non-PCV13-type-IPD (NVT-IPD), respectively. We estimated absolute VE using the adjusted odds ratio of prior PCV13 receipt (1-aOR x 100 %). RESULTS Among 1,161 IPD cases, 223 (19.2 %) were VT cases and 938 (80.8 %) were NVT controls. Of those, 108 cases (48.4 %; 108/223) and 600 controls (64.0 %; 600/938) had received > 3 PCV13 doses; 23 cases (17.6 %) and 15 controls (2.4 %) had received no PCV doses. VE ≥ 3 PCV13 doses against VT-IPD was 90.2 % (95 % Confidence Interval75.4-96.1 %), respectively. Among the most commonly circulating VT-IPD serotypes, VE of ≥ 3 PCV13 doses was 86.8 % (73.7-93.3 %), 50.2 % (28.4-80.5 %), and 93.8 % (69.8-98.8 %) against serotypes 19A, 3, and 19F, respectively. CONCLUSIONS At least three doses of PCV13 continue to be effective in preventing VT-IPD among children aged < 5 years in the US. PCV13 was protective against serotypes 19A and 19F IPD; protection against serotype 3 IPD did not reach statistical significance.
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Affiliation(s)
- Kristin L Andrejko
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Ryan Gierke
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer B Rosen
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Ann Thomas
- Oregon Public Health Division, Portland, OR, USA
| | | | - Maria Rosales
- California Emerging Infections Program, Richmond, CA, USA
| | - Sue Petit
- Connecticut Department of Public Health, Hartford, CT, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sopio Chochua
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer R Verani
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam L Cohen
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamara Pilishvili
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Acosta AM, Simon A, Thomas S, Tunali A, Satola S, Jain S, Farley MM, Tondella ML, Skoff TH. Evaluation of Asymptomatic Bordetella Carriage in a Convenience Sample of Children and Adolescents in Atlanta, Georgia, United States. J Pediatric Infect Dis Soc 2024; 13:105-109. [PMID: 37974480 DOI: 10.1093/jpids/piad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
Few data exist on asymptomatic carriage of Bordetella species among populations receiving acellular pertussis vaccine. We conducted a cross-sectional study among acellular-vaccinated children presenting to an emergency department (ED). Bordetella pertussis carriage prevalence was <1% in this population, a lower prevalence than that found in recent studies among whole-cell pertussis-vaccinated participants.
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Affiliation(s)
- Anna M Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Simon
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stepy Thomas
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
| | - Amy Tunali
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
| | - Sarah Satola
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
| | - Shabnam Jain
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica M Farley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Medical Subspecialty Section Atlanta Veterans Administration Medical Center, Atlanta, GA, USA
| | - M Lucia Tondella
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tami H Skoff
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Oliver SE, Rubis AB, Soeters HM, Reingold A, Barnes M, Petit S, Farley MM, Harrison LH, Como-Sabetti K, Khanlian SA, Wester R, Thomas A, Schaffner W, Marjuki H, Wang X, Hariri S. Epidemiology of Invasive Nontypeable Haemophilus influenzae Disease-United States, 2008-2019. Clin Infect Dis 2023; 76:1889-1895. [PMID: 36722332 DOI: 10.1093/cid/ciad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nontypeable Haemophilus influenzae (NTHi) is the most common cause of invasive H. influenzae disease in the United States (US). We evaluated the epidemiology of invasive NTHi disease in the US, including among pregnant women, infants, and people with human immunodeficiency virus (PWH). METHODS We used data from population- and laboratory-based surveillance for invasive H. influenzae disease conducted in 10 sites to estimate national incidence of NTHi, and to describe epidemiology in women of childbearing age, infants aged ≤30 days (neonates), and PWH living in the surveillance catchment areas. H. influenzae isolates were sent to the Centers for Disease Control and Prevention for species confirmation, serotyping, and whole genome sequencing of select isolates. RESULTS During 2008-2019, average annual NTHi incidence in the US was 1.3/100 000 population overall, 5.8/100 000 among children aged <1 year, and 10.2/100 000 among adults aged ≥80 years. Among 225 reported neonates with NTHi, 92% had a positive culture within the first week of life and 72% were preterm. NTHi risk was 23 times higher among preterm compared to term neonates, and 5.6 times higher in pregnant/postpartum compared to nonpregnant women. More than half of pregnant women with invasive NTHi had loss of pregnancy postinfection. Incidence among PWH aged ≥13 years was 9.5 cases per 100 000, compared to 1.1 cases per 100 000 for non-PWH (rate ratio, 8.3 [95% confidence interval, 7.1-9.7]; P < .0001). CONCLUSIONS NTHi causes substantial invasive disease, especially among older adults, pregnant/postpartum women, and neonates. Enhanced surveillance and evaluation of targeted interventions to prevent perinatal NTHi infections may be warranted.
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Affiliation(s)
- Sara E Oliver
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy B Rubis
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arthur Reingold
- School of Public Health, University of California, Berkley, California, USA
| | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - Monica M Farley
- Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Lee H Harrison
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Rachel Wester
- New York State Department of Health, Albany, New York, USA
| | - Ann Thomas
- Oregon Health Authority, Portland, Oregon, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Henju Marjuki
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hariri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Prasad N, Rhodes J, Deng L, McCarthy NL, Moline HL, Baggs J, Reddy SC, Jernigan JA, Havers FP, Sosin DM, Thomas A, Lynfield R, Schaffner W, Reingold A, Burzlaff K, Harrison LH, Petit S, Farley MM, Herlihy R, Nanduri S, Pilishvili T, McNamara LA, Schrag SJ, Fleming-Dutra KE, Kobayashi M, Arvay M. Changes in the Incidence of Invasive Bacterial Disease During the COVID-19 Pandemic in the United States, 2014-2020. J Infect Dis 2023; 227:907-916. [PMID: 36723871 PMCID: PMC10961849 DOI: 10.1093/infdis/jiad028] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Descriptions of changes in invasive bacterial disease (IBD) epidemiology during the coronavirus disease 2019 (COVID-19) pandemic in the United States are limited. METHODS We investigated changes in the incidence of IBD due to Streptococcus pneumoniae, Haemophilus influenzae, group A Streptococcus (GAS), and group B Streptococcus (GBS). We defined the COVID-19 pandemic period as 1 March to 31 December 2020. We compared observed IBD incidences during the pandemic to expected incidences, consistent with January 2014 to February 2020 trends. We conducted secondary analysis of a health care database to assess changes in testing by blood and cerebrospinal fluid (CSF) culture during the pandemic. RESULTS Compared with expected incidences, the observed incidences of IBD due to S. pneumoniae, H. influenzae, GAS, and GBS were 58%, 60%, 28%, and 12% lower during the pandemic period of 2020, respectively. Declines from expected incidences corresponded closely with implementation of COVID-19-associated nonpharmaceutical interventions (NPIs). Significant declines were observed across all age and race groups, and surveillance sites for S. pneumoniae and H. influenzae. Blood and CSF culture testing rates during the pandemic were comparable to previous years. CONCLUSIONS NPIs likely contributed to the decline in IBD incidence in the United States in 2020; observed declines were unlikely to be driven by reductions in testing.
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Affiliation(s)
- Namrata Prasad
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia Rhodes
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Li Deng
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie L McCarthy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heidi L Moline
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sujan C Reddy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John A Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fiona P Havers
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel M Sosin
- New Mexico Emerging Infections Program, New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Ann Thomas
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California, USA
- Berkeley School of Public Health, University of California, Berkeley, California, USA
| | - Kari Burzlaff
- New York State Department of Health, Albany, New York, USA
| | - Lee H Harrison
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and the Atlanta VAMC, Atlanta, Georgia, USA
| | - Rachel Herlihy
- Colorado Department of Public Health and the Environment, Denver, Colorado, USA
| | - Srinivas Nanduri
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tamara Pilishvili
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucy A McNamara
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Miwako Kobayashi
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Arvay
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Witt LS, Smith G, Sexton ME, Farley MM, Jacob JT. 416. Evaluating Indwelling Devices and Mortality in Invasive Carbapenem-Resistant Enterobacterales Infections, Atlanta, GA, 2012–2019. Open Forum Infect Dis 2022. [PMCID: PMC9752111 DOI: 10.1093/ofid/ofac492.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) infections pose a grave public health threat due to the potentially silent transmission leading to outbreaks, limited therapeutic options and high mortality. We sought to identify risk factors for mortality in patients with invasive CRE infections and describe the association between indwelling medical devices and 90-day mortality. Methods The Georgia Emerging Infections Program performs active population and laboratory based surveillance for CRE in the Atlanta, Georgia metropolitan area. Using this data we created a retrospective observational cohort of patients with invasive CRE infections between 2012 and 2019. Invasive infections were defined as resistant isolates obtained from a normally sterile site (Table 1). Indwelling medical devices, including central venous catheters (CVCs), were present within two calendar days prior to infection. We completed bivariate analyses examining the relationship between covariates and mortality. Multivariable log binomial regression was used to estimate adjusted risk ratios (aRR) for the association of covariates and all-cause 90-day mortality. Sub-group analyses were completed evaluating only those patients with CVCs and those with at least two indwelling devices.
Definition of Carbapenem-resistant Enterobacterales ![]() Abbreviations: MIC – minimum inhibitory concentration Results There were 154 invasive CRE infections (Table 2) with 87.7% having at least one indwelling device and an overall mortality of 23.4%. Intensive care unit (ICU) admission, having at least two indwelling devices, and requiring chronic dialysis were associated with mortality on bivariate analysis. The presence of any indwelling device (aRR 1.02, 95% CI 0.36, 2.89) or specifically a CVC (aRR 1.13, 95% CI 0.54, 2.37) were not associated with increased risk of 90-day mortality in unadjusted or multivariable analysis (Table 3). Having at least two indwelling devices was associated with increased risk of mortality (aRR 2.48, 95% CI: 1.02, 5.99) (Table 3). Characteristics of Patients with Invasive CRE Infections in Atlanta, Georgia 2012-2019
![]() Race: 6 unknowns, Ethnicity: 28 unknowns Other race: American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander Other sites of infection: deep tissue, sterile fluid, or other sterile site Other indwelling devices: endotracheal or nasotracheal tube, nephrostomy tube, nasogastric tube, other * 1 missing **16 patients never admitted to the hospital and 2 with missing data Risk Ratios for Invasive Devices and Mortality Including Subgroup Analyses
![]() 1 Adjusted for indwelling device, Charlson comorbidity score, intensive care admission, previous stay at LTACH 2 Adjusted for central venous catheter, Charlson comorbidity score, intensive care admission, previous stay at LTACH 3 Adjusted for at least two indwelling devices, Charlson comorbidity score, previous stay at LTACH Abbreviations: LTACH - Long Term Acute Care hospital Conclusion In patients with invasive CRE infections, indwelling medical device use was frequent but only associated with mortality in patients with multiple devices. Stewardship of medical devices may be an important target for intervention in this population. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | - Gillian Smith
- Georgia Emerging Infections Program, Atlanta, GA; Foundation for Atlanta Veterans Education and Research, Decatur, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA, Atlanta, Georgia
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Seagle EE, Jackson BR, Lockhart SR, Jenkins EN, Revis A, Farley MM, Harrison LH, Schaffner W, Markus TM, Pierce RA, Zhang AY, Lyman MM. Recurrent Candidemia: Trends and Risk Factors Among Persons Residing in 4 US States, 2011-2018. Open Forum Infect Dis 2022; 9:ofac545. [PMID: 36324324 PMCID: PMC9620433 DOI: 10.1093/ofid/ofac545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Candidemia is a common healthcare-associated infection with high mortality. Estimates of recurrence range from 1% to 17%. Few studies have focused on those with recurrent candidemia, who often experience more severe illness and greater treatment failure. We describe recurrent candidemia trends and risk factors. Methods We analyzed population-based candidemia surveillance data collected during 2011-2018. Persons with >1 episode (defined as the 30-day period after a positive Candida species) were classified as having recurrent candidemia. We compared factors during the initial episode between those who developed recurrent candidemia and those who did not. Results Of the 5428 persons identified with candidemia, 326 (6%) had recurrent infection. Recurrent episodes occurred 1.0 month to 7.6 years after any previous episode. In multivariable logistic regression controlling for surveillance site and year, recurrent candidemia was associated with being 19-44 years old (vs ≥65 years; adjusted odds ratio [aOR], 3.05 [95% confidence interval {CI}, 2.10-4.44]), being discharged to a private residence (vs medical facility; aOR, 1.53 [95% CI, 1.12-2.08]), hospitalization in the 90 days prior to initial episode (aOR, 1.66 [95% CI, 1.27-2.18]), receipt of total parenteral nutrition (aOR, 2.08 [95% CI, 1.58-2.73]), and hepatitis C infection (aOR, 1.65 [95% CI, 1.12-2.43]). Conclusions Candidemia recurrence >30 days after initial infection occurred in >1 in 20 persons with candidemia. Associations with younger age and hepatitis C suggest injection drug use may play a modifiable role. Prevention efforts targeting central line care and total parenteral nutrition use may help reduce the risk of recurrent candidemia.
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Affiliation(s)
- Emma E Seagle
- ASRT, Inc, Atlanta, Georgia, USA,Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn R Lockhart
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily N Jenkins
- Correspondence: Emily N. Jenkins, MPH, ASRT, Inc, Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-9, Atlanta, GA, 30329 ()
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA,Foundation for Atlanta Veterans Education and Research, Atlanta, Georgia, USA,Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Monica M Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA,Georgia Emerging Infections Program, Atlanta, Georgia, USA,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Rebecca A Pierce
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Alexia Y Zhang
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
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7
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Benedict K, Gold JAW, Jenkins EN, Roland J, Barter D, Czaja CA, Johnston H, Clogher P, Farley MM, Revis A, Harrison LH, Tourdot L, Davis SS, Phipps EC, Felsen CB, Tesini BL, Escutia G, Pierce R, Zhang A, Schaffner W, Lyman M. Low sensitivity of ICD-10 coding for culture-confirmed candidemia cases in an active surveillance system—United States, 2019–2020. Open Forum Infect Dis 2022; 9:ofac461. [DOI: 10.1093/ofid/ofac461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
We evaluated healthcare facility use of ICD-10 codes for culture-confirmed candidemia cases detected by active public health surveillance during 2019–2020. Most cases (56%) did not receive a candidiasis code, suggesting that studies relying on ICD-10 codes likely underestimate disease burden.
