Population-Based Surveillance of Neisseria meningitidis Antimicrobial Resistance in the United States

Abstract Background. Antimicrobial treatment and chemoprophylaxis of patients and their close contacts is critical to reduce the morbidity and mortality and prevent secondary cases of meningococcal disease. Through the 1990's, the prevalence of antimicrobial resistance to commonly used antimicrobials among Neisseria meningitidis was low in the United States. Susceptibility testing was performed to ascertain whether the proportions of isolates with reduced susceptibility to antimicrobials commonly used for N meningitidis have increased since 2004 in the United States. Methods. Antimicrobial susceptibility testing was performed by broth microdilution on 466 isolates of N meningitidis collected in 2004, 2008, 2010, and 2011 from an active, population-based surveillance system for susceptibility to ceftriaxone, ciprofloxacin, penicillin G, rifampin, and azithromycin. The molecular mechanism of reduced susceptibility was investigated for isolates with intermediate or resistant phenotypes. Results. All isolates were susceptible to ceftriaxone and azithromycin, 10.3% were penicillin G intermediate (range, 8% in 2008–16.7% in 2010), and <1% were ciprofloxacin, rifampin, or penicillin G resistant. Of the penicillin G intermediate or resistant isolates, 63% contained mutations in the penA gene associated with reduced susceptibility to penicillin G. All ciprofloxacin-resistant isolates contained mutations in the gyrA gene associated with reduced susceptibility. Conclusions. Resistance of N meningitidis to antimicrobials used for empirical treatment of meningitis in the United States has not been detected, and resistance to penicillin G and chemoprophylaxis agents remains uncommon. Therapeutic agent recommendations remain valid. Although periodic surveillance is warranted to monitor trends in susceptibility, routine clinical testing may be of little use.

Download Full-text

Active, Population-Based Surveillance for Severe Rotavirus Gastroenteritis in Children in the United States

PEDIATRICS ◽

10.1542/peds.2007-3378 ◽

2008 ◽

Vol 122 (6) ◽

pp. 1235-1243 ◽

Cited By ~ 120

Author(s):

D. C. Payne ◽

M. A. Staat ◽

K. M. Edwards ◽

P. G. Szilagyi ◽

J. R. Gentsch ◽

...

Keyword(s):

United States ◽

The United States ◽

Population Based ◽

Rotavirus Gastroenteritis ◽

Active Population

Download Full-text

A survey of methods used for antimicrobial susceptibility testing in veterinary diagnostic laboratories in the United States

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638717714505 ◽

2017 ◽

Vol 29 (5) ◽

pp. 669-675 ◽

Cited By ~ 7

Author(s):

David A. Dargatz ◽

Matthew M. Erdman ◽

Beth Harris

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Clinical Laboratory ◽

The United States ◽

Antimicrobial Susceptibility Testing ◽

Disk Diffusion ◽

Diffusion Method ◽

Broth Microdilution

Antimicrobial resistance is a serious threat to animal and human health worldwide, requiring a collaborative, holistic approach. The U.S. Government has developed a national strategy to address antimicrobial resistance, with one component being to monitor antimicrobial resistance in agricultural settings. We developed a survey to collect information about antimicrobial susceptibility testing (AST) from the veterinary diagnostic laboratory community in the United States, assessing current practices and technologies and determining how AST information is shared. Of the 132 surveys administered, 52 (39%) were returned. Overall, responding laboratories conducted susceptibility tests on 98,788 bacterial isolates in 2014, with Escherichia coli being the most common pathogen tested across all animal species. The 2 most common AST methods employed were the disk diffusion method (71%) and the Sensititre platform broth microdilution system (59%). Laboratories primarily used the Clinical Laboratory Standards Institute (CLSI) VET-01 standard (69%) and the automatically calculated interpretations provided by the commercial AST systems (61%) for interpreting their AST data. Only 22% of laboratories published AST data on a periodic basis, usually via annual reports published on the laboratory’s website or through peer-reviewed journals for specific pathogens. Our results confirm that disk diffusion and broth microdilution remain the standard AST methods employed by U.S. veterinary diagnostic laboratories, and that CLSI standards are commonly used for interpreting AST results. This information will help determine the most efficient standardized methodology for future surveillance. Furthermore, the current infrastructure within laboratories, once harmonized, will help provide a mechanism for conducting national surveillance programs.

