Search

Background Previous reports suggested that US methicillin-resistant Staphylococcus aureus (MRSA) strain epidemiology has changed since the rise of USA300 MRSA. We describe invasive MRSA trends by strain type. Methods Data came from 5 Centers for Disease Control and Prevention Emerging Infections Program sites conducting population-based surveillance and collecting isolates for invasive MRSA (ie, from normally sterile body sites), 2005–2013. MRSA bloodstream infection (BSI) incidence per 100 000 population was stratified by strain type and epidemiologic classification of healthcare exposures. Invasive USA100 vs USA300 case characteristics from 2013 were compared through logistic regression. Results From 2005 to 2013, USA100 incidence decreased most notably for hospital-onset (6.1 vs 0.9/100 000 persons, P <.0001) and healthcare-associated, community-onset (10.7 vs 4.9/100 000 persons, P <.0001) BSIs. USA300 incidence for hospital-onset BSIs also decreased (1.5 vs 0.6/100 000 persons, P <.0001). However, USA300 incidence did not significantly change for healthcare-associated, community-onset (3.9 vs 3.3/100 000 persons, P =.05) or community-associated BSIs (2.5 vs 2.4/100 000 persons, P =.19). Invasive MRSA was less likely to be USA300 in patients who were older (adjusted odds ratio [aOR], 0.97 per year [95% confidence interval {CI},.96–.98]), previously hospitalized (aOR, 0.36 [95% CI,.24–.54]), or had central lines (aOR, 0.44 [95% CI,.27–.74]), and associated with USA300 in people who inject drugs (aOR, 4.58 [95% CI, 1.16–17.95]). Conclusions Most of the decline in MRSA BSIs was from decreases in USA100 BSI incidence. Prevention of USA300 MRSA BSIs in the community will be needed to further reduce burden from MRSA BSIs. [ABSTRACT FROM AUTHOR]

Background Common melanocytic naevi are considered early biomarkers associated with risk of cutaneous malignant melanoma. We sought to investigate if residing at different latitudes in Sweden influences the population’s anatomical distribution of naevi in children and melanoma in adults. Methods The nationwide Swedish Cancer Registry 1990–2012 gave cumulative number of invasive melanomas per body site, stratified by sex and age in northern (62–69 °N) ( n = 2823) and southern (55–58 °N) Sweden ( n = 24,115). A population-based cross-sectional study conducted in 2002 provided the allocation of naevi among 7-year-olds in northern (5695 naevi in 679 children) and southern Sweden (8392 naevi in 681 children). Results In 2012, northern Sweden had a two-fold lower melanoma incidence: 19.8/100.000 age-standardised population compared with 41.0/100.000 in the south. Similarly, a lower mean naevi density in children was demonstrated: 7.3 (standard deviation (SD) 5.4) in boys and 7.0 (4.7) in girls in the north versus 13.3 (8.4) in boys and 11.9 (8.5) in girls in the south. Across latitudes of residing, gender profiles and proportional body-site distributions of melanoma and naevi, respectively, were largely homogenous, but in southern Sweden slightly higher on the trunk; a body site associated with intermittent sun exposure. Childhood naevi distributions matched with melanomas in young and middle-aged adults. Conclusion This large population-based study demonstrated that latitude of residing similarly affects the number and anatomical distribution of naevi in children and melanoma in adults. It supports a role of childhood naevi as predictors of overall and subsite risk of melanoma among young adults. [ABSTRACT FROM AUTHOR]

An observational population-based study conducted among 2 sets of 7-year-old children in Sweden in 2002 and 2007 revealed evidence of improved sun protection, also reflected in a significant reduction in the total number of melanocytic naevi. Based on these data-sets, the aim of the current study was to determine whether the overall reduction in naevi had impacted differently on body sites based on their main pattern of sun exposure. In 2002, median naevi counts/m2 were highest on intermittently sun-exposed sites: 13.8 (95% CI 8.0–22.7) compared with chronically sun-exposed sites: 11.0 (95% CI 0.0–20.5). In 2007, median naevi counts/m2 on intermittently sun-exposed body sites were significantly lower: 8.7 (95% CI 4.7–15.2), p < 0.0001, while on chronically exposed sites median naevi counts/m2 were unaltered: 10.3 (95% CI 0.0–14.4), p = 0.9313. Changes were most evident among boys. Future research can evaluate whether this shift in naevi distribution in Swedish children translates into a reduction in cutaneous melanomas on intermittently sun-exposed body sites. [ABSTRACT FROM AUTHOR]

Background In 2009, the Centers for Disease Control and Prevention (CDC) implemented Clostridioides difficile infection (CDI) surveillance through the Emerging Infections Program (EIP) to monitor the incidence and evolving epidemiology of CDI in the United States. Since 2012, ribotypes (RTs) 027, 106, 002, 014, and 020 have constituted the top five strain types among both US community- and healthcare-associated isolates. Here we describe the changes in molecular epidemiology of C. difficile isolates collected in the United States in 2017. Methods In 2017, CDI surveillance was conducted at 10 EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, and TN). A convenience sample of clinical laboratories across EIP sites submitted C. difficile -positive stool specimens to the MN Department of Health Public Health Laboratory and Hines VA Hospital (IL) for culture. Isolates were forwarded to CDC and characterized by capillary-based PCR-ribotyping and PCR detection of tcdA , tcdB , cdtA , cdtB , and deletions in tcdC. Results In 2017, 1,051 C. difficile isolates were submitted; the total number of isolates received from each site ranged from 11 to 286 with a median of 85.5. In total, 143 RTs were observed, with the majority of isolates harboring toxin genes tcdA and tcdB (95%) and a wild-type tcdC sequence (71%). Among 556 healthcare-associated isolates, RT 027 was the most prevalent and the top RT at 5 sites (CA, GA, MD, NM, TN). Ribotype 106 was the most prevalent among 495 community-associated CA isolates and the top RT at 6 sites (CO, CT, GA, MD, MN, TN). Ribotype 027 significantly decreased from 2012 to 2017 among both healthcare-associated (21% vs 15%; p = 0.02) and community-associated isolates (17% vs 6%; P < 0.0001). Among healthcare-associated isolates, RT 076, which was observed in 8 EIP sites, increased from 2% in 2016 to 5% in 2017 (p = 0.05) and replaced RT 020 as one of the top 5 healthcare-associated RTs in 2017. Conclusion Despite an overall decline since 2012, RT 027 remained the most prevalent RT among healthcare-associated isolates submitted in 2017. The increased frequency of RT 076 among healthcare-associated isolates submitted in 2017 highlights the evolving molecular epidemiology of C. difficile and the need for continued surveillance to monitor potential emerging strains. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Abstract: Most Campylobacter infections are self-limiting but antimicrobial treatment (e.g., macrolides, fluoroquinolones) is necessary in severe or prolonged cases. Susceptibility testing continues to play a critical role in guiding therapy and epidemiological monitoring of resistance. The methods of choice for Campylobacter recommended by the Clinical and Laboratory Standards Institute (CLSI) are agar dilution and broth microdilution, while a disk diffusion method was recently standardized by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Macrolides, quinolones, and tetracyclines are among the common antimicrobials recommended for testing. Molecular determination of Campylobacter resistance via DNA sequencing or PCR-based methods has been performed. High levels of resistance to tetracycline and ciprofloxacin are frequently reported by many national surveillance programs, but resistance to erythromycin and gentamicin in Campylobacter jejuni remains low. Nonetheless, variations in susceptibility observed over time underscore the need for continued public health monitoring of Campylobacter resistance from humans, animals, and food. [Copyright &y& Elsevier]