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Coussens NP, Molinaro AL, Culbertson KJ, Peryea T, Zahoránszky-Köhalmi G, Hall MD, Daines DA. Better living through chemistry: Addressing emerging antibiotic resistance. Exp Biol Med (Maywood) 2018; 243:538-553. [PMID: 29409348 PMCID: PMC5882019 DOI: 10.1177/1535370218755659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The increasing emergence of multidrug-resistant bacteria is recognized as a major threat to human health worldwide. While the use of small molecule antibiotics has enabled many modern medical advances, it has also facilitated the development of resistant organisms. This minireview provides an overview of current small molecule drugs approved by the US Food and Drug Administration (FDA) for use in humans, the unintended consequences of antibiotic use, and the mechanisms that underlie the development of drug resistance. Promising new approaches and strategies to counter antibiotic-resistant bacteria with small molecules are highlighted. However, continued public investment in this area is critical to maintain an edge in our evolutionary "arms race" against antibiotic-resistant microorganisms. Impact statement The alarming increase in antibiotic-resistant microorganisms is a rapidly emerging threat to human health throughout the world. Historically, small molecule drugs have played a major role in controlling bacterial infections and they continue to offer tremendous potential in countering resistant organisms. This minireview provides a broad overview of the relevant issues, including the diversity of FDA-approved small molecule drugs and mechanisms of drug resistance, unintended consequences of antibiotic use, the current state of development for small molecule antibacterials and financial challenges that impact progress towards novel therapies. The content will be informative to diverse stakeholders, including clinicians, basic scientists, translational scientists and policy makers, and may be used as a bridge between these key players to advance the development of much-needed therapeutics.
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Affiliation(s)
- Nathan P Coussens
- National Center for Advancing Translational Sciences, Division of Pre-Clinical Innovation, Rockville, MD 20850, USA
| | - Ashley L Molinaro
- Department of Biological Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Kayla J Culbertson
- Department of Biological Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Tyler Peryea
- National Center for Advancing Translational Sciences, Division of Pre-Clinical Innovation, Rockville, MD 20850, USA
| | - Gergely Zahoránszky-Köhalmi
- National Center for Advancing Translational Sciences, Division of Pre-Clinical Innovation, Rockville, MD 20850, USA
| | - Matthew D Hall
- National Center for Advancing Translational Sciences, Division of Pre-Clinical Innovation, Rockville, MD 20850, USA
| | - Dayle A Daines
- Department of Biological Sciences, Old Dominion University, Norfolk, VA 23529, USA
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Hirsch AG, Durden TE, Nordberg C, Berger A, Schwartz BS. Associations of Four Community Factors With Longitudinal Change in Hemoglobin A 1c Levels in Patients With Type 2 Diabetes. Diabetes Care 2018; 41:461-468. [PMID: 29258994 PMCID: PMC5864143 DOI: 10.2337/dc17-1200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/20/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate associations of community factors with glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS We identified patients with type 2 diabetes who had an HbA1c ≥7.5% (58 mmol/mol) and subsequent HbA1c testing within 90-270 days. We used mixed-effect models to assess whether treatment intensification (TI) and community domains (community socioeconomic deprivation [CSD], food availability, fitness assets, and utilitarian physical activity favorability [quartiled]) were associated with HbA1c change over 6 and 24 months, controlling for demographics, HbA1c, BMI, and time with evidence of type 2 diabetes. We evaluated whether community domains modified associations of TI with HbA1c change using cross product terms. RESULTS There were 15,308 patients with 69,818 elevated HbA1c measures. The average reduction in HbA1c over 6 months was 0.07% less in townships with a high level of CSD (third quartile versus the first). Reductions were 0.10% greater for HbA1c in townships with the best food availability (versus worst). HbA1c reductions were 0.17-0.19% greater in census tracts in the second and third quartiles of utilitarian physical activity favorability versus the first. The association of TI with 6-month HbA1c change was weaker in townships and boroughs with the worst CSD (versus best) and in boroughs with the best fitness assets (versus worst). The association of TI with 24-month HbA1c change was weaker in census tracts with the worst CSD (versus third quartile) and strongest in census tracts most favorable for utilitarian physical activity (versus worst). CONCLUSIONS Community domains were associated with HbA1c change and blunted TI effectiveness.
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Affiliation(s)
- Annemarie G Hirsch
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - T Elizabeth Durden
- Department of Sociology and Anthropology, Bucknell University, Lewisburg, PA
| | - Cara Nordberg
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, PA
| | - Andrea Berger
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, PA
| | - Brian S Schwartz
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Ferri M, Ranucci E, Romagnoli P, Giaccone V. Antimicrobial resistance: A global emerging threat to public health systems. Crit Rev Food Sci Nutr 2018; 57:2857-2876. [PMID: 26464037 DOI: 10.1080/10408398.2015.1077192] [Citation(s) in RCA: 482] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Antimicrobial resistance (AMR) became in the last two decades a global threat to public health systems in the world. Since the antibiotic era, with the discovery of the first antibiotics that provided consistent health benefits to human medicine, the misuse and abuse of antimicrobials in veterinary and human medicine have accelerated the growing worldwide phenomenon of AMR. This article presents an extensive overview of the epidemiology of AMR, with a focus on the link between food producing-animals and humans and on the legal framework and policies currently implemented at the EU level and globally. The ways of responding to the AMR challenges foresee an array of measures that include: designing more effective preventive measures at farm level to reduce the use of antimicrobials; development of novel antimicrobials; strengthening of AMR surveillance system in animal and human populations; better knowledge of the ecology of resistant bacteria and resistant genes; increased awareness of stakeholders on the prudent use of antibiotics in animal productions and clinical arena; and the public health and environmental consequences of AMR. Based on the global nature of AMR and considering that bacterial resistance does not recognize barriers and can spread to people and the environment, the article ends with specific recommendations structured around a holistic approach and targeted to different stakeholders.
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Affiliation(s)
| | | | | | - Valerio Giaccone
- d Department of Animal Medicine , Veterinary School, Padua University , Padua , Italy
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54
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Anker JCH, Koch A, Ethelberg S, Mølbak K, Larsen J, Jepsen MR. Distance to pig farms as risk factor for community-onset livestock-associated MRSA CC398 infection in persons without known contact to pig farms-A nationwide study. Zoonoses Public Health 2018; 65:352-360. [PMID: 29314752 DOI: 10.1111/zph.12441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 11/30/2022]
Abstract
MRSA CC398 is an emerging MRSA strain found in livestock, mainly in pigs. Direct occupational livestock contact is the principal risk factor for human MRSA CC398 infection. Nonetheless, in recent years, an increasing number of MRSA CC398 cases has been observed in persons without known pig contact. Such cases, referred to as MRSA CC398 of unknown origin (MUO CC398), have, like livestock-onset (LO) MRSA CC398 cases, been found concentrated in rural, livestock-producing areas. The presence of MUO CC398 cases indicates alternative and unknown MRSA CC398 transmission pathways into the community. We performed a nationwide study in Denmark of the geographic distributions of MRSA cases in general and persons with MUO CC398 or LO MRSA CC398 infections (1 January 2006-11 February 2015), with the Danish population as background population. Place of living of study persons was mapped using the ArcGIS software, and information on pig farms was retrieved from the Central Husbandry Register. The incidence of MUO CC398 infections was clearly higher in rural than in urban areas, and such cases lived on average closer to pig farms than the general population. However, within three pig-farming-dense municipalities, patients with MUO CC398 infections did not live closer to pig farms than population controls. This shows that direct environmental spread from neighbouring pig farms of MRSA CC398 is unlikely. Instead, community spread through other means of transmission than direct spread from farms may more likely explain the clustering of MUO CC398 in livestock-dense areas.
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Affiliation(s)
- J C H Anker
- Statens Serum Institut, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - A Koch
- Statens Serum Institut, Copenhagen, Denmark
| | | | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
| | - J Larsen
- Statens Serum Institut, Copenhagen, Denmark
| | - M R Jepsen
- University of Copenhagen, Copenhagen, Denmark
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55
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Poulsen MN, Pollak J, Sills DL, Casey JA, Rasmussen SG, Nachman KE, Cosgrove SE, Stewart D, Schwartz BS. Residential proximity to high-density poultry operations associated with campylobacteriosis and infectious diarrhea. Int J Hyg Environ Health 2017; 221:323-333. [PMID: 29268955 DOI: 10.1016/j.ijheh.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
Poultry carry zoonotic bacteria that can cause gastroenteritis in humans. Environmental transmission of pathogens from poultry operations may increase gastrointestinal infection risk in surrounding communities. To evaluate associations between residential proximity to high-density poultry operations and individual-level diarrheal illnesses, we conducted a nested case-control study among 514,488 patients in Pennsylvania (2006-2015). Using electronic health records, we identified cases of five gastrointestinal outcomes: three pathogen-specific infections, including Escherichia coli (n = 1425), Campylobacter (n = 567), and Salmonella (n = 781); infectious diarrhea (n = 781); and non-specific diarrhea (2012-2015; n = 28,201). We estimated an inverse-distance squared activity metric for poultry operations based on farm and patient addresses. Patients in the second and fourth (versus first) quartiles of the poultry operation activity metric had increased odds of Campylobacter (AOR [CI], Q2: 1.36 [1.01, 1.82]; Q3: 1.38 [0.98, 1.96]; Q4: 1.75 [1.31, 2.33]). Patients in the second, third, and fourth quartiles had increased odds of infectious diarrhea (Q2: 1.76 [1.29, 2.39]; Q3: 1.76 [1.09, 2.85]; Q4: 1.60 [1.12, 2.30]). Stratification revealed stronger relations of fourth quartile and both Campylobacter and infectious diarrhea in townships, the most rural community type in the study geography. Increasing extreme rainfall in the week prior to diagnosis strengthened fourth quartile Campylobacter associations. The poultry operation activity metric was largely unassociated with E. coli, Salmonella, and non-specific diarrhea. Findings suggest high-density poultry operations may be associated with campylobacteriosis and infectious diarrhea in nearby communities, highlighting additional public health concerns of industrial agriculture.
