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Aarø NS, Torpdahl M, Rasmussen T, Jensen M, Nielsen HL. Salmonella infections in Denmark from 2013-2022 with focus on serotype distribution, invasiveness, age, sex, and travel exposition. Eur J Clin Microbiol Infect Dis 2024; 43:947-957. [PMID: 38512514 PMCID: PMC11108954 DOI: 10.1007/s10096-024-04808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To analyze the nationwide incidence of Salmonella infections in Denmark from 2013 to 2022. METHODS Confirmed cases of Salmonella enterica subsp. enterica were examined using the National Register of Enteric Pathogens during 2013-2022. Proportions, incidence rates (IR), relative risk (RR), and 95% confidence intervals (CI) were calculated to assess differences in serotypes, invasiveness, age, sex, and travel exposure. RESULTS We identified 9,944 Danish Salmonella enterica subsp. enterica cases, with an average annual incidence rate of 16.9 per 100,000 inhabitants, declining during the COVID-19 pandemic. Typhoidal cases totaled 206, with an average annual IR of 0.35 per 100,000 inhabitants. Enteric fever patients had a median age of 24 years (IQR:17-36). Leading non-typhoid Salmonella (NTS) serotypes were S. Enteritidis (26.4%), monophasic S. Typhimurium (16.5%), and S. Typhimurium (13.5%). Median age for NTS cases was 42 (IQR: 18-62), with even sex distribution, and a third reported travel prior to onset of disease. The overall percentage of invasive NTS (iNTS) infection was 8.1% (CI: 7.6-8.7). Eleven serotypes were associated with higher invasiveness, with S. Dublin and S. Panama having the highest invasiveness with age and sex-adjusted RR of 7.31 (CI: 6.35-8.43) and 5.42 (CI: 3.42-8.60), respectively, compared to all other NTS serotypes. Increased age was associated with higher RR for iNTS infection. CONCLUSION During the decade, there was a limited number of typhoidal cases. The dominant NTS serotypes were S. Enteritidis and monophasic S. Typhimurium, whereas S. Dublin and S. Panama exhibited the highest invasive potential.
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Affiliation(s)
| | - Mia Torpdahl
- Department for Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Torben Rasmussen
- Department of Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark
| | - Martin Jensen
- Research Data and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Holliday LR, Perry MD. Network-wide analysis of the Serosep EntericBio Gastro Panel 2 for the detection of enteric pathogens in Public Health Wales microbiology laboratories. J Med Microbiol 2022; 71. [PMID: 35639604 DOI: 10.1099/jmm.0.001555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. A retrospective data analysis of 34 months (spanning 2016-2020) of 961573 diagnostic results obtained before and after nucleic acid amplification testing (NAAT) implementation, across the Public Health Wales microbiology network.Hypothesis / Gap Statement. This is the first network-wide analysis of the implementation of enteric NAAT in diagnostic microbiology.Aim. To assess the outcome of replacing microscopy and bacterial culture with NAAT as the primary test in the diagnosis of: Campylobacter spp., Salmonella sp., Shigella spp., Shiga toxin-producing Escherichia coli (STEC), Cryptosporidium spp. and Giardia duodenalis infections.Methodology. Following NAAT introduction, bacterial culture was performed as a secondary test, to provide further information from NAAT positive samples for epidemiological purposes. Primary detection rates and overall bacterial culture rates were calculated for each target pathogen using both testing regimes (Stage I) including a comparison of in-patient and out-patient diagnoses (Stage II).Results. Stage I analysis showed that the primary detection rate significantly increased for Campylobacter spp. (P<0.0001), Salmonella sp. (P=0.0151), Shigella spp. (P<0.0001), STEC (P<0.0001), Cryptosporidium spp. (P<0.0001) and Giardia duodenalis (P<0.0001) when using NAAT compared to microscopy or bacterial culture. A significant decrease was seen in the overall rate of Campylobacter spp. isolation by bacterial culture (P<0.0001), whilst other targets remained unaffected. Stage II analysis showed that NAAT positive out-patient samples were more likely to be supplemented by a positive bacterial culture than NAAT positive in-patient samples for Campylobacter spp. (P<0.0001), Salmonella sp. (P=0.0004) and STEC (P=0.0039). However, Shigella spp. was more frequently isolated from NAAT positive in-patient samples (P=0.0005). A notable increase was seen for G. duodenalis detection from in-patient samples (P=0.0002). Reference laboratory data showed the NAAT assay can detect at least 53 serotypes of STEC but may not be able to detect some of the rarer species of Cryptosporidium seen in human infections.Conclusion. The implementation of NAAT has significantly increased the primary detection rate of all target enteric pathogens in Wales and information gleaned previously from direct culture is largely unaffected.
