scholarly journals 1258. Antibiotic Resistant Nontyphoidal Salmonella Infection Following International Travel — United States, 2018

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S718-S718
Author(s):  
Laura Ford ◽  
Hazel Shah ◽  
Jessica Chen ◽  
Dana Eikmeier ◽  
Samir Hanna ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Treatment Options ◽  
Genetic Resistance ◽  
International Travel ◽  
First Line ◽  
Surveillance Network ◽  
Antibiotic Resistant ◽  
Salmonella Infections ◽  
Increased Risk ◽  
Target Prevention

Abstract Background Antibiotic resistance in nontyphoidal Salmonella can limit treatment options for patients requiring antibiotic therapy. We assessed the contribution of international travel to resistance among nontyphoidal Salmonella infections. Methods We describe characteristics of nontyphoidal Salmonella infections in the Foodborne Diseases Active Surveillance Network during 2018 that were also reported to PulseNet and the National Antimicrobial Resistance Monitoring System. We defined genetic resistance to first-line antibiotics as the presence of genes or mutations known to confer decreased susceptibility or resistance to ciprofloxacin, azithromycin, or ceftriaxone. We used multivariable logistic regression to assess the association between resistance to first-line antibiotics and international travel in the 7 days before symptom onset overall and by United Nations statistical region, and we estimated the contribution of travel to resistance using population attributable fractions. Results Among 3,238 nontyphoidal Salmonella infections, 356 (11%) were in patients who traveled internationally in the 7 days before symptom onset. Of these, 109/356 (31%) had isolates with genetic resistance to first-line antibiotics, compared with 308/2882 (11%) non-travelers. Resistance was more likely following travel, after adjusting for age and sex (OR 3.7, 95% CI 2.9–4.8). Nine genes or mutations conferred resistance to first-line antibiotics among travel-associated isolates. The risk of resistance varied by region and was highest after travel to Asia (OR 7.5, 95% CI 4.7–12.0). Overall, 17.1% (95% CI 12.2%–21.7%) of genetic resistance to first-line antibiotics was attributable to international travel. Conclusion For patients with nontyphoidal Salmonella infections, international travel is associated with approximately three-fold increased risk that first-line agents could be ineffective. The estimated 17% of resistance to first-line antibiotics attributable to travel is encoded by relatively few genes and mutations. Investigation of the major sources of resistant strains could help target prevention efforts. Travel region should be considered when treating empirically; treatment should be adjusted based on results from antibiotic susceptibility testing. Disclosures All Authors: No reported disclosures

scholarly journals Relationship Between Census Tract–Level Poverty and Domestically Acquired Salmonella Incidence: Analysis of Foodborne Diseases Active Surveillance Network Data, 2010–2016

2019 ◽  
Vol 222 (8) ◽  
pp. 1405-1412
Author(s):  
James L Hadler ◽  
Paula Clogher ◽  
Tanya Libby ◽  
Elisha Wilson ◽  
Nadine Oosmanally ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Relative Risk ◽  
Active Surveillance ◽  
Census Tract ◽  
Incidence Rates ◽  
International Travel ◽  
Poverty Level ◽  
Surveillance Network ◽  
Catchment Population ◽  
Salmonella Infections

Abstract Background The relationships between socioeconomic status and domestically acquired salmonellosis and leading Salmonella serotypes are poorly understood. Methods We analyzed surveillance data from laboratory-confirmed cases of salmonellosis from 2010–2016 for all 10 Foodborne Disease Active Surveillance Network (FoodNet) sites, having a catchment population of 47.9 million. Case residential data were geocoded, linked to census tract poverty level, and then categorized into 4 groups according to census tract poverty level. After excluding those reporting international travel before illness onset, age-specific and age-adjusted salmonellosis incidence rates were calculated for each census tract poverty level, overall and for each of the 10 leading serotypes. Results Of 52 821geocodable Salmonella infections (>96%), 48 111 (91.1%) were domestically acquired. Higher age-adjusted incidence occurred with higher census tract poverty level (P < .001; relative risk for highest [≥20%] vs lowest [<5%] census tract poverty level, 1.37). Children <5 years old had the highest relative risk (2.07). Although this relationship was consistent by race/ethnicity and by serotype, it was not present in 5 FoodNet sites or among those aged 18–49 years. Conclusion Children and older adults living in higher-poverty census tracts have had a higher incidence of domestically acquired salmonellosis. There is a need to understand socioeconomic status differences for risk factors for domestically acquired salmonellosis by age group and FoodNet site to help focus prevention efforts.