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Affiliation(s)
- Melissa N Poulsen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah L Sills
- Department of Civil and Environmental Engineering, Bucknell University, Lewisburg, PA, USA
| | - Joan A Casey
- Department of Environmental Science, Policy & Management, University of California, Berkeley, CA, USA
| | - Sara G Rasmussen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dalton Stewart
- Department of Civil and Environmental Engineering, Bucknell University, Lewisburg, PA, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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56
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Davis MF, Rankin SC, Schurer JM, Cole S, Conti L, Rabinowitz P. Checklist for One Health Epidemiological Reporting of Evidence (COHERE). One Health 2017; 4:14-21. [PMID: 28825424 PMCID: PMC5536878 DOI: 10.1016/j.onehlt.2017.07.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/02/2017] [Accepted: 07/16/2017] [Indexed: 12/14/2022] Open
Abstract
One Health is defined as the intersection and integration of knowledge regarding humans, animals, and the environment, yet as the One Health scientific literature expands, there is considerable heterogeneity of approach and quality of reporting in One Health studies. In addition, many researchers who publish such studies do not include or integrate data from all three domains of human, animal, and environmental health. This points to a critical need to unify guidelines for One Health studies. This report details the Checklist for One Health Epidemiological Reporting of Evidence (COHERE) to guide the design and publication format of future One Health studies. COHERE was developed by a core writing team and international expert review group that represents multiple disciplines, including human medicine, veterinary medicine, public health, allied professionals, clinical laboratory science, epidemiology, the social sciences, ecohealth and environmental health. The twin aims of the COHERE standards are to 1) improve the quality of reporting of observational or interventional epidemiological studies that collect and integrate data from humans, animals and/or vectors, and their environments; and 2) promote the concept that One Health studies should integrate knowledge from these three domains. The 19 standards in the COHERE checklist address descriptions of human populations, animal populations, environmental assessment, spatial and temporal relationships of data from the three domains, integration of analyses and interpretation, and inclusion of expertise in the research team from disciplines related to human health, animal health, and environmental health.
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Affiliation(s)
- Meghan F. Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shelley C. Rankin
- Department of Pathobiology, Clinical Microbiology Laboratory, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janna M. Schurer
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stephen Cole
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Conti
- Florida Department of Agriculture and Consumer Services, FL, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences and Global Health, University of Washington School of Public Health, USA
- Department of Family Medicine (joint), University of Washington School of Medicine, Seattle, WA, USA
- Department of Medicine, Division of Allergy and Infectious Diseases (adjunct), University of Washington School of Medicine, Seattle, WA, USA
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57
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Phage-mediated dissemination of virulence factors in pathogenic bacteria facilitated by antibiotic growth promoters in animals: a perspective. Anim Health Res Rev 2017; 18:160-166. [DOI: 10.1017/s1466252317000147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractAddition of sub-therapeutic antibiotics to the feed of food-producing animals for growth promotion and disease prevention has become a common agricultural practice in many countries. The emergence of antibiotic-resistant pathogens is a looming concern associated with the use of antibiotic growth promoters (AGPs) around the world. In addition, some studies have shown that AGPs may not only affect antibiotic resistance but may also stimulate the dissemination of virulence factors via bacteriophages. Although only a few studies are currently available in the literature regarding this topic, in this article we endeavor to provide a perspective about how AGPs would impact the transmission of virulence factors by horizontal gene transfer via phages in a few pathogenic bacterial species significant to livestock production.
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58
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Booth BJ, Jones RR, Turyk ME, Freels S, Patel DM, Stayner LT, Ward MH. Livestock and poultry density and childhood cancer incidence in nine states in the USA. ENVIRONMENTAL RESEARCH 2017; 159:444-451. [PMID: 28858758 PMCID: PMC5784771 DOI: 10.1016/j.envres.2017.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 07/15/2017] [Accepted: 08/11/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND Parental occupational and childhood exposures to farm animals have been positively associated with childhood brain tumors, whereas associations with childhood leukemia are equivocal. The developing immune system may be influenced by allergen, virus, or other exposures from animal sources, which may contribute to childhood cancer incidence. METHODS Incident cancers (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], central nervous system [CNS], peripheral nervous system [PNS]) for children aged 0-4 diagnosed between 2003 and 2008 were obtained from nine National Cancer Institute Surveillance, Epidemiology and End Results (SEER) registries and were linked to U.S. Census of Agriculture data from 2002 and 2007 by county of diagnosis. Animal densities (animal units [AU]/km2; one animal unit is 1000 pounds of animal weight) were estimated for hogs, cattle, chickens (layers and broilers, separately), equine (horses, ponies, mules, burros, donkeys), goats, sheep, turkeys, and total animals. Animal density was examined in models as both continuous (AU per km2) and categorical variables (quartiles). Animal operation densities (per km2) by size of operation (cattle, hogs, chickens, sheep) were modeled continuously. Rate ratios and 95% confidence intervals were estimated using Poisson regression. RESULTS We found positive associations between AML and broiler chicken densities (RRper 10AU/km2 = 1.14, 95% CI = 1.02-1.26). ALL rates increased with densities of hog operations (RRper operation/100km2 = 1.06, 95% CI = 1.02-1.11). PNS cancer rates were inversely associated with layer chicken density (RRper log of AU/km2 = 0.94, 95% CI = 0.89-0.99). No association was found between any cancer type and densities of cattle, equine, or goats. CONCLUSIONS Although limited by the ecologic study design, some of our findings are novel and should be examined in epidemiological studies with individual level data.
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Affiliation(s)
- Benjamin J Booth
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., Room 6E138, Rockville, MD 20850, USA; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., Room 6E138, Rockville, MD 20850, USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Deven M Patel
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., Room 6E138, Rockville, MD 20850, USA
| | - Leslie T Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., Room 6E138, Rockville, MD 20850, USA.
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59
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Beresin GA, Wright JM, Rice GE, Jagai JS. Swine exposure and methicillin-resistant Staphylococcus aureus infection among hospitalized patients with skin and soft tissue infections in Illinois: A ZIP code-level analysis. ENVIRONMENTAL RESEARCH 2017; 159:46-60. [PMID: 28772149 PMCID: PMC5862075 DOI: 10.1016/j.envres.2017.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA), a bacterial pathogen, is a predominant cause of skin and soft tissue infections (SSTI) in the United States. Swine-production facilities have been recognized as potential environmental reservoirs of MRSA. To better understand how swine production may contribute to MRSA infection, we evaluated the association between MRSA infection among SSTI inpatients and exposure measures derived from national swine inventory data. METHODS Based on adjusted odds ratios from logistic regression models, we evaluated the association between swine exposure metrics and MRSA infections among all Illinois inpatient hospitalizations for SSTI from January 2008 through July 2011. We also assessed if swine exposures had greater association with suspected community-onset MRSA (CO-MRSA) compared to suspected hospital-onset MRSA (HO-MRSA). Exposures were estimated using the Farm Location and Agricultural Production Simulator, generating the number of farms with greater than 1000 swine per residential ZIP code and the residential ZIP code-level swine density (swine/km2). RESULTS For every increase in 100 swine/km2 within a residential ZIP code, the adjusted OR (aOR) for MRSA infection was 1.36 (95% CI: 1.28-1.45). For every additional large farm (i.e., >1000 swine) per ZIP code, the aOR for MRSA infection was 1.06 (95% CI: 1.04-1.07). The aOR for ZIP codes with any large farms compared to those with no large farms was 1.24 (95% CI: 1.19-1.29). We saw no evidence of an increased association for CO-MRSA compared to HO-MRSA with either continuous exposure metric (aORs=0.99), and observed inconsistent results across exposure categories. CONCLUSIONS These publicly-available, ecological exposure data demonstrated positive associations between swine exposure measures and individual-level MRSA infections among SSTI inpatients. Though it is difficult to draw definitive conclusions due to limitations of the data, these findings suggest that the risk of MRSA may increase based on indirect environmental exposure to swine production. Future research can address measurement error related to these data by improving exposure assessment precision, increased specification of MRSA strain, and better characterization of specific environmental exposure pathways.
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Affiliation(s)
- Glennon A Beresin
- Association of Schools and Programs of Public Health Environmental Health Fellowship hosted by Environmental Protection Agency: 1900 M Street NW, Suite 710, Washington, DC 20036, United States.
| | - J Michael Wright
- US Environmental Protection Agency, National Center for Environmental Assessment, 26 West Martin Luther King Dr., Cincinnati, OH 45268, United States
| | - Glenn E Rice
- US Environmental Protection Agency, National Center for Environmental Assessment, 26 West Martin Luther King Dr., Cincinnati, OH 45268, United States
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O'Connor AM, Auvermann BW, Dzikamunhenga RS, Glanville JM, Higgins JPT, Kirychuk SP, Sargeant JM, Totton SC, Wood H, Von Essen SG. Authors' response to comments from Nachman KE et al. Syst Rev 2017; 6:210. [PMID: 29061188 PMCID: PMC5654098 DOI: 10.1186/s13643-017-0611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022] Open
Abstract
Authors' response to comments letter to the editor from Nachman KE et al.
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Affiliation(s)
- Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA. .,College of Veterinary Medicine, Iowa State University, Ames, IA, USA.
| | - Brent W Auvermann
- Department of Biological and Agricultural Engineering, Texas A&M University, Amarillo, TX, USA
| | - Rungano S Dzikamunhenga
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | | | - Julian P T Higgins
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shelley P Kirychuk
- Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jan M Sargeant
- Department of Population Medicine, Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | - Sarah C Totton
- College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Hannah Wood
- Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Susanna G Von Essen
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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61
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Zomer TP, Wielders CCH, Veenman C, Hengeveld P, van der Hoek W, de Greeff SC, Smit LAM, Heederik DJ, Yzermans CJ, Bosch T, Maassen CBM, van Duijkeren E. MRSA in persons not living or working on a farm in a livestock-dense area: prevalence and risk factors. J Antimicrob Chemother 2017; 72:893-899. [PMID: 27999031 DOI: 10.1093/jac/dkw483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/09/2016] [Indexed: 12/27/2022] Open
Abstract
Objectives MRSA emerged in livestock and persons in contact with livestock is referred to as livestock-associated MRSA (LA-MRSA). We assessed the prevalence and risk factors for MRSA carriage in persons not living or working on a farm. Methods A cross-sectional study was performed among 2492 adults living in close proximity of livestock farms. Persons working and/or living on farms were excluded. Nasal swabs were cultured using selective media. Participants completed questionnaires and the distance from the residential address to the nearest farm was calculated. The Mann-Whitney U -test was used to compare median distances. Risk factors were explored with logistic regression. Results Fourteen persons carried MRSA (0.56%; 95% CI 0.32%-0.92%), 10 of which carried LA-MRSA of multiple-locus variable-number tandem repeat analysis complex (MC) 398 (0.40%; 95% CI 0.20%-0.71%). MRSA MC 398 carriers lived significantly closer to the nearest farm than non-carriers (median: 184 versus 402 m; P < 0.01). In bivariate analyses correcting for contact with livestock, this difference remained significant. Conclusions Although the prevalence was low, living near farms increased the risk of MRSA MC 398 carriage for persons not living or working on a farm. Further research is necessary to identify the transmission routes.