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Affiliation(s)
- Kaitlin Benedict
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeremy A W Gold
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Emily N Jenkins
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
- ASRT, Inc. , Atlanta, Georgia , USA
| | - Jeremy Roland
- California Emerging Infections Program , Oakland, California , USA
| | - Devra Barter
- Colorado Department of Public Health and Environment , Denver, Colorado , USA
| | - Christopher A Czaja
- Colorado Department of Public Health and Environment , Denver, Colorado , USA
| | - Helen Johnston
- Colorado Department of Public Health and Environment , Denver, Colorado , USA
| | - Paula Clogher
- Connecticut Emerging Infections Program, Yale School of Public Health , New Haven, Connecticut , USA
| | - Monica M Farley
- Emory University School of Medicine , Atlanta, Georgia , USA
- Atlanta VA Medical Center , Atlanta, Georgia , USA
| | - Andrew Revis
- Atlanta VA Medical Center , Atlanta, Georgia , USA
- Georgia Emerging Infections Program , Atlanta, Georgia , USA
- Foundation for Atlanta Veterans Education and Research , Atlanta, Georgia , USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA
| | - Laura Tourdot
- Minnesota Department of Health , Saint Paul, Minnesota , USA
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program , Albuquerque, New Mexico , USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program , Albuquerque, New Mexico , USA
- University of New Mexico , Albuquerque, New Mexico , USA
| | | | - Brenda L Tesini
- University of Rochester School of Medicine , Rochester, New York , USA
| | - Gabriela Escutia
- Public Health Division, Oregon Health Authority , Portland, Oregon USA
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority , Portland, Oregon USA
| | - Alexia Zhang
- Public Health Division, Oregon Health Authority , Portland, Oregon USA
| | | | - Meghan Lyman
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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8
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Cartee JC, Joseph SJ, Weston E, Pham CD, Thomas JC, Schlanger K, St Cyr SB, Farley MM, Moore AE, Tunali AK, Cloud C, Raphael BH. Phylogenomic comparison of Neisseria gonorrhoeae causing disseminated gonococcal infections and uncomplicated gonorrhea in Georgia, United States. Open Forum Infect Dis 2022; 9:ofac247. [DOI: 10.1093/ofid/ofac247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Disseminated gonococcal infection (DGI) is a rare complication caused by the systemic dissemination of Neisseria gonorrhoeae (Ng) to normally sterile anatomical sites. Little is known about the genetic diversity of DGI gonococcal strains and how they relate to other gonococcal strains causing uncomplicated mucosal infections. We used whole genome sequencing to characterize DGI isolates (n = 30) collected from a surveillance system in Georgia (GA), USA during 2017-2020 to understand phylogenetic clustering among DGI as well as uncomplicated uro-and-extragenital gonococcal (UGI) isolates (n = 110) collected in Fulton County, GA during 2017-2019. We also investigated the presence or absence of genetic markers related to antimicrobial resistance (AMR) as well as surveyed the genomes for putative virulence genetic factors associated with normal human-serum (NHS) resistance that might facilitate DGI. We found that DGI strains demonstrated significant genetic variability similar to the population structure of isolates causing UGI, with sporadic incidences of geographically clustered DGI strains. DGI isolates contained various AMR markers and genetic mechanisms associated with NHS resistance. DGI isolates had a higher frequency of the porB1A allele compared with UGI (67% vs. 9%, p < 0.0001); however, no single NHS resistance marker was found in all DGI isolates. Continued DGI surveillance with genome-based characterization of DGI isolates is necessary to better understand specific factors that promote systemic dissemination.
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Affiliation(s)
- John C. Cartee
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Sandeep J. Joseph
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Emily Weston
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
- Current affiliation: Division of Global Health and Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Cau D. Pham
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Jesse C. Thomas
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Karen Schlanger
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Sancta B. St Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
| | - Monica M. Farley
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, 30322, United States
- Atlanta VA Medical Center, Atlanta, GA, 30033, United States
| | - Ashley E. Moore
- Georgia Department of Public Health, Atlanta, GA, 30303, United States
| | - Amy K. Tunali
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, 30322, United States
- Atlanta VA Medical Center, Atlanta, GA, 30033, United States
| | - Charletta Cloud
- Georgia Department of Public Health, Atlanta, GA, 30303, United States
| | - Brian H. Raphael
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States
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9
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Kobayashi M, Matanock A, Xing W, Adih WK, Li J, Gierke R, Almendares O, Reingold A, Alden N, Petit S, Farley MM, Harrison LH, Holtzman C, Baumbach J, Thomas A, Schaffner W, McGee L, Pilishvili T. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV-United States, 2008-2018. J Acquir Immune Defic Syndr 2022; 90:6-14. [PMID: 35384920 PMCID: PMC9009407 DOI: 10.1097/qai.0000000000002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older. METHODS We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs. RESULTS In 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively. CONCLUSIONS Despite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.
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Affiliation(s)
- Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Almea Matanock
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wei Xing
- Weems Design Studio Inc, Decatur, GA
| | - William K Adih
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jianmin Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan Gierke
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Olivia Almendares
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Arthur Reingold
- Berkeley School of Public Health, University of California, Berkeley, CA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, CO
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, GA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Ann Thomas
- Oregon Department of Human Services, Portland, OR; and
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tamara Pilishvili
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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10
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Gold JAW, Revis A, Thomas S, Perry L, Blakney RA, Chambers T, Bentz ML, Berkow EL, Lockhart SR, Lysen C, Nunnally NS, Jordan A, Kelly HC, Montero AJ, Farley MM, Oliver NT, Pouch SM, Webster AS, Jackson BR, Beer KD. Clinical Characteristics, Healthcare Utilization, and Outcomes among Patients in a Pilot Surveillance System for Invasive Mold Disease—Georgia, United States, 2017–2019. Open Forum Infect Dis 2022; 9:ofac215. [DOI: 10.1093/ofid/ofac215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Invasive mold diseases (IMD) cause severe illness, but public health surveillance data are lacking. We describe data collected from a laboratory-based, pilot IMD surveillance system.
Methods
During 2017–2019, the Emerging Infections Program conducted active IMD surveillance at three Atlanta-area hospitals. We ascertained potential cases by reviewing histopathology, culture, and Aspergillus galactomannan results and classified patients as having an IMD case (based on European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [MSG] criteria) or a non-MSG IMD case (based on the treating clinician’s diagnosis and use of mold-active antifungal therapy). We described patient features and compared patients with MSG versus non-MSG IMD cases.
Results
Among 304 patients with potential IMD, 104 (34.2%) met an IMD case definition (41 MSG, 63 non-MSG). The most common IMD types were invasive aspergillosis (n = 66, 63.5%), mucormycosis (n = 8, 7.7%), and fusariosis (n = 4, 3.8%); the most frequently affected body sites were pulmonary (n = 66, 63.5%), otorhinolaryngologic (n = 17, 16.3%), and cutaneous/deep tissue (n = 9, 8.7%). Forty-five (43.3%) IMD patients received intensive care unit-level care, and 90-day all-cause mortality was 32.7%; these outcomes did not differ significantly between MSG and non-MSG IMD patients.
Conclusions
IMD patients had high mortality rates and a variety of clinical presentations. Comprehensive IMD surveillance is needed to assess emerging trends, and strict application of MSG criteria for surveillance might exclude > one-half of clinically significant IMD cases.
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Affiliation(s)
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Stepy Thomas
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lewis Perry
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Rebekah A. Blakney
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Taylor Chambers
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Monica M. Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nora T. Oliver
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie M. Pouch
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew S. Webster
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Weston EJ, Heidenga BL, Farley MM, Tunali A, D'Angelo MT, Moore A, Workowski K, Raphael BH, Weinstock H, Torrone E. Surveillance for Disseminated Gonococcal Infections, Active Bacterial Core surveillance (ABCs) - United States, 2015-2019. Clin Infect Dis 2022; 75:953-958. [PMID: 35090024 DOI: 10.1093/cid/ciac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Disseminated gonococcal infections (DGI) are thought to be uncommon; surveillance is limited and case reports are analyzed retrospectively or in case clusters. We describe the population-level burden of culture-confirmed DGI through the Active Bacterial Core surveillance (ABCs) system. METHODS During 2015-2016, retrospective surveillance was conducted among residents in two ABCs areas and prospectively in three ABCs areas during 2017-2019. A DGI case was defined as isolation of Neisseria gonorrhoeae (Ng) from a normally sterile site. A case report form was completed for each case and antimicrobial susceptibility testing (AST) was performed on available isolates. RESULTS During 2015-2019, 77 DGI cases were identified (~a rate of 0.13 cases per 100,000 population) and accounted for 0.06% of all reported gonorrhea cases in the three surveillance areas. Most DGI cases were male (64%), non-Hispanic Black (68%), and ranged from 16-67 years; blood (55%) and joint (40%) were the most common sterile sites. Among 29 isolates with AST results during 2017-2019, all were susceptible to ceftriaxone. CONCLUSIONS DGI is an infrequent complication of Ng; since Ng can quickly develop antimicrobial resistance, continued DGI surveillance, including monitoring trends in antimicrobial susceptibility, could help inform DGI treatment recommendations.
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Affiliation(s)
- Emily J Weston
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica M Farley
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States.,Atlanta VA Medical Center, Atlanta, GA, United States
| | - Amy Tunali
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States.,Atlanta VA Medical Center, Atlanta, GA, United States
| | | | - Ashley Moore
- Georgia Department of Public Health, Atlanta, GA, United States
| | - Kimberly Workowski
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States.,Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States
| | - Brian H Raphael
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hillard Weinstock
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth Torrone
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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Titanji BK, Farley MM, Schinazi RF, Marconi VC. Response to Correspondence: Baricitinib: Impact on Coronavirus Disease 2019 (COVID-19) Coagulopathy? Jorgensen et al. Clin Infect Dis 2021; 73:e3980-e3981. [PMID: 32797226 PMCID: PMC7454400 DOI: 10.1093/cid/ciaa1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
| | - Raymond F Schinazi
- Department of Pediatrics, Emory University School of Medicine,
Atlanta, Georgia, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public
Health, Atlanta, Georgia, USA
- The Emory Vaccine Center, Atlanta, Georgia, USA
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13
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Titanji BK, Farley MM, Schinazi RF, Marconi VC. Reply to Jorgensen, et al. Clin Infect Dis 2021; 73:e3978-e3979. [PMID: 32797235 PMCID: PMC7454319 DOI: 10.1093/cid/ciaa1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
| | - Raymond F Schinazi
- Department of Pediatrics, Emory University School of Medicine,
Atlanta, Georgia, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public
Health, Atlanta, Georgia, USA
- The Emory Vaccine Center, Atlanta,
Georgia, USA
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14
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Matanock A, Li J, Adih W, Xing W, Schaffner W, Alden NB, Harrison L, Petit S, Baumbach J, Reingold A, Almendares O, Gierke R, Holtzman C, Farley MM, Thomas A, Pilishvili T, Kobayashi M. 70. Changes in Invasive Pneumococcal Disease among Adults Living with HIV Following Introduction of 13-Valent Pneumococcal Conjugate Vaccine, 2008–2018. Open Forum Infect Dis 2021. [PMCID: PMC8644523 DOI: 10.1093/ofid/ofab466.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background People living with HIV (PLHIV) are at increased risk of invasive pneumococcal disease (IPD). The 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for children in 2010, and for immunocompromised adults (including PLHIV) in series with 23-valent polysaccharide vaccine (PPSV23) in 2012. We evaluated changes in IPD incidence in adults ≥19 years old by HIV status after PCV13 introduction and proportion of remaining IPD due to serotypes included in the 15- (PCV15) and 20-valent (PCV20) conjugate vaccines expected to be licensed in 2021. Methods IPD cases were identified through CDC’s Active Bacterial Core surveillance (ABCs). HIV status was obtained from medical records. Isolates were serotyped by Quellung reaction, or whole-genome sequencing and grouped into PCV13-types, PPV11-types (unique to PPSV23), or non-vaccine types. We estimated IPD incidence (cases per 100,000 people) using national projections of ABCs cases as numerators and national case-based HIV surveillance (PLHIV) or US census data (non-PLHIV) as denominators. We compared IPD incidence in 2011–12 and 2017–18 to pre-PCV13 baseline (2008–09) by serotype groups. We assessed the proportion of IPD due to serotypes included in PCV15 and PCV20. Results Overall IPD incidence at baseline was 306.7 for PLHIV and 15.2 for non-PLHIV. From baseline to 2017–18, IPD incidence declined in PLHIV (-40.3%; 95% CI: -47.7, -32.3%) and non-PLHIV (-28.2%; 95% CI: -30.9, -25.5%). The largest reductions were in PCV13-type IPD during both periods (-44.2% for PLHIV and -42.2% for non-PLHIV in 2011–12; -72.5% for PLHIV and -62.2% for non-PLHIV in 2017–18) compared to baseline (Figures 1, 2). In 2017–2018, overall IPD and PCV13-type rates were 16.8 (95% CI: 15.1, 18.5) and 12.6 (95% CI: 9.9, 15.3) times as high in PLHIV vs non-PLHIV, respectively; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2% and 16.5% of IPD in PLHIV. IPD incidence rates among adults aged ≥19 years old by serotype group in PLHIV, 2008–2018 ![]()
IPD incidence rates among adults aged ≥19 years old by serotype group in non-PLHIV, 2008–2018 ![]()
Conclusion IPD rates declined significantly in both PLHIV and non-PLHIV during the study period due to reductions in PCV13-type IPD; however, IPD rates remained 17-fold higher in PLHIV compared to non-PLHIV, mainly due to non-PCV13 types. Higher-valent pneumococcal conjugate vaccines provide opportunities to reduce some of the remaining IPD burden in PLHIV. Disclosures William Schaffner, MD, VBI Vaccines (Consultant) Lee Harrison, MD, GSK, Merck, Pfizer, Sanofi Pasteur (Consultant)
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Affiliation(s)
| | - Jianmin Li
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Adih
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wei Xing
- Weems Design Studio Inc. Contractor to CDC, Atlanta, Georgia
| | | | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Lee Harrison
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Joan Baumbach
- New Mexico Departmet of Health, Santa Fe, New Mexico
| | | | | | - Ryan Gierke
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, USA, Atlanta, Georgia
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15
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Gierke R, Farley MM, Schaffner W, Thomas A, Reingold A, Harrison L, Holtzman C, Burzlaff K, Petit S, Barnes M, Torres S, Beall B, Pilishvili T. 1299. Epidemiology of Invasive Pneumococcal Disease (IPD) in the United States 2011-2019. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.1491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for U.S. children aged < 5 years in February 2010 and recommended in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults aged ≥ 65 years in 2014. PCV13 has led to dramatic reductions in invasive pneumococcal disease (IPD) burden. New, higher valency PCVs (PCV15, PCV20) are expected to be licensed for adults in late 2021. We examined remaining PCV13-type IPD among children and adults and assessed IPD burden potentially preventable through PCV15 and PCV20 use.