Salmonella Infections Associated with International Travel: A Foodborne Diseases Active Surveillance Network (FoodNet) Study

2011 ◽  
Vol 8 (9) ◽  
pp. 1031-1037 ◽  
Author(s):  
Laura R. Johnson ◽  
L. Hannah Gould ◽  
John R. Dunn ◽  
Ruth Berkelman ◽  
Barbara E. Mahon, for the FoodNet Travel Worki
Keyword(s):  
Active Surveillance ◽  
International Travel ◽  
Foodborne Diseases ◽  
Surveillance Network ◽  
Salmonella Infections

scholarly journals 714. Increase in Multidrug-resistant Salmonella Serotype I 4,[5],12:i:- Infections Linked to Pork—United States, 2009–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S408-S409
Author(s):  
Ian D Plumb ◽  
Allison C Brown ◽  
Erin K Stokes ◽  
Jessica Chen ◽  
Beth Tolar ◽  
...  
Keyword(s):  
United States ◽  
Sequence Data ◽  
The United States ◽  
Multidrug Resistant ◽  
Whole Genome Sequence ◽  
Swine Production ◽  
Surveillance Network ◽  
Antibiotic Resistant ◽  
Salmonella Infections ◽  
Salmonella Serotype

Abstract Background Salmonella enterica I 4,[5],12:i:- is the 5th most common serotype causing clinical Salmonella infections in the United States. A strain with resistance to ampicillin, streptomycin, sulfamethoxazole, and tetracycline (ASSuT) has been linked to swine production in Europe and the United States. We reviewed U.S. surveillance data to describe clinical infections with antibiotic-resistant I 4,[5],12:i:-. Methods We reviewed data from CDC’s National Antimicrobial Resistance Monitoring System (NARMS) from 2009–2018 to describe trends. We analyzed whole-genome sequence data in PulseNet, the molecular surveillance network for foodborne illness in the United States, from 2015–2018 to distinguish between strains of I 4,[5],12:i:- using core-genome multilocus sequence typing, and identified antibiotic resistance determinants (ARDs). We reviewed data from the Foodborne Disease Outbreak Surveillance System to identify foods associated with outbreaks during 2009–2018. Results From 2009–2013 to 2014–2018, I 4,[5],12:i:- increased as a proportion of nontyphoidal Salmonella isolates in NARMS from 4.3% to 5.0% (P=0.006), while I 4,[5],12:i:- resistant to ASSuT increased from 1.1% to 2.6% (P< 0.001). Of the 3,056 sequenced I 4,[5],12:i:- isolates in PulseNet, 2,105 (69%) were in a clade within 0–108 alleles of each other (ASSuT clade). Within this clade, 77% of isolates had ARDs conferring resistance to ASSuT, compared with 3% outside the clade. Isolates in the clade were also more likely than those outside the clade to have ARDs conferring decreased susceptibility to ciprofloxacin (13.1% vs. 5.2%, P< 0.001) and resistance to ceftriaxone (5.4% vs. 2.3%, P< 0.001). Among I 4,[5],12:i:- outbreaks with a single food source, those related to the ASSuT clade were more often linked to pork (10/15 [67%] vs. 1/5 [20%], P=0.07). Conclusion The increase in I 4,[5],12:i:- infections during 2009–2018 was likely driven by a clade of which most members had resistance to ASSuT, and many had decreased susceptibility to antibiotics used for empiric treatment. The association of this strain with outbreaks linked to pork suggests that measures to decrease carriage of Salmonella and selection for this strain in swine could prevent clinical infections with multidrug resistant Salmonella I 4,[5],12:i-. Disclosures All Authors: No reported disclosures