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Affiliation(s)
- Tizza P Zomer
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Cornelia C H Wielders
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Christiaan Veenman
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Paul Hengeveld
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Lidwien A M Smit
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, TD 3508, The Netherlands
| | - Dick J Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, TD 3508, The Netherlands
| | - C Joris Yzermans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, BN 3500, The Netherlands
| | - Thijs Bosch
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Catharina B M Maassen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Engeline van Duijkeren
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
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Hryniewicz MM, Garbacz K. Borderline oxacillin-resistant Staphylococcus aureus (BORSA) – a more common problem than expected? J Med Microbiol 2017; 66:1367-1373. [DOI: 10.1099/jmm.0.000585] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Maria M. Hryniewicz
- Department of Oral Microbiology, Medical University of Gdansk, Dębowa 25, 80-204 Gdansk, Poland
| | - Katarzyna Garbacz
- Department of Oral Microbiology, Medical University of Gdansk, Dębowa 25, 80-204 Gdansk, Poland
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Nachman KE, Lam J, Schinasi LH, Smith TC, Feingold BJ, Casey JA. O'Connor et al. systematic review regarding animal feeding operations and public health: critical flaws may compromise conclusions. Syst Rev 2017; 6:179. [PMID: 28859697 PMCID: PMC5580209 DOI: 10.1186/s13643-017-0575-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/22/2017] [Indexed: 12/27/2022] Open
Abstract
In this comment, we summarize several scientific concerns with the recently published systematic review from O'Connor and colleagues that examined the relationship between proximity to animal-feeding operations and health of individuals in nearby communities. The authors utilized a bias tool not designed for environmental health research, erroneously excluded important studies, and incorrectly interpreted others. As a result, the conclusions drawn in the review misrepresent the evidence from the published literature, limiting its value to policymakers, researchers, and the public.
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Affiliation(s)
- Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA.
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Suite W7010-E, Baltimore, MD, 21205, USA.
- Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, MD, USA.
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Juleen Lam
- Program on Reproductive Health and the Environment, Department of OB/GYN & RS, University of California, San Francisco, CA, USA
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tara C Smith
- Department of Epidemiology, University of Iowa College of Public Health, 145N. Riverside Drive, Iowa City, IA, USA
- Center for Emerging Infectious Diseases, University of Iowa College of Public Health, Coralville, IA, USA
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, Kent, OH, USA
| | - Beth J Feingold
- Department of Environmental Health Sciences, University at Albany School of Public Health, State University of New York, Rensselaer, NY, USA
| | - Joan A Casey
- School of Public Health, University of California, Berkeley, CA, USA
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Price LB, Hungate BA, Koch BJ, Davis GS, Liu CM. Colonizing opportunistic pathogens (COPs): The beasts in all of us. PLoS Pathog 2017; 13:e1006369. [PMID: 28796836 PMCID: PMC5552013 DOI: 10.1371/journal.ppat.1006369] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Lance B. Price
- Milken Institute School of Public Health, George Washington University, Washington DC, United States of America
- Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona, United States of America
- * E-mail:
| | - Bruce A. Hungate
- Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, Arizona, United States of America
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Benjamin J. Koch
- Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, Arizona, United States of America
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Gregg S. Davis
- Milken Institute School of Public Health, George Washington University, Washington DC, United States of America
| | - Cindy M. Liu
- Milken Institute School of Public Health, George Washington University, Washington DC, United States of America
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Hoelzer K, Wong N, Thomas J, Talkington K, Jungman E, Coukell A. Antimicrobial drug use in food-producing animals and associated human health risks: what, and how strong, is the evidence? BMC Vet Res 2017; 13:211. [PMID: 28676125 PMCID: PMC5496648 DOI: 10.1186/s12917-017-1131-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 06/23/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a public health threat. Because antimicrobial consumption in food-producing animals contributes to the problem, policies restricting the inappropriate or unnecessary agricultural use of antimicrobial drugs are important. However, this link between agricultural antibiotic use and antibiotic resistance has remained contested by some, with potentially disruptive effects on efforts to move towards the judicious or prudent use of these drugs. MAIN TEXT The goal of this review is to systematically evaluate the types of evidence available for each step in the causal pathway from antimicrobial use on farms to human public health risk, and to evaluate the strength of evidence within a 'Grades of Recommendations Assessment, Development and Evaluation'(GRADE) framework. The review clearly demonstrates that there is compelling scientific evidence available to support each step in the causal pathway, from antimicrobial use on farms to a public health burden caused by infections with resistant pathogens. Importantly, the pathogen, antimicrobial drug and treatment regimen, and general setting (e.g., feed type) can have significant impacts on how quickly resistance emerges or spreads, for how long resistance may persist after antimicrobial exposures cease, and what public health impacts may be associated with antimicrobial use on farms. Therefore an exact quantification of the public health burden attributable to antimicrobial drug use in animal agriculture compared to other sources remains challenging. CONCLUSIONS Even though more research is needed to close existing data gaps, obtain a better understanding of how antimicrobial drugs are actually used on farms or feedlots, and quantify the risk associated with antimicrobial use in animal agriculture, these findings reinforce the need to act now and restrict antibiotic use in animal agriculture to those instances necessary to ensure the health and well-being of the animals.
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Affiliation(s)
- Karin Hoelzer
- The Pew Charitable Trusts, 901 E Street NW, Washington, DC 20004 USA
| | - Nora Wong
- The Pew Charitable Trusts, 901 E Street NW, Washington, DC 20004 USA
| | - Joe Thomas
- The Pew Charitable Trusts, 901 E Street NW, Washington, DC 20004 USA
| | - Kathy Talkington
- The Pew Charitable Trusts, 901 E Street NW, Washington, DC 20004 USA
| | - Elizabeth Jungman
- The Pew Charitable Trusts, 901 E Street NW, Washington, DC 20004 USA
| | - Allan Coukell
- The Pew Charitable Trusts, 901 E Street NW, Washington, DC 20004 USA
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Affiliation(s)
- Richard A Stein
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, USA
- Department of Natural Sciences, LaGuardia Community College, City University of New York, New York, NY, USA
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Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses. PLoS One 2017; 12:e0176285. [PMID: 28510584 PMCID: PMC5433765 DOI: 10.1371/journal.pone.0176285] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/07/2017] [Indexed: 02/04/2023] Open
Abstract
Background The rate of community-acquired Clostridium difficile infection (CA-CDI) is increasing. While receipt of antibiotics remains an important risk factor for CDI, studies related to acquisition of C. difficile outside of hospitals are lacking. As a result, risk factors for exposure to C. difficile in community settings have been inadequately studied. Main objective To identify novel environmental risk factors for CA-CDI Methods We performed a population-based retrospective cohort study of patients with CA-CDI from 1/1/2007 through 12/31/2014 in a 10-county area in central North Carolina. 360 Census Tracts in these 10 counties were used as the demographic Geographic Information System (GIS) base-map. Longitude and latitude (X, Y) coordinates were generated from patient home addresses and overlaid to Census Tracts polygons using ArcGIS; ArcView was used to assess “hot-spots” or clusters of CA-CDI. We then constructed a mixed hierarchical model to identify environmental variables independently associated with increased rates of CA-CDI. Results A total of 1,895 unique patients met our criteria for CA-CDI. The mean patient age was 54.5 years; 62% were female and 70% were Caucasian. 402 (21%) patient addresses were located in “hot spots” or clusters of CA-CDI (p<0.001). “Hot spot” census tracts were scattered throughout the 10 counties. After adjusting for clustering and population density, age ≥ 60 years (p = 0.03), race (<0.001), proximity to a livestock farm (0.01), proximity to farming raw materials services (0.02), and proximity to a nursing home (0.04) were independently associated with increased rates of CA-CDI. Conclusions Our study is the first to use spatial statistics and mixed models to identify important environmental risk factors for acquisition of C. difficile and adds to the growing evidence that farm practices may put patients at risk for important drug-resistant infections.
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Koziel JA, Frana TS, Ahn H, Glanville TD, Nguyen LT, van Leeuwen J(H. Efficacy of NH3 as a secondary barrier treatment for inactivation of Salmonella Typhimurium and methicillin-resistant Staphylococcus aureus in digestate of animal carcasses: Proof-of-concept. PLoS One 2017; 12:e0176825. [PMID: 28475586 PMCID: PMC5419515 DOI: 10.1371/journal.pone.0176825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/18/2017] [Indexed: 12/14/2022] Open
Abstract
Managing the disposal of infectious animal carcasses from routine and catastrophic disease outbreaks is a global concern. Recent research suggests that burial in lined and aerated trenches provides the rapid pathogen containment provided by burial, while reducing air and water pollution potential and the length of time that land is taken out of agricultural production. Survival of pathogens in the digestate remains a concern, however. A potential answer is a 'dual'-barrier approach in which ammonia is used as a secondary barrier treatment to reduce the risk of pathogen contamination when trench liners ultimately leak. Results of this study showed that the minimum inhibitory concentration (MIC) of NH3 is 0.1 M (~1,468 NH3-N mg/L), and 0.5 M NH3 (~7,340 NH3-N mg/L) for ST4232 & MRSA43300, respectively at 24 h and pH = 9±0.1 and inactivation was increased by increasing NH3 concentration and/or treatment time. Results for digestate treated with NH3 were consistent with the MICs, and both pathogens were completely inactivated within 24 h.