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Affiliation(s)
- Lucy R Holliday
- Public Health Wales Microbiology, Singleton Hospital, Swansea, UK
| | - Michael D Perry
- Public Health Wales Microbiology, University Hospital of Wales, Heath Park, Cardiff, UK
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Mughini-Gras L, Pijnacker R, Duijster J, Heck M, Wit B, Veldman K, Franz E. Changing epidemiology of invasive non-typhoid Salmonella infection: a nationwide population-based registry study. Clin Microbiol Infect 2019; 26:941.e9-941.e14. [PMID: 31760114 DOI: 10.1016/j.cmi.2019.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Non-typhoid Salmonella (NTS) may invade beyond the intestine, causing bacteraemia, sepsis, and infection of normally sterile sites. The epidemiology of invasive NTS (iNTS) infection is under-researched. We determined trends, risk factors, serotype distribution, antimicrobial resistance (AMR), and attributable sources of iNTS infection in a high-income setting. METHODS 22,837 records of culture-confirmed human salmonellosis cases and 10,008 serotyped Salmonella isolates from five putative animal reservoirs (pigs, cattle, broilers, layers, reptiles) in the Netherlands during 2005-2018 were retrieved from national surveillance registries. Risk factors for iNTS infection were identified using logistic regression analysis. Source attribution modelling was based on serotyping, prevalence, and exposure data. RESULTS The average annual percentage of iNTS infections was 4.6% (range 3.5-5.7%). An increase in iNTS infections was observed since 2012 (odds ratio (OR) 1.09, 95% confidence interval (95% CI) 1.04-1.14). Increased iNTS infection risk was associated with wintertime (OR 1.37, 95% CI 1.12-1.66), male sex (OR 1.73, 95% CI 1.51-1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR 1.54, 95% CI 1.23-1.93). While 52% of iNTS infections (n = 950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9%, n = 163), Panama (21.6%, n = 106), and Poona (14.1%, n = 71). Cattle were a larger source of iNTS than non-iNTS infections (12.2% vs. 7.6%). Lower AMR and multi-resistance rates were observed among iNTS (37.9%) than non-iNTS isolates (48.6%). DISCUSSION The increase in iNTS infections, which is reported also in other countries, is of public health and clinical concern. The underlying reasons seem to be multi-factorial in nature. iNTS infection risk depends more on the infecting serotypes and patient demographics, and less on the attributable reservoirs and AMR profiles.
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Affiliation(s)
- L Mughini-Gras
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - R Pijnacker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - J Duijster
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - M Heck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - B Wit
- Netherlands Food and Consumer Product Safety Authority, Wageningen, the Netherlands
| | - K Veldman
- Wageningen BioVeterinary Research (WBVR), Lelystad, the Netherlands
| | - E Franz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Reimschuessel R, Grabenstein M, Guag J, Nemser SM, Song K, Qiu J, Clothier KA, Byrne BA, Marks SL, Cadmus K, Pabilonia K, Sanchez S, Rajeev S, Ensley S, Frana TS, Jergens AE, Chappell KH, Thakur S, Byrum B, Cui J, Zhang Y, Erdman MM, Rankin SC, Daly R, Das S, Ruesch L, Lawhon SD, Zhang S, Baszler T, Diaz-Campos D, Hartmann F, Okwumabua O. Multilaboratory Survey To Evaluate Salmonella Prevalence in Diarrheic and Nondiarrheic Dogs and Cats in the United States between 2012 and 2014. J Clin Microbiol 2017; 55:1350-1368. [PMID: 28202802 PMCID: PMC5405253 DOI: 10.1128/jcm.02137-16] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/05/2017] [Indexed: 12/31/2022] Open
Abstract
Eleven laboratories collaborated to determine the periodic prevalence of Salmonella in a population of dogs and cats in the United States visiting veterinary clinics. Fecal samples (2,965) solicited from 11 geographically dispersed veterinary testing laboratories were collected in 36 states between January 2012 and April 2014 and tested using a harmonized method. The overall study prevalence of Salmonella in cats (3 of 542) was <1%. The prevalence in dogs (60 of 2,422) was 2.5%. Diarrhea was present in only 55% of positive dogs; however, 3.8% of the all diarrheic dogs were positive, compared with 1.8% of the nondiarrheic dogs. Salmonella-positive dogs were significantly more likely to have consumed raw food (P = 0.01), to have consumed probiotics (P = 0.002), or to have been given antibiotics (P = 0.01). Rural dogs were also more likely to be Salmonella positive than urban (P = 0.002) or suburban (P = 0.001) dogs. In the 67 isolates, 27 unique serovars were identified, with three dogs having two serovars present. Antimicrobial susceptibility testing of 66 isolates revealed that only four of the isolates were resistant to one or more antibiotics. Additional characterization of the 66 isolates was done using pulsed-field gel electrophoresis and whole-genome sequencing (WGS). Sequence data compared well to resistance phenotypic data and were submitted to the National Center for Biotechnology Information (NCBI). This study suggests an overall decline in prevalence of Salmonella-positive dogs and cats over the last decades and identifies consumption of raw food as a major risk factor for Salmonella infection. Of note is that almost half of the Salmonella-positive animals were clinically nondiarrheic.