Methods
IPD cases (isolation of pneumococcus from sterile sites) were identified through CDC’s Active Bacterial Core surveillance during 1998–2019. Isolates were serotyped by Quellung or whole genome sequencing. Incidence rates (cases/100,000) were calculated using U.S. Census Bureau population denominators.
Results
After introduction of PCV13 in children, by 2013–2014, PCV13-type IPD declined 89% (from 15 to 2 cases/100,000) in children age < 5 years and 67% (from 19 to 7 cases/100,000) in adults age ≥ 65 years. During 2014–2019, rates of PCV13-type IPD in children and adults remained stable. In 2018–2019, among children age < 5 years, serotypes 3, 19F, 19A, and 6C accounted for most of the remaining PCV13-type IPD (46%, 32%, 14% and 4% respectively) (Figure 1). Among adults age ≥ 65 years, serotypes 3, 6C, 19A, and 19F accounted for most of the remaining PCV13-type IPD (62%, 12%, 10%, and 9% respectively) (Figure 1). During 2015–2019, rates of PCV15 and PCV20-type IPD have remained stable. In 2018–2019, among adults age ≥ 65 years, PCV15 non-PCV13-type IPD rates were 3.6 cases per 100,000 and accounted for 15% of all IPD. PCV20 non-PCV13-type IPD rates were 6.8 cases per 100,000 and accounted for 29% of all IPD (Figure 2). Among children age < 5 years, PCV15 non-PCV13-type IPD rates were 1.6 cases per 100,000 and accounted for 17% of all IPD. PCV20 non-PCV13-type IPD rates were 2.8 cases per 100,000 and accounted for 39% of all IPD (Figure 2).
Figure 1. Incidence rates of IPD among children < 5 years old, by pneumococcal conjugate vaccine type and individual PCV13 serotypes, 2011–2019
Figure 2. Incidence rates of IPD among adults ≥ 65 years old, by pneumococcal conjugate vaccine type and individual PCV13 serotypes, 2011–2019
Conclusion
Following the dramatic reductions after PCV13 introduction, PCV13-type IPD has remained stable during the past five years. There are opportunities to prevent an additional 30% IPD burden among adults through new PCV use.
Disclosures
William Schaffner, MD, VBI Vaccines (Consultant) Lee Harrison, MD, GSK, Merck, Pfizer, Sanofi Pasteur (Consultant)
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Affiliation(s)
- Ryan Gierke
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Art Reingold
- University of California, Berkeley, Berkeley, CA
| | - Lee Harrison
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Kari Burzlaff
- New York State Department of Health, Buffalo, New York
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Salina Torres
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, USA, Atlanta, Georgia
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16
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Gopalsamy SN, Ramakrishnan A, Shariff MM, Gabel J, Brennan S, Drenzek C, Farley MM, Gaynes RP, Cartwright EJ. Brucellosis Initially Misidentified as Ochrobactrum anthropi Bacteremia: A Case Report and Review of the Literature. Open Forum Infect Dis 2021; 8:ofab473. [PMID: 34660837 PMCID: PMC8514177 DOI: 10.1093/ofid/ofab473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
Automated identification systems may misidentify Brucella, the causative agent of brucellosis, which may be re-emerging in the United States as the result of an expanding feral swine population. We present a case of Brucella suis likely associated with feral swine exposure that was misidentified as Ochrobactrum anthropi, a phylogenetic relative.
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Affiliation(s)
| | - Aditi Ramakrishnan
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mustaf M Shariff
- Department of Medicine, Northside Hospital Gwinnett, Lawrenceville, Georgia, USA
| | - Julie Gabel
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Skyler Brennan
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Cherie Drenzek
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Robert P Gaynes
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Emily J Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
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17
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Moline HL, Whitaker M, Deng L, Rhodes JC, Milucky J, Pham H, Patel K, Anglin O, Reingold A, Chai SJ, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Farley MM, Ryan PA, Kim S, Nunez VT, Como-Sabetti K, Lynfield R, Sosin DM, McMullen C, Muse A, Barney G, Bennett NM, Bushey S, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Chatelain R, Ortega J, Murthy BP, Zell E, Schrag SJ, Taylor C, Shang N, Verani JR, Havers FP. Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults Aged ≥65 Years - COVID-NET, 13 States, February-April 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1088-1093. [PMID: 34383730 PMCID: PMC8360274 DOI: 10.15585/mmwr.mm7032e3] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical trials of COVID-19 vaccines currently authorized for emergency use in the United States (Pfizer-BioNTech, Moderna, and Janssen [Johnson & Johnson]) indicate that these vaccines have high efficacy against symptomatic disease, including moderate to severe illness (1-3). In addition to clinical trials, real-world assessments of COVID-19 vaccine effectiveness are critical in guiding vaccine policy and building vaccine confidence, particularly among populations at higher risk for more severe illness from COVID-19, including older adults. To determine the real-world effectiveness of the three currently authorized COVID-19 vaccines among persons aged ≥65 years during February 1-April 30, 2021, data on 7,280 patients from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were analyzed with vaccination coverage data from state immunization information systems (IISs) for the COVID-NET catchment area (approximately 4.8 million persons). Among adults aged 65-74 years, effectiveness of full vaccination in preventing COVID-19-associated hospitalization was 96% (95% confidence interval [CI] = 94%-98%) for Pfizer-BioNTech, 96% (95% CI = 95%-98%) for Moderna, and 84% (95% CI = 64%-93%) for Janssen vaccine products. Effectiveness of full vaccination in preventing COVID-19-associated hospitalization among adults aged ≥75 years was 91% (95% CI = 87%-94%) for Pfizer-BioNTech, 96% (95% CI = 93%-98%) for Moderna, and 85% (95% CI = 72%-92%) for Janssen vaccine products. COVID-19 vaccines currently authorized in the United States are highly effective in preventing COVID-19-associated hospitalizations in older adults. In light of real-world data demonstrating high effectiveness of COVID-19 vaccines among older adults, efforts to increase vaccination coverage in this age group are critical to reducing the risk for COVID-19-related hospitalization.
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18
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Soeters HM, Oliver SE, Plumb ID, Blain AE, Zulz T, Simons BC, Barnes M, Farley MM, Harrison LH, Lynfield R, Massay S, McLaughlin J, Muse AG, Petit S, Schaffner W, Thomas A, Torres S, Watt J, Pondo T, Whaley MJ, Hu F, Wang X, Briere EC, Bruce MG. Epidemiology of Invasive Haemophilus influenzae Serotype a Disease-United States, 2008-2017. Clin Infect Dis 2021; 73:e371-e379. [PMID: 32589699 PMCID: PMC9628811 DOI: 10.1093/cid/ciaa875] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/19/2020] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Haemophilus influenzae serotype a (Hia) can cause invasive disease similar to serotype b; no Hia vaccine is available. We describe the epidemiology of invasive Hia disease in the United States overall and specifically in Alaska during 2008-2017. METHODS Active population- and laboratory-based surveillance for invasive Hia disease was conducted through Active Bacterial Core surveillance sites and from Alaska statewide invasive bacterial disease surveillance. Sterile-site isolates were serotyped via slide agglutination or real-time polymerase chain reaction. Incidences in cases per 100 000 were calculated. RESULTS From 2008 to 2017, an estimated average of 306 invasive Hia disease cases occurred annually in the United States (estimated annual incidence: 0.10); incidence increased by an average of 11.1% annually. Overall, 42.7% of cases were in children aged <5 years (incidence: 0.64), with highest incidence among children aged <1 year (1.60). Case fatality was 7.8% overall and was highest among adults aged ≥65 years (15.1%). Among children aged <5 years, the incidence was 17 times higher among American Indian and Alaska Native (AI/AN) children (8.29) than among children of all other races combined (0.49). In Alaska, incidences among all ages (0.68) and among children aged <1 year (24.73) were nearly 6 and 14 times higher, respectively, than corresponding US incidences. Case fatality in Alaska was 10.2%, and the vast majority (93.9%) of cases occurred among AI/AN. CONCLUSIONS Incidence of invasive Hia disease has increased since 2008, with the highest burden among AI/AN children. These data can inform prevention strategies, including Hia vaccine development.
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Affiliation(s)
- Heidi M. Soeters
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sara E. Oliver
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ian D. Plumb
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Amy E. Blain
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tammy Zulz
- Arctic Investigations Program, CDC, Anchorage, AK, USA
| | | | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Monica M. Farley
- Emory University School of Medicine and The Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT, USA
| | | | - Ann Thomas
- Oregon Health Authority, Portland, OR, USA
| | | | - James Watt
- California Department of Public Health, Richmond, CA, USA
| | - Tracy Pondo
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Fang Hu
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Xin Wang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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19
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Seagle EE, Jackson BR, Lockhart SR, Georgacopoulos O, Nunnally NS, Roland J, Barter DM, Johnston HL, Czaja CA, Kayalioglu H, Clogher P, Revis A, Farley MM, Harrison LH, Davis SS, Phipps EC, Tesini BL, Schaffner W, Markus TM, Lyman MM. The landscape of candidemia during the COVID-19 pandemic. Clin Infect Dis 2021; 74:802-811. [PMID: 34145450 DOI: 10.1093/cid/ciab562] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 co-infection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. METHODS We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention's Emerging Infections Program during April-August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher exact tests. RESULTS Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 co-infection, whereas intensive care unit-level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All cause in-hospital fatality was two times higher among those with COVID-19 (62.5%) than without (32.1%). CONCLUSIONS One quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19.
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Affiliation(s)
- Emma E Seagle
- ASRT, Inc; Atlanta, Georgia, USA.,Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Shawn R Lockhart
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Ourania Georgacopoulos
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Natalie S Nunnally
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Jeremy Roland
- California Emerging Infections Program; Oakland, California, USA
| | - Devra M Barter
- Colorado Department of Public Health and Environment; Denver, Colorado, USA
| | - Helen L Johnston
- Colorado Department of Public Health and Environment; Denver, Colorado, USA
| | | | - Hazal Kayalioglu
- Connecticut Emerging Infections Program, Yale School of Public Health; New Haven, Connecticut, USA
| | - Paula Clogher
- Connecticut Emerging Infections Program, Yale School of Public Health; New Haven, Connecticut, USA
| | - Andrew Revis
- Atlanta VA Medical Center; Atlanta, Georgia, USA.,Foundation for Atlanta Veterans Education and Research; Atlanta, Georgia, USA.,Georgia Emerging Infections Program; Atlanta, Georgia, USA
| | - Monica M Farley
- Atlanta VA Medical Center; Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Baltimore, Maryland, USA
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico; Albuquerque, New Mexico, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico; Albuquerque, New Mexico, USA
| | - Brenda L Tesini
- University of Rochester School of Medicine; Rochester, New York, USA
| | | | | | - Meghan M Lyman
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
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20
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Gold JAW, Seagle EE, Nadle J, Barter DM, Czaja CA, Johnston H, Farley MM, Thomas S, Harrison LH, Fischer J, Pattee B, Mody RK, Phipps EC, Shrum Davis S, Tesini BL, Zhang AY, Markus TM, Schaffner W, Lockhart SR, Vallabhaneni S, Jackson BR, Lyman M. Treatment Practices for Adults with Candidemia at Nine Active Surveillance Sites - United States, 2017-2018. Clin Infect Dis 2021; 73:1609-1616. [PMID: 34079987 DOI: 10.1093/cid/ciab512] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Candidemia is a common opportunistic infection causing substantial morbidity and mortality. Because of an increasing proportion of non-albicans Candida species and rising antifungal drug resistance, the Infectious Diseases Society of America (IDSA) changed treatment guidelines in 2016 to recommend echinocandins over fluconazole as first-line treatment for adults with candidemia. We describe candidemia treatment practices and adherence to the updated guidelines. METHODS During 2017-2018, the Emerging Infections Program conducted active population-based candidemia surveillance at nine U.S. sites using a standardized case definition. We assessed factors associated with initial antifungal treatment for the first candidemia case among adults using multivariable logistic regression models. To identify instances of potentially inappropriate treatment, we compared the first antifungal drug received with species and antifungal susceptibility testing (AFST) results from initial blood cultures. RESULTS Among 1,835 patients who received antifungal treatment, 1,258 (68.6%) received an echinocandin and 543 (29.6%) received fluconazole as initial treatment. Cirrhosis (adjusted odds ratio = 2.06, 95% confidence interval: 1.29-3.29) was the only underlying medical condition significantly associated with initial receipt of an echinocandin (versus fluconazole). Over half (n = 304, 56.0%) of patients initially treated with fluconazole grew a non-albicans species. Among 265 patients initially treated with fluconazole and with fluconazole AFST results, 28 (10.6%) had a fluconazole-resistant isolate. CONCLUSIONS A substantial proportion of patients with candidemia were initially treated with fluconazole, resulting in potentially inappropriate treatment for those involving non-albicans or fluconazole-resistant species. Reasons for non-adherence to IDSA guidelines should be evaluated, and clinician education is needed.
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Affiliation(s)
- Jeremy A W Gold
- Mycotic Diseases Branch, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Emma E Seagle
- Mycotic Diseases Branch, CDC, Atlanta, Georgia, USA.,ASRT Inc., Atlanta, GA, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California, USA
| | - Devra M Barter
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Stepy Thomas
- Georgia Emerging Infections, Emory University School of Medicine, Atlanta, GA, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill Fischer
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Rajal K Mody
- Minnesota Department of Health, Saint Paul, Minnesota, USA.,Division of State and Local Readiness, CDC, Atlanta, Georgia, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Brenda L Tesini
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Alexia Y Zhang
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | | | | | | | | | | | - Meghan Lyman
- Mycotic Diseases Branch, CDC, Atlanta, Georgia, USA
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21
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McGee L, Chochua S, Li Z, Mathis S, Rivers J, Metcalf B, Ryan A, Alden N, Farley MM, Harrison LH, Snippes Vagnone P, Lynfield R, Smelser C, Muse A, Thomas AR, Schrag S, Beall BW. Multistate, Population-Based Distributions of Candidate Vaccine Targets, Clonal Complexes, and Resistance Features of Invasive Group B Streptococci Within the United States, 2015-2017. Clin Infect Dis 2021; 72:1004-1013. [PMID: 32060499 DOI: 10.1093/cid/ciaa151] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis and an important cause of invasive infections in pregnant and nonpregnant adults. Vaccines targeting capsule polysaccharides and common proteins are under development. METHODS Using whole genome sequencing, a validated bioinformatics pipeline, and targeted antimicrobial susceptibility testing, we characterized 6340 invasive GBS isolates recovered during 2015-2017 through population-based Active Bacterial Core surveillance (ABCs) in 8 states. RESULTS Six serotypes accounted for 98.4% of isolates (21.8% Ia, 17.6% V, 17.1% II, 15.6% III, 14.5% Ib, 11.8% IV). Most (94.2%) isolates were in 11 clonal complexes (CCs) comprised of multilocus sequence types identical or closely related to sequence types 1, 8, 12, 17, 19, 22, 23, 28, 88, 452, and 459. Fifty-four isolates (0.87%) had point mutations within pbp2x associated with nonsusceptibility to 1 or more β-lactam antibiotics. Genes conferring resistance to macrolides and/or lincosamides were found in 56% of isolates; 85.2% of isolates had tetracycline resistance genes. Two isolates carrying vanG were vancomycin nonsusceptible (minimum inhibitory concentration = 2 µg/mL). Nearly all isolates possessed capsule genes, 1-2 of the 3 main pilus gene clusters, and 1 of 4 homologous alpha/Rib family determinants. Presence of the hvgA virulence gene was primarily restricted to serotype III/CC17 isolates (465 isolates), but 8 exceptions (7 IV/CC452 and 1 IV/CC17) were observed. CONCLUSIONS This first comprehensive, population-based quantitation of strain features in the United States suggests that current vaccine candidates should have good coverage. The β-lactams remain appropriate for first-line treatment and prophylaxis, but emergence of nonsusceptibility warrants ongoing monitoring.