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Affiliation(s)
- Jacek A. Koziel
- Dept. of Agricultural and Biosystems Engineering, Iowa State University, Ames, Iowa, United States of America
- Dept. of Civil, Construction and Environmental Engineering, Iowa State University, Ames, Iowa, United States of America
- Dept. of Food Science and Human Nutrition, Iowa State University, Iowa State University, Ames, Iowa, United States of America
| | - Timothy S. Frana
- Dept. of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, Iowa, United States of America
| | - Heekwon Ahn
- Dept. of Animal Biosystems Science, Chungnam National University, Daejeon, Republic of Korea
| | - Thomas D. Glanville
- Dept. of Agricultural and Biosystems Engineering, Iowa State University, Ames, Iowa, United States of America
| | - Lam T. Nguyen
- Dept. of Agricultural and Biosystems Engineering, Iowa State University, Ames, Iowa, United States of America
| | - J. (Hans) van Leeuwen
- Dept. of Agricultural and Biosystems Engineering, Iowa State University, Ames, Iowa, United States of America
- Dept. of Civil, Construction and Environmental Engineering, Iowa State University, Ames, Iowa, United States of America
- Dept. of Food Science and Human Nutrition, Iowa State University, Iowa State University, Ames, Iowa, United States of America
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Rasmussen SG, Casey JA, Bandeen-Roche K, Schwartz BS. Proximity to Industrial Food Animal Production and Asthma Exacerbations in Pennsylvania, 2005-2012. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E362. [PMID: 28362334 PMCID: PMC5409563 DOI: 10.3390/ijerph14040362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
Abstract
The research on industrial food animal production (IFAP) and asthma exacerbations in the United States has relied on small sample sizes and/or self-reported outcomes. We assessed associations of proximity to large-scale and densely stocked swine and dairy/veal IFAP with three types of asthma exacerbations: hospitalizations, emergency encounters, and oral corticosteroid (OCS) medication orders from Geisinger Clinic in Pennsylvania. We used a diagnosis code (International Classification of Diseases, 9th Revision, Clinical Modification code 493.x) and medication orders from electronic health records to identify these exacerbations among asthma patients (n = 35,269) from 2005-2012. We compared residential proximity to swine or dairy/veal IFAP (dichotomized as <3 miles (4.8 km) or ≥3 miles) among asthma patients with and without exacerbations and estimated odds ratios using multilevel logistic regression. In adjusted models, proximity to IFAP was associated (odds ratio (95% confidence interval)) with OCS orders (1.11 (1.04-1.19)) and hospitalizations (1.29 (1.15-1.46)), but not emergency encounters (1.12 (0.91-1.37)). This study contributes to growing evidence that IFAP may impact health, in this case clinically-documented asthma exacerbations. No prior study has evaluated the association of IFAP and clinically-documented asthma exacerbations in the United States.
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Affiliation(s)
- Sara G Rasmussen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Joan A Casey
- Department of Environmental Science, Policy & Management, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA 17822, USA.
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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See I, Wesson P, Gualandi N, Dumyati G, Harrison LH, Lesher L, Nadle J, Petit S, Reisenauer C, Schaffner W, Tunali A, Mu Y, Ahern J. Socioeconomic Factors Explain Racial Disparities in Invasive Community-Associated Methicillin-Resistant Staphylococcus aureus Disease Rates. Clin Infect Dis 2017; 64:597-604. [PMID: 28362911 PMCID: PMC5656382 DOI: 10.1093/cid/ciw808] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/27/2016] [Indexed: 01/30/2023] Open
Abstract
Background Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) incidence in the United States is higher among black persons than white persons. We explored the extent to which socioeconomic factors might explain this racial disparity. Methods A retrospective cohort was based on the Centers for Disease Control and Prevention's Emerging Infections Program surveillance data for invasive community-associated MRSA cases (isolated from a normally sterile site of an outpatient or on hospital admission day ≤3 in a patient without specified major healthcare exposures) from 2009 to 2011 in 33 counties of 9 states. We used generalized estimating equations to determine census tract-level factors associated with differences in MRSA incidence and inverse odds ratio-weighted mediation analysis to determine the proportion of racial disparity mediated by socioeconomic factors. Results Annual invasive community-associated MRSA incidence was 4.59 per 100000 among whites and 7.60 per 100000 among blacks (rate ratio [RR], 1.66; 95% confidence interval [CI], 1.52-1.80). In the mediation analysis, after accounting for census tract-level measures of federally designated medically underserved areas, education, income, housing value, and rural status, 91% of the original racial disparity was explained; no significant association of black race with community-associated MRSA remained (RR, 1.05; 95% CI, .92-1.20). Conclusions The racial disparity in invasive community-associated MRSA rates was largely explained by socioeconomic factors. The specific factors that underlie the association between census tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (eg, poverty, crowding) and biological factors (not explored in this analysis), should be elucidated to define strategies for reducing racial disparities in community-associated MRSA rates.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Wesson
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, USA
| | | | | | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta, USA
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
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Tustin AW, Hirsch AG, Rasmussen SG, Casey JA, Bandeen-Roche K, Schwartz BS. Associations between Unconventional Natural Gas Development and Nasal and Sinus, Migraine Headache, and Fatigue Symptoms in Pennsylvania. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:189-197. [PMID: 27561132 PMCID: PMC5289909 DOI: 10.1289/ehp281] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Unconventional natural gas development (UNGD) produces environmental contaminants and psychosocial stressors. Despite these concerns, few studies have evaluated the health effects of UNGD. OBJECTIVES We investigated associations between UNGD activity and symptoms in a cross-sectional study in Pennsylvania. METHODS We mailed a self-administered questionnaire to 23,700 adult patients of the Geisinger Clinic. Using standardized and validated questionnaire items, we identified respondents with chronic rhinosinusitis (CRS), migraine headache, and fatigue symptoms. We created a summary UNGD activity metric that incorporated well phase, location, total depth, daily gas production and inverse distance-squared to patient residences. We used logistic regression, weighted for sampling and response rates, to assess associations between quartiles of UNGD activity and outcomes, both alone and in combination. RESULTS The response rate was 33%. Of 7,785 study participants, 1,850 (24%) had current CRS symptoms, 1,765 (23%) had migraine headache, and 1,930 (25%) had higher levels of fatigue. Among individuals who met criteria for two or more outcomes, adjusted odds ratios for the highest quartile of UNGD activity compared with the lowest were [OR (95% CI)] 1.49 (0.78, 2.85) for CRS plus migraine, 1.88 (1.08, 3.25) for CRS plus fatigue, 1.95 (1.18, 3.21) for migraine plus fatigue, and 1.84 (1.08, 3.14) for all three outcomes together. Significant associations were also present in some models of single outcomes. CONCLUSIONS This study provides evidence that UNGD is associated with nasal and sinus, migraine headache, and fatigue symptoms in a general population representative sample. Citation: Tustin AW, Hirsch AG, Rasmussen SG, Casey JA, Bandeen-Roche K, Schwartz BS. 2017. Associations between unconventional natural gas development and nasal and sinus, migraine headache, and fatigue symptoms in Pennsylvania. Environ Health Perspect 125:189-197; http://dx.doi.org/10.1289/EHP281.
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Affiliation(s)
- Aaron W. Tustin
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Annemarie G. Hirsch
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
| | - Sara G. Rasmussen
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joan A. Casey
- Robert Wood Johnson Health and Society Scholars Program, University of California, San Francisco, San Francisco and University of California, Berkeley, Berkeley, California, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian S. Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Hirsch AG, Stewart WF, Sundaresan AS, Young AJ, Kennedy TL, Scott Greene J, Feng W, Tan BK, Schleimer RP, Kern RC, Lidder A, Schwartz BS. Nasal and sinus symptoms and chronic rhinosinusitis in a population-based sample. Allergy 2017; 72:274-281. [PMID: 27590749 DOI: 10.1111/all.13042] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to describe the first US-based study to use the European Position Paper on Rhinosinusitis (EPOS) criteria to study the prevalence of chronic rhinosinusitis (CRS) in a general-population sample. METHODS A CRS symptom questionnaire was mailed to 23 700 primary care patients from Geisinger Clinic, a health system serving 45 counties in Pennsylvania. CRS cases were categorized into four unique subgroups based on EPOS symptoms: obstruction and discharge with no smell loss or pain/pressure; smell loss without pain/pressure; facial pain and/or pressure without smell loss; and both smell loss and pain/pressure. All cases were required to have nasal obstruction or discharge. Logistic regression was used to evaluate potential factors associated with CRS subgroups. RESULTS We found that 11.9% of patients met criteria for CRS. Prevalence peaked at 15.9% between ages 50 and 59 years and then dropped to 6.8% after age 69. The odds of CRS was higher among patients who were white, younger, smokers, had a history of Medical Assistance, and had other diseases. When CRS subgroups were modeled separately, these associations were no longer significant for some CRS subgroups. Comorbid diseases were most strongly associated with CRS cases who reported smell loss and facial pain and/or pressure and had the weakest associations with CRS cases who did not report these symptoms. CONCLUSIONS CRS is a highly prevalent and heterogeneous condition. Differences in risk factors and health outcomes across symptom subgroups may be indicative of differences in etiology that have implications for disease management.