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Affiliation(s)
- Renate Reimschuessel
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Laurel, Maryland, USA
| | - Michael Grabenstein
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Laurel, Maryland, USA
| | - Jake Guag
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Laurel, Maryland, USA
| | - Sarah M Nemser
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Laurel, Maryland, USA
| | - Kyunghee Song
- U.S. Food and Drug Administration, Center for Veterinary Medicine, Office of New Animal Drug Evaluation, Rockville, Maryland, USA
| | - Junshan Qiu
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | - Kristin A Clothier
- California Animal Health and Food Safety Laboratory, University of California, Davis, Davis, California, USA
| | - Barbara A Byrne
- School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Stanley L Marks
- School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Kyran Cadmus
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kristy Pabilonia
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Susan Sanchez
- College of Veterinary Medicine, Department of Infectious Disease, Athens Veterinary Diagnostic Laboratory, The University of Georgia, Athens, Georgia, USA
| | - Sreekumari Rajeev
- Veterinary Diagnostic and Investigational Laboratory, College of Veterinary Medicine, The University of Georgia, Tifton, Georgia, USA
| | - Steve Ensley
- College of Veterinary Medicine, Veterinary Diagnostic Laboratory, Iowa State University, Ames, Iowa, USA
| | - Timothy S Frana
- College of Veterinary Medicine, Veterinary Diagnostic Laboratory, Iowa State University, Ames, Iowa, USA
| | - Albert E Jergens
- College of Veterinary Medicine, Veterinary Diagnostic Laboratory, Iowa State University, Ames, Iowa, USA
| | - Kimberly H Chappell
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Siddhartha Thakur
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Beverly Byrum
- Ohio Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, Reynoldsburg, Ohio, USA
| | - Jing Cui
- Ohio Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, Reynoldsburg, Ohio, USA
| | - Yan Zhang
- Ohio Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, Reynoldsburg, Ohio, USA
| | - Matthew M Erdman
- U.S. Department of Agriculture, National Veterinary Services Laboratories, Ames, Iowa, USA
| | - Shelley C Rankin
- University of Pennsylvania, Matthew J. Ryan Veterinary Hospital, Philadelphia, Pennsylvania, USA
| | - Russell Daly
- Veterinary and Biomedical Sciences Department, Animal Disease Research and Diagnostic Laboratory, South Dakota State University, Brookings, South Dakota, USA
| | - Seema Das
- Veterinary and Biomedical Sciences Department, Animal Disease Research and Diagnostic Laboratory, South Dakota State University, Brookings, South Dakota, USA
| | - Laura Ruesch
- Veterinary and Biomedical Sciences Department, Animal Disease Research and Diagnostic Laboratory, South Dakota State University, Brookings, South Dakota, USA
| | - Sara D Lawhon
- College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Shuping Zhang
- College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Timothy Baszler
- Washington Animal Disease Diagnostic Laboratory, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Dubraska Diaz-Campos
- Washington Animal Disease Diagnostic Laboratory, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Faye Hartmann
- Department of Pathobiological Sciences/WVDL, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ogi Okwumabua