Akathisia: Problem of History or Concern of Today

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S14) ◽  
pp. 1-16 ◽  
Author(s):  
Naveed Iqbal ◽  
Tim Lambert ◽  
Prakash Masand
Keyword(s):  
Treatment Options ◽  
Extended Period ◽  
Screening Tools ◽  
First Line ◽  
Anticholinergic Medications ◽  
Conventional Antipsychotics ◽  
Reduced Frequency ◽  
Increased Risk ◽  
History Of ◽  
New Generation

AbstractAkathisia is a neurological side effect of antipsychotic medications, which are used to treat various psychiatric disorders. Akathisia is characterized by physical restlessness and a subjective urge to move. Although side effects such as akathisia, dystonia, and dyskinesia are common with the use of conventional antipsychotics, they occur in reduced frequency with the use of new-generation antipsychotics. Despite a lowered incidence profile, akathisia and similar conditions continue to affect patients. Neuroleptic-induced akathisia can present as fidgety movements while seated, rocking in place while standing, pacing, inability to sit or stand still for an extended period of time, and an overwhelming urge to move. These symptoms can cause severe distress and an increased risk of suicide for affected patients. First-line treatment of akathisia includes benzodiazepines or β-blockers for patients who do not have symptoms of Parkinson's disease and anticholinergic medications for patients with Parkinson's symptoms. Clinicians should ensure that an accurate diagnosis of akathisia is made and that target symptoms are decreasing due to treatment. At the same time, it must be ensured that the treatment used does not negatively affect the mental health of the patient. This expert roundtable supplement will address the diagnosis, pathophysiology, phenomenology, classification, and history of akathisia as well as discuss screening tools and treatment options for the condition.

scholarly journals Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept

2021 ◽  
Author(s):  
B. González Astorga ◽  
F. Salvà Ballabrera ◽  
E. Aranda Aguilar ◽  
E. Élez Fernández ◽  
P. García-Alfonso ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Effective Therapeutic Option ◽  
Line Setting ◽  
First Line Treatment

AbstractColorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient’s profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.

scholarly journals Immunotherapy in hepatocellular carcinoma: evaluation and management of adverse events associated with atezolizumab plus bevacizumab

2021 ◽  
Vol 13 ◽  
pp. 175883592110311
Author(s):  
Chiun Hsu ◽  
Lorenza Rimassa ◽  
Hui-Chuan Sun ◽  
Arndt Vogel ◽  
Ahmed O. Kaseb
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Kinase Inhibitor ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Safety Data ◽  
Standard Of Care ◽  
Antiangiogenic Agents ◽  
Efficacy And Safety ◽  
First Line

In light of positive efficacy and safety findings from the IMbrave150 trial of atezolizumab plus bevacizumab, this novel combination has become the preferred first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC). Several additional trials are ongoing that combine an immune checkpoint inhibitor with another agent such as a multiple kinase inhibitor or antiangiogenic agent. Therefore, the range of first-line treatment options for unresectable HCC is likely to increase, and healthcare providers need succinct information about the use of such combinations, including their efficacy and key aspects of their safety profiles. Here, we review efficacy and safety data on combination immunotherapies and offer guidance on monitoring and managing adverse events, especially those associated with atezolizumab plus bevacizumab. Because of their underlying liver disease and high likelihood of portal hypertension, patients with unresectable HCC are at particular risk of gastrointestinal bleeding, and this risk may be exacerbated by treatments that include antiangiogenic agents. Healthcare providers also need to be alert to the risks of proteinuria and hypertension, colitis, hepatitis, and reactivation of hepatitis B or C virus infection. They should also be aware of the possibility of rarer but potentially life-threatening adverse events such as pneumonitis and cardiovascular events. Awareness of the risks associated with these therapies and knowledge of adverse event monitoring and management will become increasingly important as the therapeutic range broadens in unresectable HCC.

scholarly journals Antibiotic-Resistant Bacteria in Green Turtle (Chelonia mydas) Rearing Seawater

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1841
Author(s):  
Thanaporn Chuen-Im ◽  
Korapan Sawetsuwannakun ◽  
Pimmnapar Neesanant ◽  
Nakarin Kitkumthorn
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Infection ◽  
High Mortality ◽  
Mortality Rates ◽  
Sea Turtle ◽  
Resistant Isolate ◽  
Resistant Bacteria ◽  
Antibiotic Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Increased Risk