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Affiliation(s)
- A. G. Hirsch
- Department of Epidemiology and Health Services Research; Geisinger Health System; Danville PA USA
| | - W. F. Stewart
- Research Development and Dissemination; Sutter Health; San Francisco CA USA
| | - A. S. Sundaresan
- Department of Epidemiology and Health Services Research; Geisinger Health System; Danville PA USA
| | - A. J. Young
- Department of Biomedical and Translational Informatics; Geisinger Health System; Danville PA USA
| | - T. L. Kennedy
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery; Geisinger Health System; Danville PA USA
| | - J. Scott Greene
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery; Geisinger Health System; Danville PA USA
| | - W. Feng
- Department of Biomedical and Translational Informatics; Geisinger Health System; Danville PA USA
| | - B. K. Tan
- Department of Otolaryngology Head and Neck Surgery Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. P. Schleimer
- Department of Otolaryngology Head and Neck Surgery Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. C. Kern
- Department of Otolaryngology Head and Neck Surgery Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - A. Lidder
- University of Rochester School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY USA
| | - B. S. Schwartz
- Department of Epidemiology and Health Services Research; Geisinger Health System; Danville PA USA
- Department of Environmental Health Sciences; Johns Hopkins University Bloomberg School of Public Health; Baltimore MA USA
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Schwartz BS, Glass TA, Pollak J, Hirsch AG, Bailey-Davis L, Moran T, Bandeen-Roche K. Depression, its comorbidities and treatment, and childhood body mass index trajectories. Obesity (Silver Spring) 2016; 24:2585-2592. [PMID: 27804225 PMCID: PMC5125866 DOI: 10.1002/oby.21627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population-representative sample. METHODS Electronic health record data from 105,163 children ages 8 to 18 years with 314,648 BMI values were used. Depression diagnoses were evaluated as ever versus never, cumulative number of encounters with diagnoses, and total duration of diagnoses. Antidepressants were evaluated as months of use. Associations were evaluated with diagnoses alone, antidepressants alone, and then together, adjusting for covariates. RESULTS A total of 6,172 (5.9%) and 10,628 (10.1%) children had a diagnosis of depression or received antidepressant treatment, respectively. At all ages, children receiving Medical Assistance (30.9%) were more likely to be treated with antidepressants. Depression diagnosis and antidepressant use were each independently and positively associated with BMI trajectories; associations were stronger with longer durations of diagnosis and treatment. Among children who received 12 or more months of antidepressants (vs. none), the mean (95% CI) weight gain at 18 years associated with antidepressant use (all classes) was 2.10 (1.76-2.45) kg. CONCLUSIONS Depression and antidepressant use were both independently associated with increasing BMIs over time, suggesting an important unintended consequence of healthcare to the obesity epidemic.
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Affiliation(s)
- Brian S. Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Center for Health Research, Geisinger Health System, Danville, PA
| | - Thomas A. Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jonathan Pollak
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Timothy Moran
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Jackson KL, Mbagwu M, Pacheco JA, Baldridge AS, Viox DJ, Linneman JG, Shukla SK, Peissig PL, Borthwick KM, Carrell DA, Bielinski SJ, Kirby JC, Denny JC, Mentch FD, Vazquez LM, Rasmussen-Torvik LJ, Kho AN. Performance of an electronic health record-based phenotype algorithm to identify community associated methicillin-resistant Staphylococcus aureus cases and controls for genetic association studies. BMC Infect Dis 2016; 16:684. [PMID: 27855652 PMCID: PMC5114817 DOI: 10.1186/s12879-016-2020-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/11/2016] [Indexed: 12/25/2022] Open
Abstract
Background Community associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is one of the most common causes of skin and soft tissue infections in the United States, and a variety of genetic host factors are suspected to be risk factors for recurrent infection. Based on the CDC definition, we have developed and validated an electronic health record (EHR) based CA-MRSA phenotype algorithm utilizing both structured and unstructured data. Methods The algorithm was validated at three eMERGE consortium sites, and positive predictive value, negative predictive value and sensitivity, were calculated. The algorithm was then run and data collected across seven total sites. The resulting data was used in GWAS analysis. Results Across seven sites, the CA-MRSA phenotype algorithm identified a total of 349 cases and 7761 controls among the genotyped European and African American biobank populations. PPV ranged from 68 to 100% for cases and 96 to 100% for controls; sensitivity ranged from 94 to 100% for cases and 75 to 100% for controls. Frequency of cases in the populations varied widely by site. There were no plausible GWAS-significant (p < 5 E −8) findings. Conclusions Differences in EHR data representation and screening patterns across sites may have affected identification of cases and controls and accounted for varying frequencies across sites. Future work identifying these patterns is necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2020-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathryn L Jackson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Michael Mbagwu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Daniel J Viox
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - James G Linneman
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | | | - Peggy L Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | | | - David A Carrell
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | | | - Jacqueline C Kirby
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Frank D Mentch
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lyam M Vazquez
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Abel N Kho
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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75
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Iweriebor BC, Obi LC, Okoh AI. Macrolide, glycopeptide resistance and virulence genes in Enterococcus species isolates from dairy cattle. J Med Microbiol 2016; 65:641-648. [DOI: 10.1099/jmm.0.000275] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Benson C. Iweriebor
- SA-MRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa
- Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
| | - Larry C. Obi
- Academic and Research Division, University of Fort Hare, Alice, Eastern Cape, South Africa
| | - Anthony I. Okoh
- SA-MRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa
- Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
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76
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Prospective multicenter surveillance identifies Staphylococcus aureus infections caused by livestock-associated strains in an agricultural state. Diagn Microbiol Infect Dis 2016; 85:360-366. [PMID: 27198741 DOI: 10.1016/j.diagmicrobio.2016.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/11/2016] [Accepted: 04/21/2016] [Indexed: 12/15/2022]
Abstract
We conducted a surveillance study to investigate the epidemiology of Staphylococcus aureus infections in Iowa, using a convenience sample. Diagnostic laboratories submitted 20 S. aureus isolates per month for a 20-month period between 2011 and 2013. Of the 2226 isolates analyzed, 73.6% were methicillin-resistant S. aureus (MRSA) and 26.4% were methicillin-susceptible S. aureus (MSSA). S. aureus infections in 25 patients (1%) were caused by ST398- and ST9-associated strain types, and appeared to be a common occurrence in areas of the state with the highest numbers of hogs and hog farms. Twenty nine (5.1%) of MSSA isolates and 10 (40.0%) livestock-associated strains were multi-drug resistant.
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77
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Larsen J, Petersen A, Sørum M, Stegger M, van Alphen L, Valentiner-Branth P, Knudsen LK, Larsen LS, Feingold B, Price LB, Andersen PS, Larsen AR, Skov RL. Meticillin-resistant Staphylococcus aureus CC398 is an increasing cause of disease in people with no livestock contact in Denmark, 1999 to 2011. ACTA ACUST UNITED AC 2016; 20:30021. [PMID: 26535590 DOI: 10.2807/1560-7917.es.2015.20.37.30021] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/12/2015] [Indexed: 02/05/2023]
Abstract
Livestock constitutes a potential reservoir of meticillin-resistant Staphylococcus aureus isolates belonging to a recently derived lineage within clonal complex 398 (MRSA CC398-IIa). Since its discovery in the early 2000s, this lineage has become a major cause of human disease in Europe, posing a serious public health challenge in countries with intensive livestock production. To retrace the history of human colonisation and infection with MRSA CC398-IIa in Denmark, we conducted a nationwide, retrospective study of MRSA isolates collected from 1999 to 2011. Among 7,429 MRSA isolates screened, we identified 416 MRSA CC398-IIa isolates. Of these, 148 were from people with infections, including 51 from patients reporting no livestock exposure. The first cases of MRSA CC398-IIa infection in Denmark occurred in 2004. Subsequently, the incidence of MRSA CC398-IIa infection showed a linear annual increase of 66% from 2004 to 2011 (from 0.09 to 1.1 per 100,000 person-years). There were clear temporal and spatial relationships between MRSA CC398-IIa-infected patients with and without livestock exposure. These findings suggest substantial dissemination of MRSA CC398-IIa from livestock or livestock workers into the Danish community and underscore the need for strategies to control its spread both on and off the farm.
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Affiliation(s)
- Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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78
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Aitken SL, Dilworth TJ, Heil EL, Nailor MD. Agricultural Applications for Antimicrobials. A Danger to Human Health: An Official Position Statement of the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2016; 36:422-32. [PMID: 26954889 DOI: 10.1002/phar.1737] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The use of antibiotics in agriculture, particularly in food-producing animals, is pervasive and represents the overwhelming majority of antibiotic use worldwide. The link between antibiotic use in animals and antibiotic resistance in humans is unequivocal. Transmission can occur by ingesting undercooked meats harboring resistant bacteria, by direct contact of animals by animal handlers, and by various other means. Antibiotics used in aquaculture and antifungals used in horticulture are also an evolving threat to human health. Regulations aimed at decreasing the amount of antibiotics used in food production to limit the development of antibiotic resistance have recently been implemented. However, further action is needed to minimize antibiotic use in agriculture. This article describes the extent of this current problem and serves as the official position of the Society of Infectious Diseases Pharmacists on this urgent threat to human health.
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Affiliation(s)
- Samuel L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas J Dilworth
- Department of Pharmacy, Wheaton Franciscan Healthcare - St. Francis, Milwaukee, Wisconsin
| | - Emily L Heil
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
| | - Michael D Nailor
- Department of Pharmacy Services, Hartford Hospital, Hartford, Connecticut.,Department of Pharmacy Practice, University of Connecticut, Storrs, Connecticut
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79
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Greenness and Birth Outcomes in a Range of Pennsylvania Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030311. [PMID: 26978381 PMCID: PMC4808974 DOI: 10.3390/ijerph13030311] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Living in communities with more vegetation during pregnancy has been associated with higher birth weights, but fewer studies have evaluated other birth outcomes, and only one has been conducted in the Eastern United States, in regions with a broad range, including high levels, of greenness. We evaluated associations between prenatal residential greenness and birth outcomes (term birth weight, small for gestational age, preterm birth, and low 5 min Apgar score) across a range of community types using electronic health record data from 2006–2013 from the Geisinger Health System in Pennsylvania. We assigned greenness based on mother’s geocoded address using the normalized difference vegetation index from satellite imagery. We used propensity scores to restrict the study population to comparable groups among those living in green vs. less-green areas. Analyses were adjusted for demographic, clinical, and environmental covariates, and stratified by community type (city, borough, and township). In cities, higher greenness (tertiles 2–3 vs. 1) was protective for both preterm (OR = 0.78, 95% CI: 0.61–0.99) and small for gestational age birth (OR = 0.73, 95% CI: 0.58–0.97), but not birth weight or Apgar score. We did not observe associations between greenness and birth outcomes in adjusted models in boroughs or townships. These results add to the evidence that greener cities might be healthier cities.