Download Full-text

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

Clinical Infectious Diseases ◽

10.1093/cid/ciz1061 ◽

2019 ◽

Vol 71 (7) ◽

pp. 1732-1737 ◽

Cited By ~ 3

Author(s):

Alexia Y Zhang ◽

Sarah Shrum ◽

Sabrina Williams ◽

Sarah Petnic ◽

Joelle Nadle ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Risk Factor ◽

Drug Use ◽

Injection Drug Use ◽

The United States ◽

Population Based ◽

Injection Drug ◽

Active Population ◽

Initial Culture

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.

Download Full-text

Clinically Important Resistance among Salmonella enterica Serotype Typhi Isolates—United States, 2003–2015

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.890 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S365-S365

Author(s):

Felicita Medalla ◽

Louise Francois Watkins ◽

Kevin Chatham-Stephens ◽

Jared Reynolds ◽

Amelia Bicknese ◽

...

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Typhoid Fever ◽

Treatment Options ◽

The United States ◽

Empiric Therapy ◽

Salmonella Typhi ◽

Antimicrobial Treatment ◽

Delayed Response ◽

Azithromycin Resistance

Abstract Background Salmonella Typhi (Typhi) causes typhoid fever, accounting for an estimated 5,700 illnesses and 623 hospitalizations per year in the United States. Most infections are acquired during travel to regions outside the United States where typhoid fever is prevalent and antimicrobial resistance is a problem. Fluoroquinolones (e.g., ciprofloxacin) are considered the treatment of choice for susceptible Typhi infections due to their superior ability to concentrate intracellularly and in bile, however, nonsusceptibility has been associated with treatment failure or delayed response. Azithromycin and ceftriaxone are treatment options. We describe antimicrobial susceptibility among Typhi isolates in the United States and the implications for management. Methods The National Antimicrobial Resistance Monitoring System at CDC conducts susceptibility testing on all Typhi isolates submitted by public health laboratories. We used broth microdilution to determine minimum inhibitory concentrations (MICs) to agents representing 9 antimicrobial classes and categorized isolates according to criteria from the Clinical and Laboratory Standards Institute. We defined ciprofloxacin nonsusceptibility as MIC ≥0.12 μg/mL, ciprofloxacin resistance as MIC ≥1, azithromycin resistance as MIC ≥32, and ceftriaxone resistance as MIC ≥4. Results From 2003–2015, isolates were tested from 4,550 patients; 2,760 (61%) were ciprofloxacin nonsusceptible, 4% were ciprofloxacin resistant. One isolate was azithromycin resistant and none were ceftriaxone resistant. Ciprofloxacin nonsusceptibility increased from 39% in 2003 to 66% in 2015; resistance increased from 0.3% to 8%. Median age of patients was 23 years (range 1–99 years), 53% were male, most were from the Northeast (33%) or the West (29%), and 74% had an isolate from blood. Conclusion Two thirds of Typhi isolates exhibited ciprofloxacin nonsusceptibility, which has increased over the last decade, and full resistance is increasing. Clinicians should be aware of high rates of fluoroquinolone nonsusceptibility when selecting empiric therapy and should tailor antimicrobial treatment to susceptibility results when feasible. Azithromycin and ceftriaxone remain important treatment options. Disclosures All authors: No reported disclosures.

Download Full-text

Antimicrobial Resistance of Neisseria meningitidis in the United States, 1997

Clinical Infectious Diseases ◽

10.1086/313599 ◽

2000 ◽

Vol 30 (1) ◽

pp. 212-213 ◽

Cited By ~ 29

Author(s):

N. E. Rosenstein ◽

S. A. Stocker ◽

T. Popovic ◽

F. C. Tenover ◽

B. A. Perkins ◽

...