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Affiliation(s)
- Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sopio Chochua
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zhongya Li
- IHRC Inc, Contractor to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saundra Mathis
- IHRC Inc, Contractor to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joy Rivers
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin Metcalf
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Ryan
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Chad Smelser
- New Mexico Department of Public Health, Santa Fe, New Mexico, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Ann R Thomas
- Oregon Department of Human Services, Portland, Oregon, USA
| | - Stephanie Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard W Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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22
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Tsay SV, Mu Y, Williams S, Epson E, Nadle J, Bamberg WM, Barter DM, Johnston HL, Farley MM, Harb S, Thomas S, Bonner LA, Harrison LH, Hollick R, Marceaux K, Mody RK, Pattee B, Shrum Davis S, Phipps EC, Tesini BL, Gellert AB, Zhang AY, Schaffner W, Hillis S, Ndi D, Graber CR, Jackson BR, Chiller T, Magill S, Vallabhaneni S. Burden of Candidemia in the United States, 2017. Clin Infect Dis 2021; 71:e449-e453. [PMID: 32107534 DOI: 10.1093/cid/ciaa193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Candidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States (US). METHODS In 2017, the Centers for Disease Control and Prevention conducted active population-based surveillance for candidemia through the Emerging Infections Program in 45 counties in 9 states encompassing approximately 17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality were estimated by extrapolating surveillance area cases to national numbers using 2017 national census data. RESULTS We identified 1226 candidemia cases across 9 surveillance sites in 2017. Based on this, we estimated that 22 660 (95% confidence interval [CI], 20 210-25 110) cases of candidemia occurred in the US in 2017. Overall estimated incidence was 7.0 cases per 100 000 persons, with highest rates in adults aged ≥ 65 years (20.1/100 000), males (7.9/100 000), and those of black race (12.3/100 000). An estimated 3380 (95% CI, 1318-5442) deaths occurred within 7 days of a positive Candida blood culture, and 5628 (95% CI, 2465-8791) deaths occurred during the hospitalization with candidemia. CONCLUSIONS Our analysis highlights the substantial burden of candidemia in the US. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions.
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Affiliation(s)
- Sharon V Tsay
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sabrina Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Epson
- California Emerging Infections Program, Oakland, California, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California, USA
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Devra M Barter
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Helen L Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Sasha Harb
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Stepy Thomas
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | | | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rosemary Hollick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaytlynn Marceaux
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rajal K Mody
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
- University of New Mexico, Albuquerque, New Mexico, USA
| | - Brenda L Tesini
- University of Rochester, Rochester, New York, USA
- New York Emerging Infections Program, Rochester, New York, USA
| | - Anita B Gellert
- New York Emerging Infections Program, Rochester, New York, USA
| | | | | | - Sherry Hillis
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Danielle Ndi
- Tennessee Emerging Infections Program, Nashville, Tennessee, USA
| | | | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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23
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Zhang AY, Shrum S, Williams S, Petnic S, Nadle J, Johnston H, Barter D, Vonbank B, Bonner L, Hollick R, Marceaux K, Harrison L, Schaffner W, Tesini BL, Farley MM, Pierce RA, Phipps E, Mody RK, Chiller TM, Jackson BR, Vallabhaneni S. The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor-Active Surveillance in Selected Sites, United States, 2014-2017. Clin Infect Dis 2021; 71:1732-1737. [PMID: 31676903 DOI: 10.1093/cid/ciz1061] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/29/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Injection drug use (IDU) is a known, but infrequent risk factor on candidemia; however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. METHODS Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. RESULTS During 2017, 1191 candidemia cases were identified in patients aged >12 years (incidence: 6.9 per 100 000 population); 128 (10.7%) had IDU history, and this proportion was especially high (34.6%) in patients with candidemia aged 19-44. Patients with candidemia and IDU history were younger than those without (median age, 35 vs 63 years; P < .001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%; relative risk [RR], 0.2 [95% confidence interval {CI}, .1-.5]), abdominal surgery (3.9% vs 17.5%; RR, 0.2 [95% CI, .09-.5]), and total parenteral nutrition (3.9% vs 22.5%; RR, 0.2 [95% CI, .07-.4]). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%; RR, 3.7 [95% CI, 3.1-4.4]), those with hepatitis C (54.7% vs 6.4%; RR, 8.5 [95% CI, 6.5-11.3]), and in people who were homeless (13.3% vs 0.8%; RR, 15.7 [95% CI, 7.1-34.5]). CONCLUSIONS Clinicians should consider injection drug use as a risk factor in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19-44 years of age and have community-associated candidemia.
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Affiliation(s)
- Alexia Y Zhang
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Sabrina Williams
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Petnic
- California Emerging Infections Program, Oakland, California, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California, USA
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | - Lindsay Bonner
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Rosemary Hollick
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Kaytlynn Marceaux
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Lee Harrison
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | | | - Brenda L Tesini
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Monica M Farley
- Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Rebecca A Pierce
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Erin Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rajal K Mody
- Minnesota Department of Health, St Paul, Minnesota, USA.,Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom M Chiller
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Snigdha Vallabhaneni
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Titanji BK, Farley MM, Mehta A, Connor-Schuler R, Moanna A, Cribbs SK, O'Shea J, DeSilva K, Chan B, Edwards A, Gavegnano C, Schinazi RF, Marconi VC. Use of Baricitinib in Patients With Moderate to Severe Coronavirus Disease 2019. Clin Infect Dis 2021; 72:1247-1250. [PMID: 32597466 PMCID: PMC7337637 DOI: 10.1093/cid/ciaa879] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Hyperinflammation is associated with increased mortality in coronavirus disease 2019 (COVID-19). In this retrospective, uncontrolled patient cohort with moderate -severe COVID-19, treatment with baricitinib plus hydroxychloroquine was associated with recovery in 11 of 15 patients. Baricitinib for the treatment of COVID-19 should be further investigated in randomized, controlled clinical trials.
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Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Ashish Mehta
- Pulmonary Medicine, Atlanta Veterans Affairs Medical Center, Department of Medicine, Decatur, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Randi Connor-Schuler
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Abeer Moanna
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Sushma K Cribbs
- Pulmonary Medicine, Atlanta Veterans Affairs Medical Center, Department of Medicine, Decatur, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse O'Shea
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kathryn DeSilva
- Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Bonnie Chan
- Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Alex Edwards
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Christina Gavegnano
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.,Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
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Kobayashi M, McGee L, Chochua S, Apostol M, Alden NB, Farley MM, Harrison LH, Lynfield R, Vagnone PS, Smelser C, Muse A, Thomas AR, Deng L, Metcalf BJ, Beall BW, Schrag SJ. Low but Increasing Prevalence of Reduced Beta-lactam Susceptibility Among Invasive Group B Streptococcal Isolates, US Population-Based Surveillance, 1998-2018. Open Forum Infect Dis 2021; 8:ofaa634. [PMID: 33553474 PMCID: PMC7850125 DOI: 10.1093/ofid/ofaa634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) isolates with mutations in the pbp2x gene that encodes penicillin binding protein 2x can have reduced beta-lactam susceptibility (RBLS) when susceptible by Clinical and Laboratory Standards Institute (CLSI) criteria. We assessed the emergence and characteristics of RBLS strains in US iGBS isolates. METHODS We analyzed iGBS isolates from 8 multistate population-based surveillance sites from 1998 to 2018. During 1998-2014, phenotypic antimicrobial susceptibility was determined by broth microdilution; criteria for 6 antibiotics were used to identify RBLS, followed by whole-genome sequencing (WGS). WGS for all isolates was added in 2015; we used phenotypic and genotypic results of >2000 isolates to validate phenotypic RBLS criteria and genotypic predictions. Since 2016, WGS has been used to screen for RBLS with broth microdilution confirmation of predicted RBLS isolates. RESULTS Of 28 269 iGBS isolates, 28 (0.1%) were nonsusceptible by CLSI criteria; 137 (0.5%) met RBLS criteria. RBLS isolates were detected in all Active Bacterial Core surveillance sites. The RBLS proportion increased, especially since 2013 (odds ratio, 1.17; 95% CI, 1.03-1.32); the proportion that were nonsusceptible remained stable. CONCLUSIONS The RBSL proportion was low but increasing among US iGBS isolates. Ongoing monitoring is needed to detect emerging threats to prevention and treatment of GBS infections.
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Affiliation(s)
- Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sopio Chochua
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mirasol Apostol
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Lee H Harrison
- University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Ann R Thomas
- Oregon Public Health Division, Portland, Oregon, USA
| | - Li Deng
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin J Metcalf
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard W Beall
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie J Schrag
- Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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26
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Collins JP, Campbell AP, Openo K, Farley MM, Cummings CN, Hill M, Schaffner W, Lindegren ML, Thomas A, Billing L, Bennett N, Spina N, Bargsten M, Lynfield R, Eckel S, Ryan P, Yousey-Hindes K, Herlihy R, Kirley PD, Garg S, Anderson EJ. Outcomes of Immunocompromised Adults Hospitalized With Laboratory-confirmed Influenza in the United States, 2011-2015. Clin Infect Dis 2021; 70:2121-2130. [PMID: 31298691 DOI: 10.1093/cid/ciz638] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/10/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-IC adults. METHODS We identified adults hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had human immunodefiency virus (HIV)/AIDS, cancer, stem cell or organ transplantation, nonsteroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, and/or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics. Multivariable logistic regression and Cox proportional hazards models controlled for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors. RESULTS Among 35 348 adults, 3633 (10%) were IC; cancer (44%), nonsteroid immunosuppressive therapy (44%), and HIV (18%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs 46%; P < .001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.20-1.76). Intensive care was more likely among IC patients 65-79 years (aOR, 1.25; 95% CI, 1.06-1.48) and those >80 years (aOR, 1.35; 95% CI, 1.06-1.73) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge, 0.86; 95% CI, .83-.88) and more likely to require mechanical ventilation (aOR, 1.19; 95% CI, 1.05-1.36). CONCLUSIONS Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.