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80
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Biswas S, Pandey PK, Farver TB. Assessing the impacts of temperature and storage on Escherichia coli, Salmonella, and L. monocytogenes decay in dairy manure. Bioprocess Biosyst Eng 2016; 39:901-13. [PMID: 26922419 DOI: 10.1007/s00449-016-1569-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
Elevated levels of animal waste-borne pathogen in ambient water is a serious human health issue. Mitigating influx of pathogens from animal waste such as dairy manure to soil and water requires improving our existing knowledge of pathogen reductions in dairy manure treatment methods. This study was conducted to enhance the understanding of human pathogen decay in liquid dairy manure in anaerobic (AN) and limited aerobic (LA) storage conditions. The decay of three pathogens (Escherichia coli, Salmonella spp., and Listeria monocytogenes) was assessed in bench-scale batch reactors fed with liquid slurry. A series of temperatures (30, 35, 42, and 50 °C) conditions were tested to determine the impacts of temperature on Escherichia coli, Salmonella, and L. monocytogenes decay in AN and LA conditions. Results showed prolonged survival of E. coli compared to Salmonella and L. monocytogenes in both LA and AN environments. Variations in survival among pathogens with temperature and environmental conditions (i.e., LA and AN) indicated the necessity of developing improved dairy manure waste treatment methods for controlling animal waste-borne pathogens. The results of this study will help in improving the current understanding of human pathogen decay in dairy manure for making informed decisions of animal manure treatment by stakeholders.
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Affiliation(s)
- Sagor Biswas
- Department of Population Health and Reproduction, School of Veterinary Medicine Extension, University of California-Davis, Davis, 95616, California, USA
| | - Pramod K Pandey
- Department of Population Health and Reproduction, School of Veterinary Medicine Extension, University of California-Davis, Davis, 95616, California, USA. .,University of California Division of Agriculture and Natural Resources, UC Cooperative Extension, Davis, 95616, California, USA.
| | - Thomas B Farver
- Department of Population Health and Reproduction, School of Veterinary Medicine Extension, University of California-Davis, Davis, 95616, California, USA
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81
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Abstract
Staphylococcus aureus isolates belonging to clonal cluster 398 (CC398) have emerged over the previous decade as a risk to livestock workers. Though most of the research to date has focused on colonization with these strains, a number of infections have also been documented, ranging from mild skin infections to more serious invasive infections and even death. Here, we review existing reports of human infections with CC398 and discuss their geographic distribution, general characteristics, and implications for future research. We identified 74 publications describing CC398 infections in humans in 19 different countries, suggesting this is an emerging worldwide issue.
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Affiliation(s)
- Tara C Smith
- Kent State University College of Public Health, 750 Hilltop Drive, Lowry Hall, Kent, OH, USA,
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82
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Casey JA, Kim BF, Larsen J, Price LB, Nachman KE. Industrial Food Animal Production and Community Health. Curr Environ Health Rep 2016; 2:259-71. [PMID: 26231503 DOI: 10.1007/s40572-015-0061-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Industrial food animal production (IFAP) is a source of environmental microbial and chemical hazards. A growing body of literature suggests that populations living near these operations and manure-applied crop fields are at elevated risk for several health outcomes. We reviewed the literature published since 2000 and identified four health outcomes consistently and positively associated with living near IFAP: respiratory outcomes, methicillin-resistant Staphylococcus aureus (MRSA), Q fever, and stress/mood. We found moderate evidence of an association of IFAP with quality of life and limited evidence of an association with cognitive impairment, Clostridium difficile, Enterococcus, birth outcomes, and hypertension. Distance-based exposure metrics were used by 17/33 studies reviewed. Future work should investigate exposure through drinking water and must improve exposure assessment with direct environmental sampling, modeling, and high-resolution DNA typing methods. Investigators should not limit study to high-profile pathogens like MRSA but include a broader range of pathogens, as well as other disease outcomes.
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Affiliation(s)
- Joan A Casey
- Robert Wood Johnson Foundation Health and Society Scholars Program, UC San Francisco and UC Berkeley, 50 University Hall, Room 583, Berkeley, CA, 94720-7360, USA,
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83
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Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, Guerin PJ, Piddock LJV. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2016; 387:176-87. [PMID: 26603922 DOI: 10.1016/s0140-6736(15)00473-0] [Citation(s) in RCA: 1326] [Impact Index Per Article: 165.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
To combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials.
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Affiliation(s)
- Alison H Holmes
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, and Department of Infectious Diseases, Imperial College London, London, UK.
| | - Luke S P Moore
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, and Department of Infectious Diseases, Imperial College London, London, UK
| | - Arnfinn Sundsfjord
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Clinical Microbiology and Infection Control, University Hospital of North Norway, Norway; Department of Medical Biology, University of Tromsø, Tromsø, Norway
| | - Martin Steinbakk
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Sadie Regmi
- Institute for Science, Ethics and Innovation (iSEI), University of Manchester, Manchester, UK
| | - Abhilasha Karkey
- Oxford Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Philippe J Guerin
- Worldwide Antimalarial Resistance Network (WWARN), and Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Laura J V Piddock
- Antimicrobials Research Group, Institute for Microbiology and Infection, University of Birmingham, Birmingham, UK
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84
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Casey JA, Schwartz BS, Stewart WF, Adler NE. Using Electronic Health Records for Population Health Research: A Review of Methods and Applications. Annu Rev Public Health 2015; 37:61-81. [PMID: 26667605 DOI: 10.1146/annurev-publhealth-032315-021353] [Citation(s) in RCA: 326] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The use and functionality of electronic health records (EHRs) have increased rapidly in the past decade. Although the primary purpose of EHRs is clinical, researchers have used them to conduct epidemiologic investigations, ranging from cross-sectional studies within a given hospital to longitudinal studies on geographically distributed patients. Herein, we describe EHRs, examine their use in population health research, and compare them with traditional epidemiologic methods. We describe diverse research applications that benefit from the large sample sizes and generalizable patient populations afforded by EHRs. These have included reevaluation of prior findings, a range of diseases and subgroups, environmental and social epidemiology, stigmatized conditions, predictive modeling, and evaluation of natural experiments. Although studies using primary data collection methods may have more reliable data and better population retention, EHR-based studies are less expensive and require less time to complete. Future EHR epidemiology with enhanced collection of social/behavior measures, linkage with vital records, and integration of emerging technologies such as personal sensing could improve clinical care and population health.
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Affiliation(s)
- Joan A Casey
- Robert Wood Johnson Foundation Health and Society Scholars Program at the University of California, San Francisco, and the University of California, Berkeley, Berkeley, California 94720-7360;
| | - Brian S Schwartz
- Departments of Environmental Health Sciences and Epidemiology, Bloomberg School of Public Health, and the Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205; .,Center for Health Research, Geisinger Health System, Danville, Pennsylvania 17822
| | - Walter F Stewart
- Research, Development and Dissemination, Sutter Health, Walnut Creek, California 94596;
| | - Nancy E Adler
- Center for Health and Community and the Department of Psychiatry, University of California, San Francisco, California 94118;
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85
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Paulson JA, Zaoutis TE. Nontherapeutic Use of Antimicrobial Agents in Animal Agriculture: Implications for Pediatrics. Pediatrics 2015; 136:e1670-7. [PMID: 26574594 DOI: 10.1542/peds.2015-3630] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Antimicrobial resistance is one of the most serious threats to public health globally and threatens our ability to treat infectious diseases. Antimicrobial-resistant infections are associated with increased morbidity, mortality, and health care costs. Infants and children are affected by transmission of susceptible and resistant food zoonotic pathogens through the food supply, direct contact with animals, and environmental pathways. The overuse and misuse of antimicrobial agents in veterinary and human medicine is, in large part, responsible for the emergence of antibiotic resistance. Approximately 80% of the overall tonnage of antimicrobial agents sold in the United States in 2012 was for animal use, and approximately 60% of those agents are considered important for human medicine. Most of the use involves the addition of low doses of antimicrobial agents to the feed of healthy animals over prolonged periods to promote growth and increase feed efficiency or at a range of doses to prevent disease. These nontherapeutic uses contribute to resistance and create new health dangers for humans. This report describes how antimicrobial agents are used in animal agriculture, reviews the mechanisms of how such use contributes to development of resistance, and discusses US and global initiatives to curb the use of antimicrobial agents in agriculture.
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86
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Cuny C, Wieler LH, Witte W. Livestock-Associated MRSA: The Impact on Humans. Antibiotics (Basel) 2015; 4:521-43. [PMID: 27025639 PMCID: PMC4790311 DOI: 10.3390/antibiotics4040521] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
During the past 25 years an increase in the prevalence of methicillin-resistant Staphylococcus aureus (HA-MRSA) was recorded worldwide. Additionally, MRSA infections may occur outside and independent of hospitals, caused by community associated MRSA (CA-MRSA). In Germany, we found that at least 10% of these sporadic infections are due to livestock-associated MRSA (LA-MRSA), which is initially associated with livestock. The majority of these MRSA cases are attributed to clonal complex CC398. LA-MRSA CC398 colonizes the animals asymptomatically in about half of conventional pig farms. For about 77%-86% of humans with occupational exposure to pigs, nasal carriage has been reported; it can be lost when exposure is interrupted. Among family members living at the same farms, only 4%-5% are colonized. Spread beyond this group of people is less frequent. The prevalence of LA-MRSA in livestock seems to be influenced by farm size, farming systems, usage of disinfectants, and in-feed zinc. LA-MRSA CC398 is able to cause the same kind of infections in humans as S. aureus and MRSA in general. It can be introduced to hospitals and cause nosocomial infections such as postoperative surgical site infections, ventilator associated pneumonia, septicemia, and infections after joint replacement. For this reason, screening for MRSA colonization at hospital admittance is recommended for farmers and veterinarians with livestock contacts. Intrahospital dissemination, typical for HA-MRSA in the absence of sufficient hygiene, has only rarely been observed for LA-MRSA to date. The proportion of LA-MRSA among all MRSA from nosocomial infections is about 3% across Germany. In geographical areas with a comparatively high density of conventional farms, LA-MRSA accounts for up to 10% of MRSA from septicemia and 15% of MRSA from wound infections. As known from comparative genome analysis, LA-MRSA has evolved from human-adapted methicillin-susceptible S. aureus, and the jump to livestock was obviously associated with several genetic changes. Reversion of the genetic changes and readaptation to humans bears a potential health risk and requires tight surveillance. Although most LA-MRSA (>80%) is resistant to several antibiotics, there are still sufficient treatment options.
