Efforts to slacken antibiotic resistance: Labeling meat products from animals raised without antibiotics in the United States

Abstract Background Community-onset urinary tract infections (coUTIs) are one of the most common indications for antibiotic prescribing. It is important to understand patient demographic factors associated with microorganisms causing coUTI and their antibiotic resistance profiles, to tailor antibiotic prescribing practices. We analyzed microbiology data to understand factors associated with coUTI in the United States (US). Methods CoUTIs were identified in the Premier Healthcare Database and Cerner Health Facts among patients treated at participating healthcare facilities in the US between 2012-2017. Cases were defined by urine cultures yielding a bacterial organism and were collected in outpatient settings or within three days of hospitalization. Only the first specimen for each encounter was included in the analysis. Data on the organisms isolated, patient’s age, sex, and US census regions of the submitting facilities were described and compared using chi-square tests for associations. Encounters were classified as inpatient (INPT), observation (OBS), emergency department (ED), and outpatient (OTPT) based on the setting in which the culture was submitted. Results Using data from 637 acute care hospitals, urine samples from 3,291,561 encounters were included, with 776,653 (25.7%) INPT, 1,063,219 (34.8%) ED, 107,760 (3.5%) OBS, and 1,092,658 (35.8%) OTPT. The pathogens most frequently associated with coUTIs were Escherichia coli (57.3%), Klebsiella pneumoniae (9.7%), Enterococcus faecalis (5.1%), Proteus mirabilis (4.9%), and Pseudomonas aeruginosa (2.9%). Female sex, age < 65y and OTPT and ED settings were associated with higher relative frequency of E. coli (all p < 0.0001). Male sex, INPT setting and age >65 y were associated with higher relative frequency of P. aeruginosa, P. mirabilis and E. faecalis (all p < 0.0001, Figure). K. pneumoniae was found at higher relative frequency in those >45y, and in INPT and OBS settings (all p < 0.0001). Figure. Distribution of pathogens most frequently associated with community onset urinary tract infections Conclusion Understanding patient factors associated with the microbiology of coUTIs is an important step in developing treatment recommendations and antibiotic stewardship efforts. Further analyses will include assessing the impact of major antibiotic resistance phenotypes, geographic and healthcare settings. Disclosures All Authors: No reported disclosures

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Designing strategies for eradication of Helicobacter pylori based on prevalence patterns of infection and antibiotic resistance in a low‐income, medically underserved community in the United States

Helicobacter ◽

10.1111/hel.12769 ◽

2020 ◽

Author(s):

Harpreet Singh ◽

Hansol Chung ◽

Imad Awan ◽

Anjali Mone ◽

Robert Cooper ◽

...

Keyword(s):

United States ◽

Helicobacter Pylori ◽

Antibiotic Resistance ◽

Low Income ◽

The United States ◽

Medically Underserved ◽

Underserved Community

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Increasing antibiotic resistance in clinical isolates of Aeromonas strains in Taiwan.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.5.1260 ◽

1996 ◽

Vol 40 (5) ◽

pp. 1260-1262 ◽

Cited By ~ 71

Author(s):

W C Ko ◽

K W Yu ◽

C Y Liu ◽

C T Huang ◽

H S Leu ◽

...

Keyword(s):

United States ◽

Antibiotic Resistance ◽

The United States ◽

Clinical Isolates ◽

Dilution Method ◽

Agar Dilution Method ◽

Extended Spectrum ◽

Agar Dilution

A total of 234 clinical isolates of Aeromonas, primarily A. hydrophila, were collected for the present study. Most were isolates from blood. By the agar dilution method, more than 90% of the Aeromonas strains were found to be susceptible to moxalactam, ceftazidime, cefepime, aztreonam, imipenem, amikacin, and fluoroquinolones, but they were more resistant to tetracycline, trimethoprim-sulfamethoxazole, some extended-spectrum cephalosporins, and aminoglycosides than strains from the United States and Australia.

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Control of Listeria monocytogenes on Cooked Cured Ham by Formulation with a Lactate-Diacetate Blend and Surface Treatment with Lauric Arginate

Journal of Food Protection ◽

10.4315/0362-028x-73.3.552 ◽

2010 ◽

Vol 73 (3) ◽

pp. 552-555 ◽

Cited By ~ 23

Author(s):

J. D. STOPFORTH ◽

D. VISSER ◽

R. ZUMBRINK ◽

L. van DIJK ◽

E. W. BONTENBAL

Keyword(s):