- Department of Pathobiological Sciences/WVDL, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Seasonal Variation of Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae Bacteremia According to Acquisition and Patient Characteristics: A Population-Based Study. Infect Control Hosp Epidemiol 2016; 37:946-953. [PMID: 27142942 DOI: 10.1017/ice.2016.89] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Seasonal variation is a characteristic of many infectious diseases, but relatively little is known about determinants thereof. We studied the impact of place of acquisition and patient characteristics on seasonal variation of bacteremia caused by the 3 most common pathogens. DESIGN Seasonal variation analysis. METHODS In 3 Danish health regions (2.3 million total inhabitants), patients with bacteremia were identified from 2000 through 2011 using information from laboratory information systems. Analyses were confined to Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. Additional data were obtained from the Danish National Hospital Registry for the construction of admission histories and calculation of the Charlson comorbidity index (CCI). Bacteremias were categorized as community acquired, healthcare associated (HCA), and hospital acquired. We defined multiple subgroups by combining the following characteristics: species, acquisition, age group, gender, CCI level, and location of infection. Assuming a sinusoidal model, seasonal variation was assessed by the peak-to-trough (PTT) ratio with a 95% confidence interval (CI). RESULTS In total, we included 16,006 E. coli, 6,924 S. aureus, and 4,884 S. pneumoniae bacteremia cases. For E. coli, the seasonal variation was highest for community-acquired cases (PTT ratio, 1.24; 95% CI, 1.17-1.32), was diminished for HCA (PTT ratio, 1.14; 95% CI, 1.04-1.25), and was missing for hospital-acquired cases. No seasonal variation was observed for S. aureus. S. pneumoniae showed high seasonal variation, which did not differ according to acquisition (overall PTT ratio, 3.42; 95% CI, 3.10-3.83). CONCLUSIONS Seasonal variation was mainly related to the species although the place of acquisition was important for E. coli. Infect Control Hosp Epidemiol 2016;37:946-953.
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Er J, Wallis P, Maloney S, Norton R. Paediatric bacteraemias in tropical Australia. J Paediatr Child Health 2015; 51:437-42. [PMID: 25316255 DOI: 10.1111/jpc.12750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
Abstract
AIM Bacteraemias in children are an important cause of morbidity and mortality. Knowledge of local epidemiology and trends is important to inform practitioners of likely pathogens in the sick child. This study aimed to determine trends over time in pathogenic organisms causing paediatric bacteraemia in North Queensland and to audit a hospital's blood culture results with respect to contamination rate. METHODS This was a retrospective review of 8385 blood cultures collected from children attending a tertiary centre in North Queensland over a 10-year period (2001-2010). RESULTS There were 696 positive blood cultures (8.3%) with 70 different bacterial species detected. Gram-positive and Gram-negative bacteria accounted for 48.6% and 51.4% of isolates, respectively. Overall, bacteraemia accounted for 4.7 per 1000 admissions. The rate of contamination was 60.6% among positive blood cultures and 5.0% for all blood cultures sampled. These results were compared with previous published reports. Notable differences were seen in the frequencies of Salmonella and group A Streptococcus bacteraemias in North Queensland when compared with other reports. There was also a decline in vaccine-preventable infections such as S. pneumoniae and an increasing trend of community-acquired MRSA bacteraemia. CONCLUSION This study has demonstrated the unique profile of causative pathogens of paediatric bacteraemias in tropical Australia. In light of the increasing prevalence of MRSA, empiric treatment for sepsis for children in this region needs to be reconsidered.