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Affiliation(s)
- Christiane Cuny
- Robert Koch Institute,Wernigerode Branch, 38855 Wernigerode, Germany.
| | - Lothar H Wieler
- Robert Koch Institute, Main Institute, 13353 Berlin, Germany.
| | - Wolfgang Witte
- Robert Koch Institute,Wernigerode Branch, 38855 Wernigerode, Germany.
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87
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Abstract
Factory farming continues to grow around the world as a low-cost way of producing animal products for human consumption. However, many of the practices associated with intensive animal farming have been criticized by public health professionals and animal welfare advocates. The aim of this essay is to raise three independent moral concerns with factory farming, and to explain why the practices associated with factory farming flourish despite the cruelty inflicted on animals and the public health risks imposed on people. I conclude that the costs of factory farming as it is currently practiced far outweigh the benefits, and offer a few suggestions for how to improve the situation for animals and people.
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88
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Schwartz BS, Pollak J, Bailey-Davis L, Hirsch AG, Cosgrove SE, Nau C, Kress AM, Glass TA, Bandeen-Roche K. Antibiotic use and childhood body mass index trajectory. Int J Obes (Lond) 2015; 40:615-21. [PMID: 26486756 PMCID: PMC4821740 DOI: 10.1038/ijo.2015.218] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 09/10/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Antibiotics are commonly prescribed for children. Use of antibiotics early in life has been linked to weight gain but there are no large-scale, population-based, longitudinal studies of the full age range among mainly healthy children. SUBJECTS/METHODS We used electronic health record data on 163 820 children aged 3-18 years and mixed effects linear regression to model associations of antibiotic orders with growth curve trajectories of annual body mass index (BMI) controlling for confounders. Models evaluated three kinds of antibiotic associations-reversible (time-varying indicator for an order in year before each BMI), persistent (time-varying cumulative orders up to BMIj) and progressive (cumulative orders up to prior BMI (BMIj-1))-and whether these varied by age. RESULTS Among 142 824 children under care in the prior year, a reversible association was observed and this short-term BMI gain was modified by age (P<0.001); effect size peaked in mid-teen years. A persistent association was observed and this association was stronger with increasing age (P<0.001). The addition of the progressive association among children with at least three BMIs (n=79 752) revealed that higher cumulative orders were associated with progressive weight gain; this did not vary by age. Among children with an antibiotic order in the prior year and at least seven lifetime orders, antibiotics (all classes combined) were associated with an average weight gain of approximately 1.4 kg at age 15 years. When antibiotic classes were evaluated separately, the largest weight gain at 15 years was associated with macrolide use. CONCLUSIONS We found evidence of reversible, persistent and progressive effects of antibiotic use on BMI trajectories, with different effects by age, among mainly healthy children. The results suggest that antibiotic use may influence weight gain throughout childhood and not just during the earliest years as has been the primary focus of most prior studies.
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Affiliation(s)
- B S Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Center for Health Research, Geisinger Health System, Danville, PA, USA
| | - J Pollak
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Bailey-Davis
- Center for Health Research, Geisinger Health System, Danville, PA, USA
| | - A G Hirsch
- Center for Health Research, Geisinger Health System, Danville, PA, USA
| | - S E Cosgrove
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C Nau
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A M Kress
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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89
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Eko KE, Forshey BM, Carrel M, Schweizer ML, Perencevich EN, Smith TC. Molecular characterization of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization and infection isolates in a Veterans Affairs hospital. Antimicrob Resist Infect Control 2015; 4:10. [PMID: 25838886 PMCID: PMC4383227 DOI: 10.1186/s13756-015-0048-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/13/2015] [Indexed: 12/11/2022] Open
Abstract
Background Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is associated with increased infection risk, yet colonization and infection isolates are rarely compared within the same study. The objectives of this study were to compare colonization and infection isolates from a Veterans Administration hospital in Iowa, and to determine the prevalence of livestock-associated MRSA (LA-MRSA) colonization and infection in a state with high livestock density. Methods All patients with available MRSA isolates collected through routine nasal screening (73%; n = 397) and from infections (27%; n = 148) between December 2010 and August 2012 were included and tested for spa type and presence of PVL and mecA genes. Clinical isolates were tested for antibiotic resistance patterns. Paired colonization and infection isolates were compared for genetic and phenotypic congruity. Results The most common spa types were t002 (and other CC5-associated strains; 65%) and t008 (and other CC8-associated strains; 20%). No classic LA-MRSA spa types were identified. CC5-associated strains were less likely to be associated with infections (22%; 77/353) compared with CC8-associated strains (49%; 53/109). MRSA colonization was more common among patients with infections (71%) compared with the general screening population (7%). In most cases (82%; 28/34), paired colonization and infection isolates were genetically and phenotypically indistinguishable. Conclusions Our data demonstrate a direct link between antecedent nasal colonization and subsequent MRSA infection. Further, our data indicate variability in colonization and infection efficiency among MRSA genotypes, which points to the need to define the molecular determinants underlying emergence of S. aureus strains in the community and nosocomial setting.
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Affiliation(s)
- Kalyani E Eko
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52246 USA
| | - Brett M Forshey
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52246 USA
| | - Margaret Carrel
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52246 USA ; Department of Geographical & Sustainability Sciences, University of Iowa, Iowa City, IA 52242 USA
| | - Marin L Schweizer
- Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA 52246 USA ; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52246 USA
| | - Eli N Perencevich
- Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA 52246 USA ; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52246 USA
| | - Tara C Smith
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52246 USA ; Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, Kent, OH 44242 USA
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90
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Shannon KL, Kim BF, McKenzie SE, Lawrence RS. Food System Policy, Public Health, and Human Rights in the United States. Annu Rev Public Health 2015; 36:151-73. [DOI: 10.1146/annurev-publhealth-031914-122621] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The US food system functions within a complex nexus of social, political, economic, cultural, and ecological factors. Among them are many dynamic pressures such as population growth, urbanization, socioeconomic inequities, climate disruption, and the increasing demand for resource-intensive foods that place immense strains on public health and the environment. This review focuses on the role that policy plays in defining the food system, particularly with regard to agriculture. It further examines the challenges of making the food supply safe, nutritious, and sustainable, while respecting the rights of all people to have access to adequate food and to attain the highest standard of health. We conclude that the present US food system is largely unhealthy, inequitable, environmentally damaging, and insufficiently resilient to endure the impacts of climate change, resource depletion, and population increases, and is therefore unsustainable. Thus, it is imperative that the US embraces policy reforms to transform the food system into one that supports public health and reflects the principles of human rights and agroecology for the benefit of current and future generations.
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Affiliation(s)
- Kerry L. Shannon
- Johns Hopkins Center for a Livable Future,
- Department of International Health,
- Johns Hopkins School of Medicine, Baltimore, Maryland 21205;, , ,
| | - Brent F. Kim
- Johns Hopkins Center for a Livable Future,
- Department of Environmental Health Sciences, and
| | - Shawn E. McKenzie
- Johns Hopkins Center for a Livable Future,
- Department of Environmental Health Sciences, and
| | - Robert S. Lawrence
- Johns Hopkins Center for a Livable Future,
- Department of International Health,
- Department of Environmental Health Sciences, and
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
- Johns Hopkins School of Medicine, Baltimore, Maryland 21205;, , ,
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91
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92
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Chui L, Li V. Technical and Software Advances in Bacterial Pathogen Typing. METHODS IN MICROBIOLOGY 2015. [DOI: 10.1016/bs.mim.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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93
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Barriere SL. Clinical, economic and societal impact of antibiotic resistance. Expert Opin Pharmacother 2014; 16:151-3. [DOI: 10.1517/14656566.2015.983077] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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94
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Capodagli GC, Lee SA, Boehm KJ, Brady KM, Pegan SD. Structural and functional characterization of methicillin-resistant Staphylococcus aureus's class IIb fructose 1,6-bisphosphate aldolase. Biochemistry 2014; 53:7604-14. [PMID: 25390935 PMCID: PMC4263427 DOI: 10.1021/bi501141t] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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Staphylococcus aureus is one of the most common
nosocomial sources of soft-tissue and skin infections and has more
recently become prevalent in the community setting as well. Since
the use of penicillins to combat S. aureus infections
in the 1940s, the bacterium has been notorious for developing resistances
to antibiotics, such as methicillin-resistant Staphylococcus
aureus (MRSA). With the persistence of MRSA as well as many
other drug resistant bacteria and parasites, there is a growing need
to focus on new pharmacological targets. Recently, class II fructose
1,6-bisphosphate aldolases (FBAs) have garnered attention to fill
this role. Regrettably, scarce biochemical data and no structural
data are currently available for the class II FBA found in MRSA (SaFBA).
With the recent finding of a flexible active site zinc-binding loop
(Z-Loop) in class IIa FBAs and its potential for broad spectrum class
II FBA inhibition, the lack of information regarding this feature
of class IIb FBAs, such as SaFBA, has been limiting for further Z-loop
inhibitor development. Therefore, we elucidated the crystal structure
of SaFBA to 2.1 Å allowing for a more direct structural analysis
of SaFBA. Furthermore, we determined the KM for one of SaFBA’s substrates, fructose 1,6-bisphosphate,
as well as performed mode of inhibition studies for an inhibitor that
takes advantage of the Z-loop’s flexibility. Together the data
offers insight into a class IIb FBA from a pervasively drug resistant
bacterium and a comparison of Z-loops and other features between the
different subtypes of class II FBAs.