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Affiliation(s)
- Jennifer P Collins
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Angela P Campbell
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kyle Openo
- Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Monica M Farley
- Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia.,Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | | | - Mary Hill
- Salt Lake Valley Health Department, Salt Lake City, Utah
| | | | | | | | | | | | | | | | | | - Seth Eckel
- Michigan Department of Health and Human Services, Lansing
| | - Patricia Ryan
- Maryland Department of Health and Mental Hygiene, Baltimore
| | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver
| | | | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evan J Anderson
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia.,Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
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Kobayashi M, McGee L, Chochua S, Apostol M, Alden NB, Farley MM, Harrison L, Holtzman C, Torres S, Thomas A, Beall B, Schrag S. 85. Characterization of Group B streptococcus Strains with Reduced Susceptibility to Beta-lactam Antibiotics, Active Bacterial Core Surveillance, 1998–2017. Open Forum Infect Dis 2020. [PMCID: PMC7777295 DOI: 10.1093/ofid/ofaa439.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In the United States, approximately 30,000 invasive group B Streptococcus (iGBS) infections occur annually; beta-lactam antibiotics (BL) are the first choice for prevention in young infants and treatment in all age groups. We obtained phenotypic and genotypic data for iGBS isolates from U.S. population-based surveillance sites to describe the emergence and characteristics of strains with reduced beta-lactam susceptibility (RS) over a 20-year period. Methods We analyzed RS iGBS isolates from eight Active Bacterial Core surveillance sites from 1998–2017. Through 2014, minimum inhibitory concentrations (MIC) for six BL were determined by broth microdilution, followed by whole genome sequencing (WGS) of RS isolates exceeding pre-defined breakpoints (Table 1). In 2015, WGS and MIC testing were performed for all isolates. After 2015, all isolates underwent WGS. MIC testing was continued on approximately 25% of isolates; otherwise, only those with modified penicillin binding protein (PBP) 2x transpeptidase amino acid sequence types or suboptimal WGS (< 1 % of isolates) underwent MIC testing. Clinical information on RS cases was abstracted from medical charts. Results Of 26,058 out of 27,269 iGBS isolates (95.6%) tested to date, 107 (0.4%) exhibited RS, increasing from 0% in 1998 to a peak of 1.1% in 2016 (P< 0.05 for trend) (Figure 1). Seven (6.5%) RS strains were from infants aged < 90 days; the rest were from adults aged ≥30 years (Table 2). RS strains consisted of 52 PBP2x types with diverse susceptibility patterns (Table 1). Seven RS strains (6.5%) had wild-type (non-modified) PBP2x; all met the RS criteria based on a single cephalosporin with a confirmed (repeated) MIC value at the break point (Table 1). Compared to non-RS strains, RS strains were more common in patients who presented with cellulitis and osteomyelitis and with underlying conditions such as diabetes or chronic skin breakdown (Table 2). Of 82 (85.4%) patients with RS strains and additional clinical information, 8.3% had known prior GBS infection; 26.8% had known BL exposure in the preceding year. ![]()
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Conclusion Preliminary results show that RS increased in recent years; strains RS to penicillin and ampicillin remain low. Variable pbp2x mutations have emerged and predominant strains have not yet been identified. Disclosures Nisha B. Alden, MPH, CDC (Grant/Research Support) Lee Harrison, MD, Dynavax (Consultant)GSK (Consultant)Merck (Consultant)OMVax (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)
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Affiliation(s)
| | - Lesley McGee
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sopio Chochua
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Lee Harrison
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Salina Torres
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Gierke R, Matanock A, Shang N, Farley MM, Schaffner W, Thomas A, Reingold A, Harrison L, Schleiss K, Burzlaff K, Petit S, Alden NB, Pilishvili T. 1474. Impact of 13-valent Pneumococcal Conjugate Vaccine (PCV13) on Non-bacteremic Pneumococcal Pneumonia (NBPP) among Adults in the United States, 2013-2017. Open Forum Infect Dis 2020. [PMCID: PMC7777900 DOI: 10.1093/ofid/ofaa439.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background PCV13 was recommended for U.S. children in 2010 and for adults ≥ 65 years in 2014. Vaccine coverage among adults ≥ 65 years was 43% in 2017. We evaluated PCV13 impact on NBPP among adults. Methods NBPP cases (clinically or radiographically confirmed pneumonia and a positive pneumococcal urine antigen test (PUAT) in a hospitalized adult aged ≥ 18 years) were identified at select hospitals in 10 sites within CDC’s Active Bacterial Core surveillance during 2013-2017. NBPP rates (per 100,000) were estimated using U.S. Census Bureau population denominators and adjusted for the proportion of pneumonia patients tested by PUAT and the number of pneumonia admissions in the catchment area. Results Between 2013 and 2017, 4,430 NBPP cases were identified. Adults aged ≥ 65 years accounted for 49% of cases. Case fatality rate was 6%. From 2013 to 2014, rates of NBPP declined from 153 to 90 (41% reduction, 95%CI 28%, 51%) in ≥ 65 year-olds; 60 to 40 (34% reduction, 95%CI 22%, 45%) in 50-64 year-olds; and 15 to 10 (36% reduction, 95%CI 25%, 47%) in 18-49 year-olds. From 2014 to 2017, rates of NBPP increased in all ages, but remained below 2013 rates (Figure). Figure. Estimated Annual Non-Bacteremic Pneumococcal Pneumonia Incidence by Age Group, 2013–2017 ![]()
Conclusion Reductions in NBPP among adults were primarily due to indirect effects of PCV13 use in children, with no additional declines following PCV13 introduction for adults aged ≥ 65 years. Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant) Nisha B. Alden, MPH, CDC (Grant/Research Support)
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Affiliation(s)
- Ryan Gierke
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nong Shang
- Centers for Disease Control and Prevention, Atlanta, GA, USA, Atlanta, GA
| | | | | | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Art Reingold
- University of California, Berkeley, Berkeley, CA
| | - Lee Harrison
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Kari Burzlaff
- New York State Department of Health, Buffalo, New York
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, USA, Atlanta, GA
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29
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Tesini BL, Lyman M, Jackson BR, Gellert A, Schaffner W, Farley MM, Shrum S, Phipps EC, Zhang AY, Pattee B, Fischer J, Johnston H, Barter D, Harrison L, Marceaux K, Nadle J. 146. antifungal Susceptibility Patterns of candida Parapsilosis Bloodstream Isolates in the US, 2008–2018. Open Forum Infect Dis 2020. [PMCID: PMC7778318 DOI: 10.1093/ofid/ofaa439.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Multidrug resistant Candida is an increasing concern. C. parapsilosis in particular has decreased in vitro susceptibility to echinocandins. As a result, fluconazole had been favored for C. parapsilosis treatment. However, there is growing concern about increasing azole resistance among Candida species. We report on antifungal susceptibility patterns of C. parapsilosis in the US from 2008 through 2018. Methods Active, population-based surveillance for candidemia through the Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program was conducted between 2008–2018, eventually encompassing 9 states (GA, MD,OR, TN, NY, CA, CO, MN, NM). Each incident isolate was sent to the CDC for species confirmation and antifungal susceptibility testing (AFST). Frequency of resistance was calculated and stratified by year and state using SAS 9.4 Results Of the 8,704 incident candidemia isolates identified, 1,471 (15%) were C. parapsilosis; the third most common species after C. albicans and C. glabrata. AFST results were available for 1,340 C. parapsilosis isolates. No resistance was detected to caspofungin (MIC50 0.25) or micafungin (MIC50 1.00) with only one (< 1%) isolate resistant to anidulafungin (MIC50 1.00). In contrast, 84 (6.3%) isolates were resistant to fluconazole and another 44 (3.3%) isolates had dose-dependent susceptibility to fluconazole (MIC50 1.00). Fluconazole resistance increased sharply from an average of 4% during 2008–2014 to a peak of 14% in 2016 with a subsequent decline to 6% in 2018 (see figure). Regional variation is also observed with fluconazole resistance ranging from 0% (CO, MN, NM) to 42% (NY) of isolates by site. ![]()
Conclusion The recent marked increase in fluconazole resistance among C. parapsilosis highlights this pathogen as an emerging drug resistant pathogen of concern and the need for ongoing antifungal resistance surveillance among Candida species. Our data support the empiric use of echinocandins for C. parapsilosis bloodstream infections and underscore the need to obtain AFST prior to fluconazole treatment. Furthermore, regional variation in fluconazole resistance emphasizes the importance of understanding local Candida susceptibility patterns. Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)
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Affiliation(s)
| | | | | | | | | | | | - Sarah Shrum
- New Mexico Emerging Infectious Program, Albuquerque, New Mexico
| | | | - Alexia Y Zhang
- Oregon Public Health Division-Acute and Communicable Disease Prevention, Portland, Oregon
| | | | - Jill Fischer
- Minnesota Department of Health, St. Paul, Minnesota
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Lee Harrison
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
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30
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Bajema K, Gierke R, Farley MM, Schaffner W, Thomas A, Reingold A, Harrison L, Lynfield R, Burzlaff K, Petit S, Barnes M, Torres S, Beall B, Pilishvili T. 180. Impact of Pneumococcal Conjugative Vaccine on Antibiotic Resistant Invasive Pneumococcal Disease in the United States. Open Forum Infect Dis 2020. [PMCID: PMC7777649 DOI: 10.1093/ofid/ofaa439.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Antibiotic-nonsusceptible invasive pneumococcal disease (NS-IPD) in the United States declined dramatically following the introduction of pneumococcal conjugative vaccines (7-valent, PCV7 in 2000, replaced by the 13-valent, PCV13 in 2010). We evaluated the long-term impact of PCV13 on NS-IPD. Methods IPD cases were identified through CDC’s Active Bacterial Core surveillance during 2005−2018. We applied 2012 Clinical and Laboratory Standards Institute breakpoints to minimum inhibitory concentrations determined by broth microdilution (2005−2014) or whole genome sequencing (2015−2018) and classified non-susceptible isolates as those intermediate or resistant to ≥1 antibiotic class. Isolates were serotyped and classified as PCV13 or non-vaccine type (NVT). Incidence rates (cases per 100,000) were calculated using United States Census Bureau population denominators. Results From 2005 to 2018, NS IPD incidence decreased from 8.5 to 3.2 among children < 5 years old and from 13.0 to 9.4 among adults ≥ 65 years old. Incidence of vaccine-type NS-IPD decreased in all age groups (Figure 1), while incidence of NVT NS-IPD increased in all age groups (Figure 2). The greatest absolute increase in NVT NS-IPD occurred among adults ≥ 65 years from 4.7 in 2005 to 7.2 in 2018. PCV13 serotypes contributed to 62% of NS-IPD (36% of NS-IPD caused by serotype 19A alone) in 2005−2009, and 27% of NS-IPD in 2014−18 (8% of NS-IPD caused by 19A). During 2014–18, NVTs 35B (11%), 33F (9%), 22F (9%), and 15A (9%) were the most common NS-IPD serotypes. Figure 1. Incidence of vaccine type antibiotic non-susceptible invasive pneumococcal disease by age group, 2005−2018. ![]()
Figure 2. Incidence of non-vaccine type antibiotic non-susceptible invasive pneumococcal disease by age group, 2005−2018. ![]()
Conclusion NS-IPD incidence decreased following PCV13 use in the United States, driven by reductions in PCV13 serotypes. Recent increases in NVT NS-IPD, most pronounced among older adults, have started to erode PCV impact on NS-IPD. PCVs in development that contain serotypes 22F and 33F could help to further reduce NS-IPD. Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)
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Affiliation(s)
- Kristina Bajema
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Gierke
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Art Reingold
- University of California, Berkeley School of Public Health, Berkeley, California
| | - Lee Harrison
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Kari Burzlaff
- New York State Department of Health, Buffalo, New York
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Salina Torres
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, USA, Atlanta, Georgia
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Pilishvili T, Gierke R, Farley MM, Schaffner W, Thomas A, Reingold A, Harrison L, Holtzman C, Burzlaff K, Petit S, Herlihy R, Torres S, Beall B. 1470. Epidemiology of Invasive Pneumococcal Disease (IPD) Following 18 years of Pneumococcal Conjugate Vaccine (PCV) Use in the United States. Open Forum Infect Dis 2020. [PMCID: PMC7777437 DOI: 10.1093/ofid/ofaa439.1651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background PCVs have been recommended for U.S. children since 2000. A 7-valent vaccine (PCV7) was introduced in 2000. This was replaced by a 13-valent vaccine (PCV13) in 2010. PCV13 was also recommended for adults aged ≥ 65 years in August 2014. We evaluated PCV impact on IPD. Methods IPD cases (isolation of pneumococcus from sterile sites) were identified through CDC’s Active Bacterial Core surveillance during 1998-2018. Isolates were serotyped by Quellung or whole genome sequencing and classified as PCV13-type and non-vaccine-type (NVT). Incidence rates (cases/100,000) were calculated using U.S. Census Bureau population denominators. Results From 1998 through 2018, overall IPD rates among children aged < 5 years decreased by 93% (from 95 to 7 cases/100,000). PCV13-type IPD decreased by 98% (from 88 to 2 cases/100,000). Among adults aged ≥ 65 years, overall IPD rates decreased by 60% (from 61 to 25 cases/100,000). PCV13-type IPD rates declined 86% (from 46 to 7 cases/100,000). Declines were most dramatic in the years following PCV7 introduction, with additional declines after PCV13 introduction in children (Figures 1 and 2). Serotypes 3, 19A, and 19F caused most of the remaining PCV13-type IPD. NVT IPD rates did not change significantly among children. Among adults aged 50-64 years, NVT IPD increased by 83% (from 6 to 12 cases/100,000) (p< 0.01). Among adults aged ≥ 65 years, NVT IPD increased by 22% (from 15 to 18 cases/100,000) (p< 0.01). The most common NVTs in 2018 were 22F (10% of all IPD), 9N (7%) and 15A (5%). Among children, the proportion of cases with meningitis increased from 5% to 14% (p< 0.01), and the proportion with pneumonia/empyema increased from 17% to 31% (p< 0.01). Among adults, the proportion of cases with meningitis did not change (3%), while the proportion with pneumonia/empyema increased from 72% to 76% (p=0.01). Figure 1: Incidence of invasive pneumococcal disease among children aged < 5 years, 1998-2018 ![]()
Figure 2: Incidence of invasive pneumococcal disease among adults aged ≥ 65 years, 1998-2018 Conclusion Overall IPD incidence among children and adults decreased following PCV introduction for children, driven primarily by reductions in PCV-type IPD. NVT IPD increased in older adults, but these increases did not eliminate reductions from PCV13-type IPD. ![]()
Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)
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Affiliation(s)
- Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, USA, Atlanta, Georgia
| | - Ryan Gierke
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Art Reingold
- University of California, Berkeley, Berkeley, CA
| | - Lee Harrison
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Kari Burzlaff
- New York State Department of Health, Buffalo, New York
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Salina Torres
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Oh DH, Seagle E, Lockhart SR, Nadle J, Barter D, Johnston H, Farley MM, Revis A, Pattee B, Phipps EC, Tesini BL, Zhang AY, Schaffner W, Jackson BR, Lyman M. 1424. Factors Associated with Failure to Clear Candidemia Infection: Surveillance Data from Eight States, 2017. Open Forum Infect Dis 2020. [PMCID: PMC7776766 DOI: 10.1093/ofid/ofaa439.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Candidemia is a bloodstream infection commonly associated with high morbidity and mortality. Failure to clear candidemia can lengthen hospitalization and treatment. Factors associated with candidemia clearance are unknown.
Methods
We analyzed 2017 candidemia surveillance data from the Centers for Disease Control and Prevention’s Emerging Infections Program. Data from eight sites (counties in California, Colorado, Georgia, Minnesota, New Mexico, New York, Oregon, and Tennessee) were included. Clearance was defined as having a blood culture negative for Candida ≤30 days after initial culture date (ICD). Cases with unknown clearance, unknown survival outcome, or death ≤30 days of ICD were excluded. Demographic and clinical factors associated with clearance were assessed with bivariate analysis using chi-square tests and multivariable logistic regression to calculate adjusted odds ratios (aOR) using backward selection (p-value< 0.10).
Results
Of 1,024 candidemia cases, 737 were included and 582 (79%) demonstrated clearance, of which 79% had evidence of clearance ≤5 days after ICD. In bivariate analysis, clearance was associated with central venous catheter (CVC) ≤2 days before ICD, CVC removal ≤7 days after ICD, and systemic antifungal medication within 14 days before ICD. Clearance was inversely associated with black race and admission from another hospital. In multivariable analysis, only race and admission from another hospital were significant predictors; age, sex, and CVC presence and subsequent removal were also retained for their clinical relevance. In the final model, clearance was less likely among black patients (aOR 0.51, 95% confidence interval [CI] 0.29-0.91) and those admitted from another hospital (aOR 0.28, 95% CI 0.11-0.75).