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Neisseria Meningitidis ◽

The United States

Download Full-text

Evolutionary Changes in Antimicrobial Resistance of Invasive Neisseria meningitidis Isolates in Belgium from 2000 to 2010: Increasing Prevalence of Penicillin Nonsusceptibility

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.06310-11 ◽

2012 ◽

Vol 56 (5) ◽

pp. 2268-2272 ◽

Cited By ~ 18

Author(s):

Sophie Bertrand ◽

Françoise Carion ◽

René Wintjens ◽

Vanessa Mathys ◽

Raymond Vanhoof

Keyword(s):

Antimicrobial Resistance ◽

Neisseria Meningitidis ◽

Antimicrobial Susceptibility ◽

Antimicrobial Treatment ◽

Penicillin G ◽

Susceptible Population ◽

Content Type ◽

Reference Centre ◽

Evolutionary Changes ◽

First Choice

ABSTRACTThis study was conducted to evaluate the evolution of the antimicrobial susceptibility ofNeisseria meningitidiscausing invasive diseases in Belgium in the period of January 2000 to December 2010. A total of 1,933 cases ofN. meningitidisfrom invasive infections were analyzed by antimicrobial susceptibility testing at the Belgian Meningococcal Reference Centre. The majority of strains were susceptible to antibiotics that are currently used for the treatment and prophylaxis of meningococcal disease, but the prevalence of clinical isolates with reduced susceptibility to penicillin increased over the years. The phenotyping, genotyping, and determination of MICs of penicillin G were performed. The systematic shift of the curves toward higher penicillin MICs in the susceptible population indicated that this population became less sensitive to penicillin in this period. A 402-bp DNA fragment in the 3′ end ofpenAwas sequenced for the 296 nonsusceptible meningococcal strains isolated between 2000 and 2010 to examine the genetic diversity and evolution of theirpenAgene. In conclusion, the data obtained in our study support the statement that the position of penicillin G as a first choice in the treatment of invasive meningococcal diseases in Belgium should be reexamined. Despite an important number of isolates displaying a reduced susceptibility to penicillin, at present the expanded-spectrum cephalosporins, such as ceftriaxone, are not affected. The follow-up of the evolutionary changes in antimicrobial resistance has also proved to be essential for the recommendation of an appropriate antimicrobial treatment for invasive meningococcal diseases.

Download Full-text

Antimicrobial resistance in Salmonella that caused foodborne disease outbreaks: United States, 2003–2012

Epidemiology and Infection ◽

10.1017/s0950268816002867 ◽

2016 ◽

Vol 145 (4) ◽

pp. 766-774 ◽

Cited By ~ 12

Author(s):

A. C. BROWN ◽

J. E. GRASS ◽

L. C. RICHARDSON ◽

A. L. NISLER ◽

A. S. BICKNESE ◽

...

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Disease Outbreaks ◽

The United States ◽

Food Group ◽

Multidrug Resistant ◽

Antimicrobial Treatment ◽

Foodborne Disease ◽

Susceptibility Data ◽

Invasive Infections

SUMMARYAlthough most non-typhoidal Salmonella illnesses are self-limiting, antimicrobial treatment is critical for invasive infections. To describe resistance in Salmonella that caused foodborne outbreaks in the United States, we linked outbreaks submitted to the Foodborne Disease Outbreak Surveillance System to isolate susceptibility data in the National Antimicrobial Resistance Monitoring System. Resistant outbreaks were defined as those linked to one or more isolates with resistance to at least one antimicrobial drug. Multidrug resistant (MDR) outbreaks had at least one isolate resistant to three or more antimicrobial classes. Twenty-one per cent (37/176) of linked outbreaks were resistant. In outbreaks attributed to a single food group, 73% (16/22) of resistant outbreaks and 46% (31/68) of non-resistant outbreaks were attributed to foods from land animals (P < 0·05). MDR Salmonella with clinically important resistance caused 29% (14/48) of outbreaks from land animals and 8% (3/40) of outbreaks from plant products (P < 0·01). In our study, resistant Salmonella infections were more common in outbreaks attributed to foods from land animals than outbreaks from foods from plants or aquatic animals. Antimicrobial susceptibility data on isolates from foodborne Salmonella outbreaks can help determine which foods are associated with resistant infections.

Download Full-text