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Affiliation(s)
- Jeremy Er
- Townsville Hospital, Townsville, Queensland, Australia
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Cox N, Cason J, Richardson L. Minimization ofSalmonellaContamination on Raw Poultry. Annu Rev Food Sci Technol 2011; 2:75-95. [DOI: 10.1146/annurev-food-022510-133715] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- N.A. Cox
- USDA/Agricultural Research Service, Russell Research Center, Athens, Georgia 30605;
| | - J.A. Cason
- USDA/Agricultural Research Service, Russell Research Center, Athens, Georgia 30605;
| | - L.J. Richardson
- Current address: The Coca Cola Company, Atlanta, Georgia 30313;
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Ravel A, Smolina E, Sargeant JM, Cook A, Marshall B, Fleury MD, Pollari F. Seasonality in human salmonellosis: assessment of human activities and chicken contamination as driving factors. Foodborne Pathog Dis 2010; 7:785-94. [PMID: 20184452 DOI: 10.1089/fpd.2009.0460] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study used integrated surveillance data to assess the seasonality in retail chicken contamination and of human activities and their role on the seasonality of human endemic salmonellosis. From June 2005 to May 2008, reported cases of salmonellosis were followed-up comprehensively using a standardized questionnaire, and 616 retail chicken breasts were systematically tested for Salmonella, in one Canadian community. Poisson regression was used to model seasonality of human cases, Salmonella in retail chicken, and to assess the relationship between these and selected meteorological variables. The case-case approach was used to compare the activities of salmonellosis cases that occurred during the summer peak to the other cases. There were 216 human endemic salmonellosis cases (incidence rate: 14.7 cases/100,000 person-years), predominantly of Typhimurium and Enteritidis serotypes (28.4% and 20.8%, respectively). The monthly distribution of cases was associated with ambient temperature (p < 0.001) with a significant seasonal peak in June (p = 0.03) and July (p = 0.0005), but it was not associated with precipitation (p = 0.38). Several activities reported by cases tended to be more frequent during summer. Particularly, attending a barbeque and gardening within the 3 days before the disease onset were two significant risk factors for salmonellosis in June or July compared with the salmonellosis cases that occurred in the other months. Out of all chicken samples, 185 (30%) tested positive for Salmonella spp., Kentucky being the dominant serotype (44.3% of positive samples). The monthly proportion of positive chicken samples showed no seasonal variations (p = 0.30) and was not associated with the monthly count of human cases (p = 0.99). In conclusion, even though evidence generally supports chicken as a primary vehicle of Salmonella to humans, the contamination of retail chicken was not driving the seasonality in human salmonellosis. Attending a barbeque or gardening during the hotter months of the year should be further assessed for their risk.
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Affiliation(s)
- André Ravel
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Saint-Hyacinthe, QC, Canada.
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Laupland KB, Schønheyder HC, Kennedy KJ, Lyytikäinen O, Valiquette L, Galbraith J, Collignon P. Salmonella enterica bacteraemia: a multi-national population-based cohort study. BMC Infect Dis 2010; 10:95. [PMID: 20398281 PMCID: PMC2861061 DOI: 10.1186/1471-2334-10-95] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 04/14/2010] [Indexed: 11/10/2022] Open
Abstract
Background Salmonella enterica is an important emerging cause of invasive infections worldwide. However, population-based data are limited. The objective of this study was to define the occurrence of S. enterica bacteremia in a large international population and to evaluate temporal and regional differences. Methods We conducted population-based laboratory surveillance for all salmonella bacteremias in six regions (annual population at risk 7.7 million residents) in Finland, Australia, Denmark, and Canada during 2000-2007. Results A total of 622 cases were identified for an annual incidence of 1.02 per 100,000 population. The incidence of typhoidal (serotypes Typhi and Paratyphi) and non-typhoidal (other serotypes) disease was 0.21 and 0.81 per 100,000/year. There was major regional and moderate seasonal and year to year variability with an increased incidence observed in the latter years of the study related principally to increasing rates of non-typhoidal salmonella bacteremias. Advancing age and male gender were significant risk factors for acquiring non-typhoidal salmonella bacteremia. In contrast, typhoidal salmonella bacteremia showed a decreasing incidence with advancing age and no gender-related excess risk. Conclusions Salmonella enterica is an important emerging pathogen and regional determinants of risk merits further investigation.
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Affiliation(s)
- Kevin B Laupland
- Department of Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada.
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Nielsen H, Hansen KK, Gradel KO, Kristensen B, Ejlertsen T, Østergaard C, Schønheyder HC. Bacteraemia as a result of Campylobacter species: a population-based study of epidemiology and clinical risk factors. Clin Microbiol Infect 2010; 16:57-61. [PMID: 19673969 DOI: 10.1111/j.1469-0691.2009.02900.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Invasive disease as a result of Campylobacter is rarely reported. We reviewed 46 cases of blood stream infection with Campylobacter in a Danish population with complete follow-up. The incidence was 2.9 per 1 million person-years with a peak incidence in the age group above 80 years. In the population, the ratio of notified bacteraemia/enteritis patients with Campylobacter infection was 0.004. Patients with bacteraemia were older and had higher comorbidity, e.g. alcoholism, immunosuppression, previous gastrointestinal surgery or HIV infection. We found 26% of blood isolates resistant to ciprofloxacin. The length of hospitalization was significantly longer in bacteraemia patients, whereas the outcome was favourable with 28-day mortality of 4% in bacteraemia patients and 1% in enteritis patients. None of the bacteraemia patients relapsed within 365-day follow-up.