Table 1. Bivariate associations for select variables between individuals with documented candidemia clearance and those without documented clearance in eight Emerging Infections Program surveillance sites, 2017
Conclusion
We found failure to clear candidemia infection to be associated with black race and prior hospital exposure, but not other factors previously shown to be associated (e.g., comorbidities, CVC presence). These associations could reflect illness severity, access to care, or other obstacles to effective treatment. Additional research is needed to investigate these associations further and identify other factors (e.g., treatment type and timing) to improve outcomes.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- David H Oh
- Tufts University School of Medicine, San Leandro, California
| | - Emma Seagle
- Centers for Disease Control and Prevention, Mycotic Disease Branch, Atlanta, Georgia
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Andrew Revis
- Foundation for Atlanta Veterans Education and Research/VA Health System, Georgia Emerging Infections Program, Atlanta, Georgia
| | | | | | | | - Alexia Y Zhang
- Oregon Public Health Division-Acute and Communicable Disease Prevention, Portland, Oregon
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Beer K, Kelly H, Blakney R, Revis A, Perry L, Bentz M, Berkow EL, Lockhart SR, matkovic E, Thomas S, Oliver N, Webster A, Pouch SM, Pouch SM, Farley MM, Jackson BR. 912. Beyond the Usual Suspects in Invasive Mold Infections: Public Health Surveillance Identifies Clinical Diversity. Open Forum Infect Dis 2020. [PMCID: PMC7776065 DOI: 10.1093/ofid/ofaa439.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Invasive mold infections (IMI) such as aspergillosis and mucormycosis are often fatal among immunocompromised patients and cause high-profile outbreaks. Public health surveillance for IMI is challenging; most epidemiologic studies are limited to transplant and cancer patients at greatest risk of IMI. The established Mycoses Study Group (MSG) case definition is useful for clinical trials but lacks sensitivity. To address these challenges, we created IMI surveillance within the Georgia Emerging Infections Program. Here, we describe cases identified through this system, using both the MSG criteria and a novel, more sensitive surveillance case definition. Methods To identify potential IMI cases, we captured 2,363 positive fungal laboratory results, including cultures, histopathology, and galactomannan tests, within a 60-day window at three large Atlanta hospitals during April 2018–March 2019. We excluded yeast and dimorphic fungi, hair and nail specimens, and cystic fibrosis patients. Potential cases underwent chart review and were classified by 2 physicians as proven, probable, or non-case according to MSG criteria. Cases that partially met MSG probable criteria and included antifungal treatment were classified as surveillance cases; definitions were mutually exclusive (Fig 1). ![]()
Results Of 120 potential IMI cases, 46 (38%) met an IMI case definition: 8 proven, 9 probable, and 29 surveillance cases (Fig 2). Of cases, 14 (30%) involved transplant or cancer in the previous year; 8 of these were proven or probable cases. IMI presented primarily as sinusitis among proven cases (50%), and pulmonary infections among probable (56%) and surveillance (45%) cases. Most surveillance cases were caused by Aspergillus spp. (72%) and accounted for all 5 cutaneous IMI (fig 3). Over 80% of cases vs. 10% of non-cases had antifungal treatment. ![]()
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Conclusion Of IMI cases identified, nearly two thirds had evidence of infection but did not meet an MSG case definition. MSG captured over half of transplant and cancer-associated cases, but these were uncommon overall, revealing most IMI lack classical risk factors. A more sensitive surveillance case definition can capture a broader spectrum of IMI patients receiving antifungal treatment to help guide clinical and public health interventions. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Hilary Kelly
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Andrew Revis
- Foundation for Atlanta Veterans Education and Research/VA Health System, Georgia Emerging Infections Program, Atlanta, Georgia
| | - Lewis Perry
- Georgia Emerging Infections Program/Georgia VA Health System, Atlanta, GA
| | | | | | | | | | - Stepy Thomas
- Emory University, Georgia Emerging Infections Program, Atlanta, GA
| | - Nora Oliver
- Emory University School of Medicine, Atlanta VAMC, and Georgia Emerging Infections Program, Atlanta, Georgia
| | - Andrew Webster
- Emory University School of Medicine and Georgia Emerging Infections Program, Atlanta, Georgia
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Wozniak JE, Chande AT, Burd EM, Band VI, Satola SW, Farley MM, Jacob JT, Jordan IK, Weiss DS. Absence of mgrB Alleviates Negative Growth Effects of Colistin Resistance in Enterobacter cloacae. Antibiotics (Basel) 2020; 9:antibiotics9110825. [PMID: 33227907 PMCID: PMC7699182 DOI: 10.3390/antibiotics9110825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022] Open
Abstract
Colistin is an important last-line antibiotic to treat highly resistant Enterobacter infections. Resistance to colistin has emerged among clinical isolates but has been associated with a significant growth defect. Here, we describe a clinical Enterobacter isolate with a deletion of mgrB, a regulator of colistin resistance, leading to high-level resistance in the absence of a growth defect. The identification of a path to resistance unrestrained by growth defects suggests colistin resistance could become more common in Enterobacter.
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Affiliation(s)
- Jessie E. Wozniak
- Emory Vaccine Center, Atlanta, GA 30317, USA; (J.E.W.); (V.I.B.)
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
| | - Aroon T. Chande
- Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
- Applied Bioinformatics Laboratory, Atlanta, GA 30346, USA
- PanAmerican Bioinformatics Institute, Cali 760043, Valle del Cauca, Colombia
| | - Eileen M. Burd
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
| | - Victor I. Band
- Emory Vaccine Center, Atlanta, GA 30317, USA; (J.E.W.); (V.I.B.)
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
| | - Sarah W. Satola
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
| | - Monica M. Farley
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
- Atlanta VA Medical Center, Decatur, GA 30033, USA
| | - Jesse T. Jacob
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
| | - I. King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
- IHRC Applied Bioinformatics Laboratory, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - David S. Weiss
- Emory Vaccine Center, Atlanta, GA 30317, USA; (J.E.W.); (V.I.B.)
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (E.M.B.); (S.W.S.); (M.M.F.); (J.T.J.)
- Emory Antibiotic Resistance Center, Atlanta, GA 30329, USA
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Correspondence:
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Mustapha MM, Marsh JW, Shutt KA, Schlackman J, Ezeonwuka C, Farley MM, Stephens DS, Wang X, Van Tyne D, Harrison LH. Transmission Dynamics and Microevolution of Neisseria meningitidis During Carriage and Invasive Disease in High School Students in Georgia and Maryland, 2006-2007. J Infect Dis 2020; 223:2038-2047. [PMID: 33107578 DOI: 10.1093/infdis/jiaa674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The mechanisms by which Neisseria meningitidis cause persistent human carriage and transition from carriage to invasive disease have not been fully elucidated. METHODS Georgia and Maryland high school students were sampled for pharyngeal carriage of N. meningitidis during the 2006-2007 school year. A total of 321 isolates from 188 carriers and all 67 invasive disease isolates collected during the same time and from the same geographic region underwent whole-genome sequencing. Core-genome multilocus sequence typing was used to compare allelic profiles, and direct read mapping was used to study strain evolution. RESULTS Among 188 N. meningitidis culture-positive students, 98 (52.1%) were N. meningitidis culture positive at 2 or 3 samplings. Most students who were positive at >1 sampling (98%) had persistence of a single strain. More than a third of students carried isolates that were highly genetically related to isolates from other students in the same school, and occasional transmission within the same county was also evident. The major pilin subunit gene, pilE, was the most variable gene, and no carrier had identical pilE sequences at different time points. CONCLUSION We found strong evidence of local meningococcal transmission at both the school and county levels. Allelic variation within genes encoding bacterial surface structures, particularly pilE, was common.
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Affiliation(s)
- Mustapha M Mustapha
- Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jane W Marsh
- Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kathleen A Shutt
- Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jessica Schlackman
- Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chinelo Ezeonwuka
- Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Monica M Farley
- Emory University Department of Medicine, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Atlanta, Georgia, USA
| | | | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daria Van Tyne
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lee H Harrison
- Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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36
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Korhonen L, Cohen J, Gregoricus N, Farley MM, Perlmutter R, Holzbauer SM, Dumyati G, Beldavs Z, Paulick A, Vinjé J, Limbago BM, Lessa FC, Guh AY. Evaluation of viral co-infections among patients with community-associated Clostridioides difficile infection. PLoS One 2020; 15:e0240549. [PMID: 33075113 PMCID: PMC7571680 DOI: 10.1371/journal.pone.0240549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023] Open
Abstract
We assessed viral co-infections in 155 patients with community-associated Clostridioides difficile infection in five U.S. sites during December 2012–February 2013. Eighteen patients (12%) tested positive for norovirus (n = 10), adenovirus (n = 4), rotavirus (n = 3), or sapovirus (n = 1). Co-infected patients were more likely than non-co-infected patients to have nausea or vomiting (56% vs 31%; p = 0.04), suggesting that viral co-pathogens contributed to symptoms in some patients. There were no significant differences in prior healthcare or medication exposures or in CDI complications.
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Affiliation(s)
- Lauren Korhonen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jessica Cohen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Atlanta Research and Education Foundation, Atlanta, Georgia, United States of America
| | - Nicole Gregoricus
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Monica M. Farley
- Emory University School of Medicine, Atlanta, Georgia, United States of America
- Veterans Affairs Medical Center, Atlanta, Georgia, United States of America
| | - Rebecca Perlmutter
- Maryland Department of Health, Baltimore, Maryland, United States of America
| | - Stacy M. Holzbauer
- Minnesota Department of Health, St Paul, Minnesota, United States of America
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ghinwa Dumyati
- New York Emerging Infections Program and University of Rochester Medical Center, Rochester, New York, United States of America
| | - Zintars Beldavs
- Oregon Health Authority, Portland, Oregon, United States of America
| | - Ashley Paulick
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brandi M. Limbago
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Fernanda C. Lessa
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Alice Y. Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
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Guh AY, Hatfield KM, Winston LG, Martin B, Johnston H, Brousseau G, Farley MM, Wilson L, Perlmutter R, Phipps EC, Dumyati GK, Nelson D, Hatwar T, Kainer MA, Paulick AL, Karlsson M, Gerding DN, McDonald LC. Toxin Enzyme Immunoassays Detect Clostridioides difficile Infection With Greater Severity and Higher Recurrence Rates. Clin Infect Dis 2020; 69:1667-1674. [PMID: 30615074 DOI: 10.1093/cid/ciz009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Few data suggest that Clostridioides difficile infections (CDIs) detected by toxin enzyme immunoassay (EIA) are more severe and have worse outcomes than those detected by nucleic acid amplification tests (NAATs) only. We compared toxin- positive and NAAT-positive-only CDI across geographically diverse sites. METHODS A case was defined as a positive C. difficile test in a person ≥1 year old with no positive tests in the prior 8 weeks. Cases were detected during 2014-2015 by a testing algorithm (specimens initially tested by glutamate dehydrogenase and toxin EIA; if discordant results, specimens were reflexed to NAAT) and classified as toxin positive or NAAT positive only. Medical charts were reviewed. Multivariable logistic regression models were used to compare CDI-related complications, recurrence, and 30-day mortality between the 2 groups. RESULTS Of 4878 cases, 2160 (44.3%) were toxin positive and 2718 (55.7%) were NAAT positive only. More toxin-positive than NAAT-positive-only cases were aged ≥65 years (48.2% vs 38.0%; P < .0001), had ≥3 unformed stools for ≥1 day (43.9% vs 36.6%; P < .0001), and had white blood cell counts ≥15 000 cells/µL (31.4% vs 21.4%; P < .0001). In multivariable analysis, toxin positivity was associated with recurrence (adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.61-2.23), but not with CDI-related complications (aOR, 0.91; 95% CI, .67-1.23) or 30-day mortality (aOR, 0.95; 95% CI, .73-1.24). CONCLUSIONS Toxin-positive CDI is more severe, but there were no differences in adjusted CDI-related complication and mortality rates between toxin-positive and NAAT-positive-only CDI that were detected by an algorithm that utilized an initial glutamate dehydrogenase screening test.
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Affiliation(s)
- Alice Y Guh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lisa G Winston
- School of Medicine, University of California, San Francisco
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver
| | | | - Monica M Farley
- Emory University School of Medicine, Atlanta, Georgia.,Veterans Affairs Medical Center, Atlanta, Georgia
| | | | | | - Erin C Phipps
- University of New Mexico, Albuquerque.,New Mexico Emerging Infections Program, Albuquerque
| | - Ghinwa K Dumyati
- New York Emerging Infections Program and University of Rochester Medical Center, Nashville
| | - Deborah Nelson
- New York Emerging Infections Program and University of Rochester Medical Center, Nashville
| | - Trupti Hatwar
- New York Emerging Infections Program and University of Rochester Medical Center, Nashville
| | | | | | - Maria Karlsson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dale N Gerding
- Stritch School of Medicine, Loyola University Chicago, Maywood.,Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
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Bozio CH, Blain A, Edge K, Farley MM, Harrison LH, Poissant T, Schaffner W, Scheuer T, Torres S, Triden L, Briere E, Oliver SE. Clinical characteristics and adverse clinical outcomes of invasive Haemophilus influenzae serotype a cases - United States, 2011-2015. Clin Infect Dis 2020; 73:e3670-e3676. [PMID: 32668450 DOI: 10.1093/cid/ciaa990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Incidence of invasive disease due to H. influenzae serotype a (Hia) increased an average of 13% annually from 2002-2015. We described clinical characteristics and adverse clinical outcomes of U.S. invasive Hia cases detected through multi-state surveillance during 2011-2015. METHODS Medical record data were abstracted for cases reported in eight jurisdictions conducting active population- and laboratory-based surveillance for invasive Hia disease across the United States. Isolates from sterile sites were serotyped by real-time polymerase chain reaction. Adverse clinical outcomes were defined as any possible complication of meningitis, bacteremic pneumonia, or bacteremia (including hearing loss, developmental delay, and speech delay, but excluding death), and were assessed at hospital discharge and one-year post-disease onset. RESULTS During 2011-2015, 190 Hia cases were reported to the eight participating sites; 169 (88.9%) had data abstracted. Many patients were aged <5 years (42.6%) or ≥65 years (20.7%). Meningitis was the most common clinical presentation among <1 year olds (71.4%); bacteremic pneumonia was the most common presentation among persons aged ≥50 years (78.7%). Overall, 95.9% of patients were hospitalized: among those hospitalized, 47.5% were admitted to an intensive care unit, and 6.2% died during hospitalization. At hospital discharge and one-year post-disease onset, adverse outcomes were identified in 17.7% and 17.8% of patients overall, and in 43.9% and 48.5% of patients with meningitis (primarily children). CONCLUSIONS Hia infection can cause severe disease requiring hospitalization and may also cause short- and long-term adverse clinical outcomes, especially among children. Novel vaccines could prevent morbidity and mortality.