Antibiotic resistance of microorganisms is a serious health problem for both humans and animals. Infection of these bacteria may result in therapy failure, leading to high mortality rates. During an early intervention program process, the Sea Turtle Conservation Center of Thailand (STCCT) has faced high mortality rates due to bacterial infection. Previously, investigation of juvenile turtle carcasses found etiological agents in tissue lesions. Further determination of sea water in the turtle holding tanks revealed a prevalence of these causative agents in water samples, implying association of bacterial isolates in rearing water and infection in captive turtles. In this study, we examined the antibiotic resistance of bacteria in seawater from the turtle holding tank for a management plan of juvenile turtles with bacterial infection. The examination was carried out in three periods: 2015 to 2016, 2018, and 2019. The highest isolate numbers were resistant to beta-lactam, whilst low aminoglycoside resistance rates were observed. No gentamicin-resistant isolate was detected. Seventy-nine isolates (71.17%) were resistant to at least one antibiotic. Consideration of resistant bacterial and antibiotic numbers over three sampling periods indicated increased risk of antibiotic-resistant bacteria to sea turtle health. Essentially, this study emphasizes the importance of antibiotic-resistant bacterial assessment in rearing seawater for sea turtle husbandry.

scholarly journals Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study

2021 ◽  
Vol 11 (8) ◽  
pp. 740
Author(s):  
Manjula D. Nugawela ◽  
Sarega Gurudas ◽  
Andrew Toby Prevost ◽  
Rohini Mathur ◽  
John Robson ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Ethnic Differences ◽  
Minority Groups ◽  
Treatment Options ◽  
Ethnic Disparities ◽  
Ethnic Minority Groups ◽  
The United Kingdom ◽  
Increased Risk ◽  
Observational Cohort ◽  
General Practices

There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007–January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02–1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16–1.32) and STDR (HR: 1.38 95% CI 1.17–1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.

Longer symptom onset to aspiration time predicts success of needle aspiration in primary spontaneous pneumothorax

Thorax ◽  
2019 ◽  
Vol 74 (8) ◽  
pp. 780-786 ◽  
Author(s):  
Constance Vuillard ◽  
Fadia Dib ◽  
Jallal Achamlal ◽  
Stéphane Gaudry ◽  
Damien Roux ◽  
...  
Keyword(s):  
Success Rate ◽  
Symptom Onset ◽  
Spontaneous Pneumothorax ◽  
Needle Aspiration ◽  
Primary Spontaneous Pneumothorax ◽  
Line Treatment ◽  
First Line ◽  
Discovery Phase ◽  
Registration Number ◽  
First Line Treatment

BackgroundNeedle aspiration (NA) is recommended as first-line treatment of primary spontaneous pneumothorax (PSP). We aimed to assess NA success and the effect of a longer symptom onset to NA time.MethodsA discovery phase was retrospectively conducted in the intensive care unit of Louis Mourier Hospital (January 2000 to December 2011) followed by a prospective validation cohort (January 2012 to August 2015). The primary outcome was immediate NA success defined by the absence of need for chest tube insertion within 24 hours of the procedure.ResultsIn the discovery phase, 130 patients were admitted for PSP and 98 had NA as first-line treatment (75%). The immediate success rate of NA was 34.7% and was higher when it was performed ≥48 hours after symptom onset (57.7% vs 25%; p=0.004). In the prospective cohort, 87 patients were admitted for PSP; 71 (82%) had NA as first-step treatment. The immediate success rate was 40.8%. NA was more successful when it was performed after 48 hours of symptoms’ onset (34.5% vs 7.1%; p=0.005). A delay between the first symptom and NA procedure ≥48 hours was associated with a higher success of NA (OR=13.54; 95% CI 1.37 to 133). A smaller pneumothorax estimated by Light’s index was associated with NA success (OR=0.95; 95% CI 0.92 to 0.98). To what extent some of these pneumothoraces would have had a spontaneous resolution remains unknown.ConclusionWhen managing PSP with NA, a longer symptom onset to NA time was associated with NA success.Trial registration numberNCT02528734.

Sign in / Sign up

Export Citation Format

Share Document