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Affiliation(s)
- H Nielsen
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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Chimalizeni Y, Kawaza K, Molyneux E. The epidemiology and management of non typhoidal salmonella infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 659:33-46. [PMID: 20204753 DOI: 10.1007/978-1-4419-0981-7_3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Simonsen J, Mølbak K, Falkenhorst G, Krogfelt KA, Linneberg A, Teunis PFM. Estimation of incidences of infectious diseases based on antibody measurements. Stat Med 2009; 28:1882-95. [PMID: 19387977 DOI: 10.1002/sim.3592] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Owing to under-ascertainment it is difficult if not impossible to determine the incidence of a given disease based on cases notified to routine public health surveillance. This is especially true for diseases that are often present in mild forms as for example diarrhoea caused by foodborne bacterial infections. This study presents a Bayesian approach for obtaining incidence estimates by use of measurements of serum antibodies against Salmonella from a cross-sectional study. By comparing these measurements with antibody measurements from a follow-up study of infected individuals it was possible to estimate the time since last infection for each individual in the cross-sectional study. These time estimates were then converted into incidence estimates. Information about the incidence of Salmonella infections in Denmark was obtained by using blood samples from 1780 persons. The estimated incidence was about 0.094 infections per person year. This number corresponds to 325 infections per culture-confirmed case captured in the Danish national surveillance system. We present a novel approach, termed as seroincidence, that has potentials to compare the sensitivity of public health surveillance between different populations, countries and over time.
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Affiliation(s)
- J Simonsen
- Division of Epidemiology, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark.
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Gradel KO, Nielsen HL, Schønheyder HC, Ejlertsen T, Kristensen B, Nielsen H. Increased short- and long-term risk of inflammatory bowel disease after salmonella or campylobacter gastroenteritis. Gastroenterology 2009; 137:495-501. [PMID: 19361507 DOI: 10.1053/j.gastro.2009.04.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/18/2009] [Accepted: 04/02/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Various commensal enteric and potentially pathogenic bacteria may be involved in the pathogenesis of inflammatory bowel diseases (IBD). We compared the risk of IBD between a cohort of patients with documented Salmonella or Campylobacter gastroenteritis and an age- and gender-matched control group from the same population in Denmark. METHODS We identified 13,324 patients with Salmonella/Campylobacter gastroenteritis from laboratory registries in North Jutland and Aarhus counties, Denmark, from 1991 through 2003, and 26,648 unexposed controls from the same counties. Of these, 176 exposed patients with IBD before the infection, their 352 unexposed controls, and 80 unexposed individuals with IBD before the Salmonella/Campylobacter infection were excluded. The final study cohort of 13,148 exposed and 26,216 unexposed individuals were followed for up to 15 years (mean, 7.5 years). RESULTS A first-time diagnosis of IBD was reported in 107 exposed (1.2%) and 73 unexposed individuals (0.5%). By age, gender, and comorbidity adjusted Cox proportional hazards regression analysis, the hazard ratio (95% confidence interval) for IBD was 2.9 (2.2-3.9) for the whole period and 1.9 (1.4-2.6) if the first year after the Salmonella/Campylobacter infection was excluded. The increased risk in exposed subjects was observed throughout the 15-year observation period. The increased risk was similar for Salmonella (n = 6463) and Campylobacter (n = 6685) and for a first-time diagnosis of Crohn's disease (n = 47) and ulcerative colitis (n = 133). CONCLUSIONS In our population-based cohort study with complete follow-up, an increased risk of IBD was demonstrated in individuals notified in laboratory registries with an episode of Salmonella/Campylobacter gastroenteritis.