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Affiliation(s)
- Catherine H Bozio
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA.,National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Amy Blain
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Karen Edge
- Colorado Department of Public Health and Environment, Colorado
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Atlanta, GA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Tara Scheuer
- California Emerging Infections Program, Oakland, CA
| | | | - Lori Triden
- Minnesota Department of Health, St. Paul, MN
| | - Elizabeth Briere
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Sara E Oliver
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
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39
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Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM, Wilson LE, Holzbauer SM, Phipps EC, Dumyati GK, Beldavs ZG, Kainer MA, Karlsson M, Gerding DN, McDonald LC. Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes. N Engl J Med 2020; 382:1320-1330. [PMID: 32242357 PMCID: PMC7861882 DOI: 10.1056/nejmoa1910215] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Efforts to prevent Clostridioides difficile infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of C. difficile infection is unclear. METHODS The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used case and census sampling weights to estimate the national burden of C. difficile infection, first recurrences, hospitalizations, and in-hospital deaths from 2011 through 2017. Health care-associated infections were defined as those with onset in a health care facility or associated with recent admission to a health care facility; all others were classified as community-associated infections. For trend analyses, we used weighted random-intercept models with negative binomial distribution and logistic-regression models to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types. RESULTS The number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011 (10,177 health care-associated and 5284 community-associated cases) and 15,512 in 2017 (7973 health care-associated and 7539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017. With accounting for NAAT use, the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of health care-associated C. difficile infection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly. CONCLUSIONS The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care-associated infections. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Alice Y Guh
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Yi Mu
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Lisa G Winston
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Helen Johnston
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Danyel Olson
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Monica M Farley
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Lucy E Wilson
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Stacy M Holzbauer
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Erin C Phipps
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Ghinwa K Dumyati
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Zintars G Beldavs
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Marion A Kainer
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Maria Karlsson
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - Dale N Gerding
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
| | - L Clifford McDonald
- From the Division of Healthcare Quality Promotion (A.Y.G., Y.M., M.K., L.C.M.) and the Career Epidemiology Field Officer Program (S.M.H.), Centers for Disease Control and Prevention, Emory University School of Medicine (M.M.F.), and the Veterans Affairs Medical Center (M.M.F.) - all in Atlanta; the University of California, San Francisco, School of Medicine, San Francisco (L.G.W.); the Colorado Department of Public Health and Environment, Denver (H.J.); the Connecticut Emerging Infections Program, Yale School of Public Health, New Haven (D.O.); the University of Maryland Baltimore County and the Maryland Department of Health, Baltimore (L.E.W.); the Minnesota Department of Health, St. Paul (S.M.H.); the University of New Mexico, New Mexico Emerging Infections Program, Albuquerque (E.C.P.); the New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.K.D.); the Oregon Health Authority, Portland (Z.G.B.); the Tennessee Department of Health, Nashville (M.A.K.); and Stritch School of Medicine, Loyola University Chicago, Maywood, and the Edward Hines, Jr. Veterans Affairs Hospital, Hines - both in Illinois (D.N.G.)
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Collins JP, Campbell AP, Openo K, Farley MM, Cummings CN, Kirley PD, Herlihy R, Yousey-Hindes K, Monroe ML, Ladisky M, Lynfield R, Baumbach J, Spina N, Bennett N, Billing L, Thomas A, Schaffner W, Price A, Garg S, Anderson EJ. Clinical Features and Outcomes of Immunocompromised Children Hospitalized With Laboratory-Confirmed Influenza in the United States, 2011-2015. J Pediatric Infect Dis Soc 2019; 8:539-549. [PMID: 30358877 DOI: 10.1093/jpids/piy101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Existing data on the clinical features and outcomes of immunocompromised children with influenza are limited. METHODS Data from the 2011-2012 through 2014-2015 influenza seasons were collected as part of the Centers for Disease Control and Prevention (CDC) Influenza Hospitalization Surveillance Network (FluSurv-NET). We compared clinical features and outcomes between immunocompromised and nonimmunocompromised children (<18 years old) hospitalized with laboratory-confirmed community-acquired influenza. Immunocompromised children were defined as those for whom ≥1 of the following applies: human immunodeficiency virus/acquired immunodeficiency syndrome, cancer, stem cell or solid organ transplantation, nonsteroidal immunosuppressive therapy, immunoglobulin deficiency, complement deficiency, asplenia, and/or another rare condition. The primary outcomes were intensive care admission, duration of hospitalization, and in-hospital death. RESULTS Among 5262 hospitalized children, 242 (4.6%) were immunocompromised; receipt of nonsteroidal immunosuppressive therapy (60%), cancer (39%), and solid organ transplantation (14%) were most common. Immunocompromised children were older than the nonimmunocompromised children (median, 8.8 vs 2.8 years, respectively; P < .001), more likely to have another comorbidity (58% vs 49%, respectively; P = .007), and more likely to have received an influenza vaccination (58% vs 39%, respectively; P < .001) and early antiviral treatment (35% vs 27%, respectively; P = .013). In multivariable analyses, immunocompromised children were less likely to receive intensive care (adjusted odds ratio [95% confidence interval], 0.31 [0.20-0.49]) and had a slightly longer duration of hospitalization (adjusted hazard ratio of hospital discharge [95% confidence interval], 0.89 [0.80-0.99]). Death was uncommon in both groups. CONCLUSIONS Immunocompromised children hospitalized with influenza received intensive care less frequently but had a longer hospitalization duration than nonimmunocompromised children. Vaccination and early antiviral use could be improved substantially. Data are needed to determine whether immunocompromised children are more commonly admitted with milder influenza severity than are nonimmunocompromised children.
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Affiliation(s)
- Jennifer P Collins
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Angela P Campbell
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kyle Openo
- Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | | | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver
| | | | - Maya L Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore
| | - Macey Ladisky
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | | | | | | | - Andrea Price
- Salt Lake Valley Health Department, Salt Lake City, Utah
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
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Collins LF, Havers FP, Tunali A, Thomas S, Clennon JA, Wiley Z, Tobin-D’Angelo M, Parrott T, Read TD, Satola SW, Petit RA, Farley MM. Invasive Nontypeable Haemophilus influenzae Infection Among Adults With HIV in Metropolitan Atlanta, Georgia, 2008-2018. JAMA 2019; 322:2399-2410. [PMID: 31860046 PMCID: PMC6990662 DOI: 10.1001/jama.2019.18800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon. OBJECTIVE To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia. DESIGN, SETTING, AND PARTICIPANTS A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up). EXPOSURES Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status. RESULTS Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection. CONCLUSIONS AND RELEVANCE Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity.
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Affiliation(s)
- Lauren F. Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Fiona P. Havers
- Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Stephanie Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Julie A. Clennon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Zanthia Wiley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Melissa Tobin-D’Angelo
- Georgia Emerging Infections Program, Atlanta
- Georgia Department of Public Health, Atlanta
| | - Tonia Parrott
- Georgia Emerging Infections Program, Atlanta
- Georgia Department of Public Health, Atlanta
| | - Timothy D. Read
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Sarah W. Satola
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Robert A. Petit
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Monica M. Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
- Atlanta VA Medical Center, Decatur, Georgia
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Howard-Anderson J, Bower CW, Smith G, Elizabeth Sexton M, Satola SW, Farley MM, Jacob JT. 506. Urinary Catheters Are Associated with Progression from Bacteriuria to Invasive Infections in Patients with Carbapenem-Resistant Enterobacteriaceae, Metropolitan Atlanta, 2011–2017. Open Forum Infect Dis 2019. [PMCID: PMC6811239 DOI: 10.1093/ofid/ofz360.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patients with carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria have better outcomes than patients with an invasive CRE infection, but patients with bacteriuria may subsequently develop an invasive infection (“progression”). We sought to evaluate risk factors, particularly urinary catheters, for progression from CRE bacteriuria to an invasive CRE infection within one year. Methods We used population-based active surveillance data from the Georgia Emerging Infections Program to identify patients in metropolitan Atlanta with CRE in urine, but not in a concomitant or previous sterile site between August 1, 2011 and July 31, 2017. CRE was defined as an isolate resistant to tested third-generation cephalosporins and a minimum inhibitory concentration of ≥4 µg/mL for meropenem, doripenem or imipenem. We then assessed if these patients developed an invasive CRE infection (positive sterile site culture) with the same organism between one day and one year later. Demographics, culture site, comorbidities, and risk factors were obtained by chart review. Univariable analyses and multivariable logistic regression with progression as the outcome were performed in SAS 9.4. Results We identified 551 patients with CRE bacteriuria in 6 years, with an annual incidence of 1.1 cases/100,000 population. Many patients previously resided in long-term care facilities (48%), had a Charlson comorbidity index (CCI) >3 (38%), a central venous catheter (CVC, 34%) or a decubitus ulcer (27%, Table 1). Twenty-five patients (5%) progressed from CRE bacteriuria to an invasive CRE infection within one year (median 34 days). Predictors of progression in univariable analyses included the presence of a urinary catheter (OR 6.4 [95% CI: 1.9–21.6]), decubitus ulcer, CVC or other indwelling device, Klebsiella pneumoniae, black race, CCI >3, and ICU stay after urine culture was obtained (Table 2). In a multivariable analysis, urinary catheter (OR 4.6 [95% CI: 1.3–16.1]) predicted progression as well as K. pneumoniae, CCI >3 and CVC. Conclusion Progression from CRE bacteriuria to an invasive CRE infection is rare but clinically significant and is associated with urinary catheters. Future interventions should target urinary catheter removal, where possible, in patients with CRE bacteriuria. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Chris W Bower
- Georgia Emerging Infections Program, Decatur, Georgia
| | - Gillian Smith
- Georgia Emerging Infections Program, Decatur, Georgia
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Beer K, Kelly H, Blakney R, Chambers T, Perry L, Singleton S, Matkovic E, Hale G, Thomas S, Oliver N, Dretler A, Tsay S, Farley MM, Jackson BR. 1714. Testing a Novel Clinical Surveillance Case Definition for Invasive Mold Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809334 DOI: 10.1093/ofid/ofz360.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Invasive mold infections (IMI) such as aspergillosis and mucormycosis are often fatal among immunosuppressed patients and have caused high-profile outbreaks. Surveillance for IMI is challenging because distinguishing a case from colonization or contamination is complex. The established case definition, Mycoses Study Group (MSG) criteria, lacks sensitivity. Because the need for surveillance remains, we designed a pilot IMI surveillance system within the Georgia Emerging Infections Program. Here, we describe cases identified through this system, using both the MSG criteria and a novel, more sensitive clinical case definition. Methods To identify potential IMI cases, we captured fungal cultures positive for mold, histopathology specimens with evidence of fungal tissue invasion, and positive galactomannan results within a 60-day window at three large hospitals in Atlanta during March 2017–2018. We excluded dimorphic fungi and hair and nail specimens. Of 194 potential cases, we selected 24 for complete medical chart review. Two physicians classified cases as proven, probable, or non-case according to MSG criteria. Cases that partially met MSG probable criteria and included antifungal treatment were classified as clinical cases; definitions were mutually exclusive (Figure 1). Results Of 24 potential IMI cases, 16 (66%) met an IMI case definition, including 5 proven, 2 probable and 9 clinical cases. Inter-rater agreement was 92%., Most (5/7) MSG cases involved Aspergillus and were more likely to have cancer, a transplant, or other immunosuppression compared with clinical cases (Figure 2 and 3). Clinical cases included conditions not specified in MSG criteria, including burns (1), wounds (1) or eye (4) infections. MSG and clinical cases more often had antifungal treatment (16/16 vs. 1/8) or died (4/16 vs. 0/8) compared with non-cases. Conclusion In this preliminary analysis of potential IMI cases, most represented true invasive infections, indicating effective exclusion of most colonization. Most of the 16 cases were classified as clinical, however, and would have been missed in a system relying on the MSG criteria alone. Results suggest that a less-specific clinical case definition incorporating antifungal treatment may improve the sensitivity and utility of IMI surveillance. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Hilary Kelly
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Taylor Chambers
- VA Health System/Georgia Emerging Infections Program, Atlanta, Georgia
| | - Lewis Perry
- Georgia Emerging Infections Program/Georgia VA Health System, Atlanta, Georgia
| | | | | | | | - Stepy Thomas
- Emory University, Georgia Emerging Infections Program, Atlanta, Georgia
| | | | - Alexandra Dretler
- Emory University, Georgia Emerging Infectious Program, Atlanta, Georgia
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Haston JC, Garg S, Campbell AP, Ferdinands J, O’Halloran A, Cummings CN, Kirley PD, Stephens S, Yousey-Hindes K, Openo KP, Fawcett E, Farley MM, Monroe M, Kim S, McMahon M, Irizarry L, Dufort E, Bennett NM, Billing LM, Thomas A, Talbot K, Spencer M, Anderson EJ. 2741. Seasonal Influenza Vaccine Timing in Children and Adults Hospitalized with Influenza in the United States, FluSurv-NET, 2013–2017. Open Forum Infect Dis 2019. [PMCID: PMC6810507 DOI: 10.1093/ofid/ofz360.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Seasonal influenza vaccine may attenuate disease severity among people infected with influenza despite vaccination, but vaccine effectiveness may decrease with increasing time between vaccination and infection. Patient characteristics may play a role in the timing of vaccine receipt. Methods We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) and included patients ≥ 9 years hospitalized with laboratory-confirmed influenza during October 1–April 30 of influenza seasons 2013–2014 through 2016–2017 who received seasonal influenza vaccine ≥ 14 days prior to admission. Vaccine history was obtained from vaccine registries, medical charts, and patient interviews. We defined “early vaccination” as vaccine receipt before October 15 and “late vaccination” as receipt after (date selected using typical season onset and median vaccination dates). Early and late groups were compared using Chi-square or Fisher exact tests. Results Among 21,751 vaccinated patients, 61% received vaccine before October 15, and distribution of vaccination date was similar across seasons (figure). Vaccination occurred earlier with increasing age (45% were vaccinated early among those 9–17 years but 65% in those ≥ 80 years, P < 0.01). White non-Hispanic patients were more likely to receive vaccine early compared with black non-Hispanic and Hispanic patients (63% vs. 55% and 54%; P < 0.01). Those with metabolic disorders, cardiovascular disease, kidney disease, and cancer were vaccinated earlier whereas those with HIV and liver disease were vaccinated later. Vaccine timing also varied by state (P < 0.01) but not by sex. Conclusion Among influenza-vaccinated older children and adults hospitalized with influenza, older age, white race, and certain medical conditions were associated with early receipt of influenza vaccination in unadjusted analysis. This may be due to frequent healthcare encounters and targeted public health strategies in high-risk groups. Understanding how timing of vaccine receipt varies among populations can provide insights into variables that must be controlled for in studying possible vaccine effectiveness waning and attenuation of disease among those who are infected despite vaccination. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jill Ferdinands
- US Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia
| | | | | | | | - Samantha Stephens
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Kyle P Openo
- Georgia Emerging Infections Program and Atlanta VA Medical Center, Decatur, Georgia
| | - Emily Fawcett
- Georgia Emerging Infections Program and Atlanta VA Medical Center, Decatur, Georgia
| | | | - Maya Monroe
- Maryland Department of Health, Baltimore, Maryland
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan
| | | | | | | | | | | | - Ann Thomas
- Oregon Health Authority, Portland, Oregon
| | - Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
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Band VI, Hufnagel DA, Jaggavarapu S, Sherman EX, Wozniak JE, Satola SW, Farley MM, Jacob JT, Burd EM, Weiss DS. Antibiotic combinations that exploit heteroresistance to multiple drugs effectively control infection. Nat Microbiol 2019; 4:1627-1635. [PMID: 31209306 PMCID: PMC7205309 DOI: 10.1038/s41564-019-0480-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/01/2019] [Indexed: 11/09/2022]
Abstract
Antibiotic-resistant bacteria are a significant threat to human health, with one estimate suggesting they will cause 10 million worldwide deaths per year by 2050, surpassing deaths due to cancer1. Because new antibiotic development can take a decade or longer, it is imperative to effectively use currently available drugs. Antibiotic combination therapy offers promise for treating highly resistant bacterial infections, but the factors governing the sporadic efficacy of such regimens have remained unclear. Dogma suggests that antibiotics ineffective as monotherapy can be effective in combination2. Here, using carbapenem-resistant Enterobacteriaceae (CRE) clinical isolates, we reveal the underlying basis for the majority of effective combinations to be heteroresistance. Heteroresistance is a poorly understood mechanism of resistance reported for different classes of antibiotics3-6 in which only a subset of cells are phenotypically resistant7. Within an isolate, the subpopulations resistant to different antibiotics were distinct, and over 88% of CRE isolates exhibited heteroresistance to multiple antibiotics ('multiple heteroresistance'). Combinations targeting multiple heteroresistance were efficacious, whereas those targeting homogenous resistance were ineffective. Two pan-resistant Klebsiella isolates were eradicated by combinations targeting multiple heteroresistance, highlighting a rational strategy to identify effective combinations that employs existing antibiotics and could be clinically implemented immediately.