United States ◽

Surface Treatment ◽

Meat Products ◽

Growth Inhibitor ◽

Antimicrobial Effect ◽

The United States ◽

Complete Inhibition ◽

Department Of Agriculture ◽

Lauric Arginate ◽

Inspection Service

Ready-to-eat (RTE) meat products have been identified as a significant source of listeriosis in humans in the United States. Meat processors in the United States are required to use one of three alternatives to control L. monocytogenes in RTE meats: (i) a postlethality inactivation treatment along with a L. monocytogenes growth inhibitor; (ii) a postlethality inactivation treatment or a growth inhibitor; or (iii) sanitation measures and intensive testing. Lauric arginate (LAE) has been proposed as an effective postlethality inactivation treatment. The present study was conducted to investigate the antimicrobial effect of a lactate-diacetate blend in the formulation combined with surface application of LAE on cooked cured ham inoculated with L. monocytogenes, vacuum packaged, and stored at 4°C for up to 90 days. The treatments evaluated were (i) control ham with no added antimicrobials (control); (ii) ham formulated with 1.68% potassium lactate and 0.12% sodium diacetate (PLSD); (iii) control ham with 0.07% LAE as a surface treatment (LAE); and (iv) ham formulated with PLSD and LAE surface treatment (sprayed in bag and distributed across meat surface during vacuum packing) (PLSD+LAE). Use of only LAE as a surface treatment resulted in an initial 1-log CFU/g reduction in levels of L. monocytogenes on ham; however, this reduction only delayed the growth of the pathogen to 8 log CFU/g by 12 days when compared with the control ham without added antimicrobials. Use of PLSD in the formulation of ham resulted in a complete inhibition of L. monocytogenes throughout storage. The combination of PLSD in the formulation and a surface treatment with LAE resulted in an initial 0.7-log CFU/g reduction of the pathogen on ham and complete inhibition of the pathogen at the reduced level throughout storage. Formulation of ham with a lactate-diacetate blend combined with lauric arginate as a surface treatment will allow RTE meat processors to effectively achieve alternative 1 status, as designated by the U.S. Department of Agriculture Food Safety and Inspection Service, in their facilities.

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Extraintestinal Pathogenic and Antimicrobial-Resistant Escherichia coli, Including Sequence Type 131 (ST131), from Retail Chicken Breasts in the United States in 2013

Applied and Environmental Microbiology ◽

10.1128/aem.02956-16 ◽

2017 ◽

Vol 83 (6) ◽

Cited By ~ 15

Author(s):

James R. Johnson ◽

Stephen B. Porter ◽

Brian Johnston ◽

Paul Thuras ◽

Sarah Clock ◽

...

Keyword(s):

United States ◽

Escherichia Coli ◽

Virulence Genes ◽

Meat Products ◽

The United States ◽

Sequence Type ◽

The Other ◽

Antibiotic Resistant ◽

Content Type ◽

E Coli

ABSTRACT Chicken meat products are hypothesized to be vehicles for transmitting antimicrobial-resistant and extraintestinal pathogenic Escherichia coli (ExPEC) to consumers. To reassess this hypothesis in the current era of heightened concerns about antimicrobial use in food animals, we analyzed 175 chicken-source E. coli isolates from a 2013 Consumer Reports national survey. Isolates were screened by PCR for ExPEC-defining virulence genes. The 25 ExPEC isolates (12% of 175) and a 2:1 randomly selected set of 50 non-ExPEC isolates were assessed for their phylogenetic/clonal backgrounds and virulence genotypes for comparison with their resistance profiles and the claims on the retail packaging label (“organic,” “no antibiotics,” and “natural”). Compared with the findings for non-ExPEC isolates, the group of ExPEC isolates had a higher prevalence of phylogroup B2 isolates (44% versus 4%; P < 0.001) and a lower prevalence of phylogroup A isolates (4% versus 30%; P = 0.001), a higher prevalence of multiple individual virulence genes, higher virulence scores (median, 11 [range, 4 to 16] versus 8 [range, 1 to 14]; P = 0.001), and higher resistance scores (median, 4 [range, 0 to 8] versus 3 [range, 0 to 10]; P < 0.001). All five isolates of sequence type 131 (ST131) were ExPEC (P = 0.003), were as extensively resistant as the other isolates tested, and had higher virulence scores than the other isolates tested (median, 12 [range, 11 to 13] versus 8 [range, 1 to 16]; P = 0.005). Organic labeling predicted lower resistance scores (median, 2 [range, 0 to 3] versus 4 [range, 0 to 10]; P = 0.008) but no difference in ExPEC status or virulence scores. These findings document a persisting reservoir of extensively antimicrobial-resistant ExPEC isolates, including isolates from ST131, in retail chicken products in the United States, suggesting a potential public health threat. IMPORTANCE We found that among Escherichia coli isolates from retail chicken meat products purchased across the United States in 2013 (many of these isolates being extensively antibiotic resistant), a minority had genetic profiles suggesting an ability to cause extraintestinal infections in humans, such as urinary tract infection, implying a risk of foodborne disease. Although isolates from products labeled “organic” were less extensively antibiotic resistant than other isolates, they did not appear to be less virulent. These findings suggest that retail chicken products in the United States, even if they are labeled “organic,” pose a potential health threat to consumers because they are contaminated with extensively antibiotic-resistant and, presumably, virulent E. coli isolates.

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484. Metallo-β-Lactamase-Positive Carbapenem-Resistant Enterobacteriaceae and Pseudomonas aeruginosa in the Antibiotic Resistance Laboratory Network, 2017–2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.557 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S237-S237

Author(s):

Allison C Brown ◽

Sarah Malik ◽

Jennifer Huang ◽

Amelia Bhatnagar ◽

Rocio Balbuena ◽

...