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Affiliation(s)
- Glenn C Capodagli
- Department of Chemistry and Biochemistry, University of Denver , Denver, Colorado 80208, United States
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95
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Deiters C, Günnewig V, Friedrich AW, Mellmann A, Köck R. Are cases of Methicillin-resistant Staphylococcus aureus clonal complex (CC) 398 among humans still livestock-associated? Int J Med Microbiol 2014; 305:110-3. [PMID: 25434977 DOI: 10.1016/j.ijmm.2014.11.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/06/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022] Open
Abstract
UNLABELLED Methicillin-resistant Staphylococcus aureus (MRSA) of clonal complex (CC) 398 are widespread among pigs, cattle and poultry as well as among humans who have contact to these livestock animals. However, there is limited data on livestock-independent dissemination of MRSA CC398 in the general population. METHODS In this case-control study MRSA isolates derived (between July 2013 and June 2014) from patients of four hospitals located in a livestock-dense region were S. aureus protein A (spa) typed and risk factors for MRSA acquisition were assessed from patients colonized or infected with MRSA CC398 vs. other MRSA molecular types (MRSA non-CC398). RESULTS Of 384 patients, 21% were colonized with MRSA CC398. Contact with livestock (Odds Ratio (OR) 46.03) and residence directly on a pig farm (OR 12.82) were associated with MRSA CC398. Of 55 patients with MRSA CC398, 21 (38%) did not report direct livestock contact. Among the latter we identified several risk factors that could have facilitated indirect transmission, such as living on farms (without being farmer), private contact with known MRSA carriers or previous hospitalization. DISCUSSION This study suggests that MRSA CC398 is still mostly disseminated via direct contact to livestock. However, a substantial proportion of patients seem to acquire MRSA CC398 via other pathways.
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Affiliation(s)
- Christian Deiters
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Str. 41, 48149 Münster, Germany; Christophorus-Kliniken GmbH, Hagenstraße 35, 48301 Nottuln, Germany
| | - Volker Günnewig
- Christophorus-Kliniken GmbH, Hagenstraße 35, 48301 Nottuln, Germany
| | - Alexander W Friedrich
- Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, Hanzeplain 1, 9700 RB Groningen, The Netherlands
| | - Alexander Mellmann
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Str. 41, 48149 Münster, Germany
| | - Robin Köck
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Str. 41, 48149 Münster, Germany.
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96
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Slifierz MJ, Friendship R, Weese JS. Zinc oxide therapy increases prevalence and persistence of methicillin-resistant Staphylococcus aureus in pigs: a randomized controlled trial. Zoonoses Public Health 2014; 62:301-8. [PMID: 25209545 DOI: 10.1111/zph.12150] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Indexed: 11/29/2022]
Abstract
There is concern that therapeutic use of zinc oxide (ZnO) in swine production may select for methicillin-resistant Staphylococcus aureus (MRSA) due to co-location of the zinc resistance gene (czrC) and methicillin resistance gene (mecA) within the staphylococcal cassette chromosome mec (SCCmec). The objective of this investigation was to determine whether MRSA carriage in pigs is influenced by exposure to therapeutic doses of in-feed ZnO (3000 mg/kg) when compared to the recommended dietary levels (100 mg/kg). A randomized controlled trial was completed using 110 pigs that were naturally colonized with czrC-positive MRSA. The pigs were followed from birth to weaning (21 d), at which point they were randomized into 8 pens and exposed to either a control feed (100 mg ZnO/kg feed; n = 49 pigs) or a treatment feed (3000 mg ZnO/kg feed; n = 50 pigs); neither feed contained additional antimicrobials. MRSA carriage was monitored weekly in each group for 4 weeks post-weaning. The prevalence of MRSA was significantly higher in the treatment group at 1-week (OR = 18.1; P < 0.01) and 2 weeks (OR = 3.01; P = 0.01) post-weaning when compared to the control group, but there was no difference later in the nursery phase. Persistent MRSA carriage (testing positive ≥2 times post-weaning) was observed in 2% (1/49) of control pigs and 22% (11/50) of treated pigs (P < 0.01). All MRSA isolates (spa types t034 and t3075) carried czrC and showed uniform resistance to zinc. These findings demonstrate that the prevalence and persistence of MRSA in nursery pigs can be affected by high levels of in-feed ZnO in the absence of antibiotics.
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Affiliation(s)
- M J Slifierz
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
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97
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Schinasi L, Wing S, Augustino KL, Ramsey KM, Nobles DL, Richardson DB, Price LB, Aziz M, MacDonald PDM, Stewart JR. A case control study of environmental and occupational exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region. Environ Health 2014; 13:54. [PMID: 24958086 PMCID: PMC4083368 DOI: 10.1186/1476-069x-13-54] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/10/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Distinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina. METHODS MRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). Participants were interviewed about recent environmental and occupational exposures. Home addresses were geocoded and publicly available data were used to estimate the density of swine in residential census block groups of residence. Conditional logistic regression models were used to derive odds ratio (OR) estimates and 95% confidence intervals (CI). Presence of the scn gene in MRSA isolates was assessed. In addition, multi locus sequence typing (MLST) of the MRSA isolates was performed, and the Diversilab® system was used to match the isolates to USA pulsed field gel electrophoresis types. RESULTS From July - December 2011, 117 cases and 119 controls were enrolled. A higher proportion of controls than cases were current workforce members (41.2% vs. 31.6%) Cases had a higher odds of living in census block groups with medium densities of swine (OR: 4.76, 95% CI: 1.36-16.69) and of reporting the ability to smell odor from a farm with animals when they were home (OR: 1.51, 95% CI: 0.80-2.86). Of 49 culture positive MRSA isolates, all were scn positive. Twenty-two isolates belonged to clonal complex 5. CONCLUSIONS Absence of livestock workers in this study precluded evaluation of occupational exposures. Higher odds of MRSA in medium swine density areas could reflect environmental exposure to swine or poultry.
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Affiliation(s)
- Leah Schinasi
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steve Wing
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerri L Augustino
- Department of Infection Control, Vidant Medical Center, Greenville, NC, USA
- Division of Infectious Diseases, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Keith M Ramsey
- Department of Infection Control, Vidant Medical Center, Greenville, NC, USA
- Division of Infectious Diseases, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Delores L Nobles
- Department of Infection Control, Vidant Medical Center, Greenville, NC, USA
- Division of Infectious Diseases, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - David B Richardson
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lance B Price
- Division of Pathogen Genomics, The Translational Genomics Research Institute, Flagstaff, Arizona, USA
- Department of Occupational and Environmental Health, George Washington University, Washington, DC, USA
| | - Maliha Aziz
- Division of Pathogen Genomics, The Translational Genomics Research Institute, Flagstaff, Arizona, USA
- Department of Occupational and Environmental Health, George Washington University, Washington, DC, USA
| | - Pia DM MacDonald
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Social & Scientific Systems, Inc., Durham, NC, USA
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, The University of NC at Chapel Hill, Chapel Hill, NC, USA
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98
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Brooks JP, Adeli A, McLaughlin MR. Microbial ecology, bacterial pathogens, and antibiotic resistant genes in swine manure wastewater as influenced by three swine management systems. WATER RESEARCH 2014; 57:96-103. [PMID: 24704907 DOI: 10.1016/j.watres.2014.03.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 03/04/2014] [Accepted: 03/09/2014] [Indexed: 05/21/2023]
Abstract
The environmental influence of farm management in concentrated animal feeding operations (CAFO) can yield vast changes to the microbial biota and ecological structure of both the pig and waste manure lagoon wastewater. While some of these changes may not be negative, it is possible that CAFOs can enrich antibiotic resistant bacteria or pathogens based on farm type, thereby influencing the impact imparted by the land application of its respective wastewater. The purpose of this study was to measure the microbial constituents of swine-sow, -nursery, and -finisher farm manure lagoon wastewater and determine the changes induced by farm management. A total of 37 farms were visited in the Mid-South USA and analyzed for the genes 16S rRNA, spaQ (Salmonella spp.), Camp-16S (Campylobacter spp.), tetA, tetB, ermF, ermA, mecA, and intI using quantitative PCR. Additionally, 16S rRNA sequence libraries were created. Overall, it appeared that finisher farms were significantly different from nursery and sow farms in nearly all genes measured and in 16S rRNA clone libraries. Nearly all antibiotic resistance genes were detected in all farms. Interestingly, the mecA resistance gene (e.g. methicillin resistant Staphylococcus aureus) was below detection limits on most farms, and decreased as the pigs aged. Finisher farms generally had fewer antibiotic resistance genes, which corroborated previous phenotypic data; additionally, finisher farms produced a less diverse 16S rRNA sequence library. Comparisons of Camp-16S and spaQ GU (genomic unit) values to previous culture data demonstrated ratios from 10 to 10,000:1 depending on farm type, indicating viable but not cultivatable bacteria were dominant. The current study indicated that swine farm management schemes positively and negatively affect microbial and antibiotic resistant populations in CAFO wastewater which has future "downstream" implications from both an environmental and public health perspective.
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Affiliation(s)
- John P Brooks
- Genetics and Precision Agriculture Unit, USDA-ARS, Mississippi State, MS 39762, USA.
| | - Ardeshir Adeli
- Genetics and Precision Agriculture Unit, USDA-ARS, Mississippi State, MS 39762, USA
| | - Michael R McLaughlin
- Genetics and Precision Agriculture Unit, USDA-ARS, Mississippi State, MS 39762, USA
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99
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Impacts of antibiotic use in agriculture: what are the benefits and risks? Curr Opin Microbiol 2014; 19:37-44. [DOI: 10.1016/j.mib.2014.05.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/14/2014] [Accepted: 05/28/2014] [Indexed: 11/20/2022]
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100
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Mansour AM, Salti HI. Cataract surgery during active methicillin-resistant Staphylococcus aureus infection. Clin Ophthalmol 2014; 8:739-42. [PMID: 24790402 PMCID: PMC3998858 DOI: 10.2147/opth.s61037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present two patients with active, foul-smelling, methicillin-resistant Staphylococcus aureus (MRSA) wounds of the forehead and sternum following craniotomy or open heart surgery. Both had debilitating cataracts and were told by the infectious diseases team that cataract surgery is very risky. Both underwent sequential bilateral phacoemulsification with no sign of infection. Patients with active MRSA wound infections may safely undergo cataract surgery with additional precautions observed intraoperatively (good wound construction) and postoperatively (topical antibiotics and close observation). Banning such surgeries can unnecessarily jeopardize the lifestyles of such patients.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Lebanon ; Rafic Hariri University Hospital, Beirut, Lebanon
| | - Haytham I Salti
- Department of Ophthalmology, American University of Beirut, Lebanon
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