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Affiliation(s)
- Victor I Band
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
| | - David A Hufnagel
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Siddharth Jaggavarapu
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Edgar X Sherman
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessie E Wozniak
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah W Satola
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica M Farley
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jesse T Jacob
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eileen M Burd
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - David S Weiss
- Emory Antibiotic Resistance Center, Atlanta, GA, USA.
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA.
- Emory Vaccine Center, Atlanta, GA, USA.
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- Research Service, Atlanta VA Medical Center, Decatur, GA, USA.
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Toda M, Williams SR, Berkow EL, Farley MM, Harrison LH, Bonner L, Marceaux KM, Hollick R, Zhang AY, Schaffner W, Lockhart SR, Jackson BR, Vallabhaneni S. Population-Based Active Surveillance for Culture-Confirmed Candidemia - Four Sites, United States, 2012-2016. MMWR Surveill Summ 2019; 68:1-15. [PMID: 31557145 PMCID: PMC6772189 DOI: 10.15585/mmwr.ss6808a1] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PROBLEM/CONDITION Candidemia is a bloodstream infection (BSI) caused by yeasts in the genus Candida. Candidemia is one of the most common health care-associated BSIs in the United States, with all-cause in-hospital mortality of up to 30%. PERIOD COVERED 2012-2016. DESCRIPTION OF SYSTEM CDC's Emerging Infections Program (EIP), a collaboration among CDC, state health departments, and academic partners that was established in 1995, was used to conduct active, population-based laboratory surveillance for candidemia in 22 counties in four states (Georgia, Maryland, Oregon, and Tennessee) with a combined population of approximately 8 million persons. Laboratories serving the catchment areas were recruited to report candidemia cases to the local EIP program staff. A case was defined as a blood culture that was positive for a Candida species collected from a surveillance area resident during 2012-2016. Isolates were sent to CDC for species confirmation and antifungal susceptibility testing. Any subsequent blood cultures with Candida within 30 days of the initial positive culture in the same patient were considered part of the same case. Trained surveillance officers collected clinical information from the medical chart for all cases, and isolates were sent to CDC for species confirmation and antifungal susceptibility testing. RESULTS Across all sites and surveillance years (2012-2016), 3,492 cases of candidemia were identified. The crude candidemia incidence averaged across sites and years during 2012-2016 was 8.7 per 100,000 population; important differences in incidence were found by site, age group, sex, and race. The crude annual incidence was the highest in Maryland (14.1 per 100,000 population) and lowest in Oregon (4.0 per 100,000 population). The crude annual incidence of candidemia was highest among adults aged ≥65 years (25.5 per 100,000 population) followed by infants aged <1 year (15.8). The crude annual incidence was higher among males (9.4) than among females (8.0) and was approximately 2 times greater among blacks than among nonblacks (13.7 versus 5.8). Ninety-six percent of cases occurred in patients who were hospitalized at the time of or during the week after having a positive culture. One third of cases occurred in patients who had undergone a surgical procedure in the 90 days before the candidemia diagnosis, 77% occurred in patients who had received systemic antibiotics in the 14 days before the diagnosis, and 73% occurred in patients who had had a central venous catheter (CVC) in place within 2 days before the diagnosis. Ten percent were in patients who had used injection drugs in the past 12 months. The median time from admission to candidemia diagnosis was 5 days (interquartile range [IQR]: 0-16 days). Among 2,662 cases that were treated in adults aged >18 years, 34% were treated with fluconazole alone, 30% with echinocandins alone, and 34% with both. The all-cause, in-hospital case-fatality ratio was 25% for any time after admission; the all-cause in-hospital case-fatality ratio was 8% for <48 hours after a positive culture for Candida species. Candida albicans accounted for 39% of cases, followed by Candida glabrata (28%) and Candida parapsilosis (15%). Overall, 7% of isolates were resistant to fluconazole and 1.6% were resistant to echinocandins, with no clear trends in resistance over the 5-year surveillance period. INTERPRETATION Approximately nine out of 100,000 persons developed culture-positive candidemia annually in four U.S. sites. The youngest and oldest persons, men, and blacks had the highest incidences of candidemia. Patients with candidemia identified in the surveillance program had many of the typical risk factors for candidemia, including recent surgery, exposure to broad-spectrum antibiotics, and presence of a CVC. However, an unexpectedly high proportion of candidemia cases (10%) occurred in patients with a history of injection drug use (IDU), suggesting that IDU has become a common risk factor for candidemia. Deaths associated with candidemia remain high, with one in four cases resulting in death during hospitalization. PUBLIC HEALTH ACTION Active surveillance for candidemia yielded important information about the disease incidence and death rate and persons at greatest risk. The surveillance was expanded to nine sites in 2017, which will improve understanding of the geographic variability in candidemia incidence and associated clinical and demographic features. This surveillance will help monitor incidence trends, track emergence of resistance and species distribution, monitor changes in underlying conditions and predisposing factors, assess trends in antifungal treatment and outcomes, and be helpful for those developing prevention efforts. IDU has emerged as an important risk factor for candidemia, and interventions to prevent invasive fungal infections in this population are needed. Surveillance data documenting that approximately two thirds of candidemia cases were caused by species other than C. albicans, which are generally associated with greater antifungal resistance than C. albicans, and the presence of substantial fluconazole resistance supports 2016 clinical guidelines recommending a switch from fluconazole to echinocandins as the initial treatment for candidemia in most patients.
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McNamara LA, Potts CC, Blain A, Topaz N, Apostol M, Alden NB, Petit S, Farley MM, Harrison LH, Triden L, Muse A, Poissant T, Wang X, MacNeil JR. Invasive Meningococcal Disease due to Nongroupable Neisseria meningitidis-Active Bacterial Core Surveillance Sites, 2011-2016. Open Forum Infect Dis 2019; 6:ofz190. [PMID: 31123695 DOI: 10.1093/ofid/ofz190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
We characterized 22 meningococcal disease cases due to nongroupable Neisseria meningitidis, a rare cause of invasive disease. Disease presentation and severity were similar to those for serogroupable meningococcal disease. However, 7 (32%) patients had complement deficiency or abnormal complement testing results, highlighting the importance of complement testing for nongroupable cases.
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Affiliation(s)
- Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caelin C Potts
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Blain
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha B Alden
- Emerging Infections Program, Communicable Disease Branch, Colorado Disease Control and Environmental Epidemiology Division, Denver, Colorado
| | - Susan Petit
- Connecticut Department of Public Health Epidemiology Program, Hartford, Connecticut
| | - Monica M Farley
- Emory University School of Medicine and the Atlanta VAMC, Atlanta, Georgia
| | - Lee H Harrison
- Departments of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori Triden
- Emerging Infections Unit, Acute Disease Investigations and Control Section, Minnesota Department of Health, St. Paul, Minnesota
| | - Alison Muse
- New York State Department of Health Emerging Infections Program, Albany, New York
| | | | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica R MacNeil
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Francois Watkins LK, McGee L, Schrag SJ, Beall B, Jain JH, Pondo T, Farley MM, Harrison LH, Zansky SM, Baumbach J, Lynfield R, Snippes Vagnone P, Miller LA, Schaffner W, Thomas AR, Watt JP, Petit S, Langley GE. Epidemiology of Invasive Group B Streptococcal Infections Among Nonpregnant Adults in the United States, 2008-2016. JAMA Intern Med 2019; 179:479-488. [PMID: 30776079 PMCID: PMC6450309 DOI: 10.1001/jamainternmed.2018.7269] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Group B Streptococcus (GBS) is an important cause of invasive bacterial disease. Previous studies have shown a substantial and increasing burden of GBS infections among nonpregnant adults, particularly older adults and those with underlying medical conditions. OBJECTIVE To update trends of invasive GBS disease among US adults using population-based surveillance data. DESIGN, SETTING, AND PARTICIPANTS In this population-based surveillance study, a case was defined as isolation of GBS from a sterile site between January 1, 2008, and December 31, 2016. Demographic and clinical data were abstracted from medical records. Rates were calculated using US Census data. Antimicrobial susceptibility testing and serotyping were performed on a subset of isolates. Case patients were residents of 1 of 10 catchment areas of the Active Bacterial Core surveillance (ABCs) network, representing approximately 11.5% of the US adult population. Patients were included in the study if they were nonpregnant, were 18 years or older, were residents of an ABCs catchment site, and had a positive GBS culture from a normally sterile body site. MAIN OUTCOMES AND MEASURES Trends in GBS cases overall and by demographic characteristics (sex, age, and race), underlying clinical conditions of patients, and isolate characteristics are described. RESULTS The ABCs network detected 21 250 patients with invasive GBS among nonpregnant adults from 2008 through 2016. The GBS incidence in this population increased from 8.1 cases per 100 000 population in 2008 to 10.9 in 2016 (P = .002 for trend). There were 3146 cases reported in 2016 (59% male; median age, 64 years; age range, 18-103 years). The GBS incidence was higher among men than women and among blacks than whites and increased with age. Projected to the US population, an estimated 27 729 cases of invasive disease and 1541 deaths occurred in the United States in 2016. Ninety-five percent of cases in 2016 occurred in someone with at least 1 underlying condition, most commonly obesity (53.9%) and diabetes (53.4%). Resistance to clindamycin increased from 37.0% of isolates in 2011 to 43.2% in 2016 (P = .02). Serotypes Ia, Ib, II, III, and V accounted for 86.4% of isolates in 2016; serotype IV increased from 4.7% in 2008 to 11.3% in 2016 (P < .001 for trend). CONCLUSIONS AND RELEVANCE The public health burden of invasive GBS disease among nonpregnant adults is substantial and continues to increase. Chronic diseases, such as obesity and diabetes, may contribute.
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Affiliation(s)
- Louise K Francois Watkins
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia.,Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Hudson Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica M Farley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Lisa A Miller
- Colorado School of Public Health, University of Colorado Denver, Aurora.,Colorado Department of Public Health and Environment, Denver
| | | | | | - James P Watt
- California Department of Public Health, Richmond
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Gayle E Langley
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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49
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Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, Harrison LH, Lynfield R, Vagnone PS, Burzlaff K, Spina NL, Dufort EM, Schaffner W, Thomas AR, Farley MM, Jain JH, Pondo T, McGee L, Beall BW, Schrag SJ. Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA Pediatr 2019; 173:224-233. [PMID: 30640366 PMCID: PMC6439883 DOI: 10.1001/jamapediatrics.2018.4826] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development. OBJECTIVE To describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development. DESIGN, SETTING, AND PARTICIPANTS This study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018. EXPOSURES Group B Streptococcus isolated from a normally sterile site. MAIN OUTCOMES AND MEASURES Early-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance. RESULTS The Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally. CONCLUSIONS AND RELEVANCE The rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention.
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Affiliation(s)
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Chad Smelser
- New Mexico Department of Public Health, Santa Fe
| | | | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Monica M. Farley
- Emory University School of Medicine, Atlanta, Georgia,Atlanta VA Medical Center, Atlanta, Georgia
| | - Jennifer H. Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard W. Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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50
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Milucky J, Carvalho MDG, Rouphael N, Bennett NM, Talbot HK, Harrison LH, Farley MM, Walston J, Pimenta F, Lessa FC. Streptococcus pneumoniae colonization after introduction of 13-valent pneumococcal conjugate vaccine for US adults 65 years of age and older, 2015-2016. Vaccine 2019; 37:1094-1100. [PMID: 30685247 DOI: 10.1016/j.vaccine.2018.12.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Vaccination of children with 13-valent pneumococcal conjugate vaccine (PCV13) led to declines in vaccine-type pneumococcal nasopharyngeal carriage among adults through indirect effects. In August 2014, PCV13 immunization of all U.S. adults ≥65 years of age was recommended. This study sought to define prevalence and serotype distribution of pneumococcal carriage among adults ≥65 years of age and to describe risk factors for colonization soon after introduction of PCV13 in adults. METHODS A cross-sectional survey of non-institutionalized U.S. adults ≥65 years of age was conducted in four states in 2015-2016. Demographic information, risk factors for disease, PCV13 vaccination history, and nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected. NP and OP swabs were processed separately and pneumococcal isolates were serotyped by Quellung reaction. Antimicrobial susceptibility of pneumococcal isolates was performed. NP swabs also underwent real-time PCR for pneumococcal detection and serotyping. RESULTS Of 2989 participants, 45.3% (1354/2989) had been vaccinated with PCV13. Fifty-five (1.8%) carried pneumococcus (45 identified by culture and 10 by real-time PCR only) and PCV13 serotypes were found in eight (0.3%) participants. Almost half (22/45) of pneumococcal isolates were not susceptible to at least one of the antibiotics tested. Vaccine-type carriage among vaccinated and unvaccinated individuals was similar (0.2% vs. 0.1%, respectively). Respiratory symptoms were associated with higher odds of pneumococcal colonization (adjusted OR: 2.1; 95% CI = 1.1-3.8). CONCLUSIONS Pneumococcal carriage among non-institutionalized adults ≥65 years of age was very low. Less than 0.5% of both vaccinated and unvaccinated individuals in our study carried vaccine-type serotypes. Over a decade of PCV vaccination of children likely led to indirect effects in adults. However, given the low vaccine-type carriage rates we observed in an already high PCV13 adult coverage setting, it is difficult to attribute our findings to the direct versus indirect effects of PCV13 on adult carriage.
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Affiliation(s)
- Jennifer Milucky
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia.
| | - Maria de Gloria Carvalho
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia
| | - Nadine Rouphael
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Hope Clinic of the Emory Vaccine Center, Emory University, Decatur, Georgia
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Department of Medicine, Rochester, New York
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monica M Farley
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine
| | - Fabiana Pimenta
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia
| | - Fernanda C Lessa
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia.
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