Keyword(s):

United States ◽

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

The United States ◽

New Drugs ◽

Carbapenem Resistant ◽

Laboratory Network ◽

Therapeutic Decisions ◽

Carbapenemase Gene ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Infections with metallo-β-lactamase (MBL)-producing organisms are emerging in the United States. Treatment options for these infections are limited. We describe MBL genes among carbapenemase positive carbapenem-resistant Enterobacteriaceae (CP-CRE) and Pseudomonas aeruginosa (CP-CRPA) isolates tested during the first two years of the Antibiotic Resistance Laboratory Network (AR Lab Network). Methods State and local public health laboratories tested CRE and CRPA isolates for organism identification, antimicrobial susceptibility, and PCR-based detection of blaKPC, blaNDM, blaOXA-48-like, blaVIM, and blaIMP carbapenemase genes. All testing results were sent to CDC at least monthly. Results Since January 2017, the AR Lab Network tested 21,733 CRE and 14,141 CRPA. CP-CRE were detected in 37% of CRE; 2% of CRPA were CP-CRPA. Among CP-CRE, 9% (686/8016) were MBL-producers (NDM, VIM, or IMP). Among MBL-producers, a blaNDM gene was detected most often (81%; 551/686). blaNDM were most common among Klebsiella spp. (47%; 261/551), blaIMP were most common among Providencia spp. (53%; 40/75), blaVIM was most common among Enterobacter spp. (19%; 25/62). Twelve percent (96) of MBL CP-CRE contained more than one carbapenemase gene. Among CP-CRPA, 73% (218/300) were MBL producers and blaVIM was the most common gene (62%; 186). Three (1%) MBL CP-CRPA contained more than one carbapenemase. Conclusion Increased testing of CRE and CRPA isolates through the AR Lab Network has facilitated early and rapid detection of hard-to-treat infections caused by MBL-producing organisms across the United States. The widespread distribution of MBL genes highlights the continued need for containment strategies that help prevent transmission between patients and among healthcare facilities. To support therapeutic decisions for severe infections caused by MBL-producing organisms, the AR Lab Network is now offering rapid susceptibility testing against aztreonam/avibactam, using digital dispenser technology. This testing program aims to close the gap between the availability of new drugs or drug combinations and the availability of commercial AST methods, thereby improving patient safety and antimicrobial stewardship. Disclosures All authors: No reported disclosures.

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Antibiotic resistance and molecular characterization of bacteremia Escherichia coli isolates from newborns in the United States

PLoS ONE ◽

10.1371/journal.pone.0219352 ◽

2019 ◽

Vol 14 (7) ◽

pp. e0219352 ◽

Cited By ~ 6

Author(s):

Bryan K. Cole ◽

Marko Ilikj ◽

Cindy B. McCloskey ◽

Susana Chavez-Bueno

Keyword(s):

United States ◽

Escherichia Coli ◽

Antibiotic Resistance ◽

Molecular Characterization ◽

The United States

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2070. Assessing Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A National Survey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1750 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S698-S698

Author(s):

Rachel M Zetts ◽

Andrea Garcia ◽

Jason Doctor ◽

Jeffrey Gerber ◽

Jeffrey A Linder ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Antibiotic Resistance ◽

National Survey ◽

Antibiotic Stewardship ◽

Primary Care Physicians ◽

Antibiotic Use ◽

The United States ◽

Incentive Program ◽

Data Feedback

Abstract Background At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship can improve prescribing and minimize the threat of antibiotic resistance. We assessed primary care physicians’ (PCPs) perceptions of antibiotic resistance, inappropriate antibiotic use, and the need for and impact of antibiotic stewardship activities. Methods We conducted a national survey of 1,550 internal and family medicine physicians and pediatricians recruited from a medical market research panel. Quotas were established to recruit participants by geographic region and specialty. For sample representativeness, survey weights were generated according to these characteristics using the American Medical Association’s Masterfile. Results Among respondents, 94% agreed that resistance is a problem in the United States, but only 55% felt it was a problem for their practice; 65% of respondents agreed they had seen an increase in resistant infections in their patients over the past 5 years. Responses about inappropriate antibiotic use were similar: 91% agreed that it was a problem, but 37% agreed that it is a problem in their practice. Additionally, 60% felt they prescribed antibiotics more appropriately than their peers. For antibiotic stewardship, 91% felt it was appropriate for office-based practices, but 53% believed that discussions with patients on the appropriate use of antibiotics is sufficient to address the problem. The majority of respondents indicated they were likely, very likely, or extremely likely to implement stewardship interventions in response to feedback or incentives from payers or health departments. The activities with the strongest likelihood to spur stewardship adoption included the state health department publishing local resistance patterns (82%), a payer creating a stand-alone incentive program for stewardship (80%), or a payer including it in a broader quality incentive program (76%). Conclusion PCPs feel that antibiotic resistance, inappropriate prescribing, and stewardship are important in the United States, but not for their own practices. This disconnect poses a challenge for the success of outpatient stewardship programs. Incentive or data feedback activities may help encourage stewardship uptake. Disclosures All authors: No reported disclosures.

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