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Affiliation(s)
- Kim O Gradel
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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Laupland KB, Schønheyder HC, Kennedy KJ, Lyytikäinen O, Valiquette L, Galbraith J, Collignon P, Church DL, Gregson DB, Kibsey P. Rationale for and protocol of a multi-national population-based bacteremia surveillance collaborative. BMC Res Notes 2009; 2:146. [PMID: 19624839 PMCID: PMC2721840 DOI: 10.1186/1756-0500-2-146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 07/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bloodstream infections are frequent causes of human illness and cause major morbidity and death. In order to best define the epidemiology of these infections and to track changes in occurrence, adverse outcome, and resistance rates over time, population based methodologies are optimal. However, few population-based surveillance systems exist worldwide, and because of differences in methodology inter-regional comparisons are limited. In this report we describe the rationale and propose first practical steps for developing an international collaborative approach to the epidemiologic study and surveillance for bacteremia. FINDINGS The founding collaborative participants represent six regions in four countries in three continents with a combined annual surveillance population of more than 8 million residents. CONCLUSION Future studies from this collaborative should lead to a better understanding of the epidemiology of bloodstream infections.
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Affiliation(s)
- Kevin B Laupland
- Departments of Medicine and Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Karina J Kennedy
- Infectious Diseases Unit and Microbiology Department, The Canberra Hospital and School of Clinical Medicine, Australian National University, Woden, Australian Capital Territory, Australia
| | - Outi Lyytikäinen
- Department of Infectious Disease Epidemiology, Hospital Infection Program, National Public Health Institute, Helsinki, Finland
| | - Louis Valiquette
- Department of Microbiology-Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John Galbraith
- Microbiology Laboratory, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Peter Collignon
- Infectious Diseases Unit and Microbiology Department, The Canberra Hospital and School of Clinical Medicine, Australian National University, Woden, Australian Capital Territory, Australia
| | - Deirdre L Church
- Departments of Medicine and Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Daniel B Gregson
- Departments of Medicine and Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Pamela Kibsey
- Microbiology Laboratory, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
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Gradel KO, Dethlefsen C, Ejlertsen T, Schønheyder HC, Nielsen H. Increased prescription rate of antibiotics prior to non-typhoid Salmonella infections: A one-year nested case-control study. ACTA ACUST UNITED AC 2009; 40:635-41. [DOI: 10.1080/00365540801961248] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gradel KO, Schønheyder HC, Kristensen B, Dethlefsen C, Ejlertsen T, Nielsen H. Are Host Characteristics or Exposure Factors Mainly Involved in the Acquisition of ZoonoticSalmonellaandCampylobacterCoinfection in Humans? Foodborne Pathog Dis 2009; 6:251-5. [DOI: 10.1089/fpd.2008.0148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kim O. Gradel
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Henrik C. Schønheyder
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Brian Kristensen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Dethlefsen
- Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Tove Ejlertsen
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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Increased risk of zoonotic Salmonella and Campylobacter gastroenteritis in patients with haematological malignancies: a population-based study. Ann Hematol 2008; 88:761-7. [PMID: 19083236 DOI: 10.1007/s00277-008-0662-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
Abstract
We hypothesised that haematological malignancies increase the risk of acquiring zoonotic Salmonella or Campylobacter gastroenteritis. The population-based study comprised all first-time Salmonella/Campylobacter gastroenteritis cases in two Danish counties (1991-2003), with age- and gender-matched controls from the background population. We linked the study cohort to registries to obtain data on malignancies, chemotherapy (yes/no), and main comorbidities diagnosed before Salmonella/Campylobacter gastroenteritis. Based on this design, we determined incidence rate ratios (IRR) in conditional logistic regression analyses, and we used weighted mean regression curves to evaluate fluctuations in risk 0-5 years after the malignancy diagnosis. Sixty-eight of 13,324 cases (0.5%) and 29 of 26,648 controls (0.1%) had haematological malignancy before their Salmonella/Campylobacter gastroenteritis. Comorbidity-adjusted IRR for Salmonella/Campylobacter gastroenteritis in patients with haematological malignancy as compared to patients without malignancy were 4.46 [95% confidence intervals (CI), 2.88-6.90] for all individuals, 8.33 (95% CI, 4.31-16.1) for Salmonella, and 2.17 (95% CI, 1.15-4.08) for Campylobacter. Stratification on chemotherapy treatment did not change these estimates. In time-related analyses, IRR were 7-8 in the first 2 years after the haematological malignancy diagnosis and 4-5 in the following 3 years. Patients with haematological malignancy had increased long-term risk of enquiring Salmonella or Campylobacter gastroenteritis.
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Morbidity and mortality of elderly patients with zoonotic Salmonella and Campylobacter: A population-based study. J Infect 2008; 57:214-22. [DOI: 10.1016/j.jinf.2008.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 06/02/2008] [Accepted: 06/13/2008] [Indexed: 11/23/2022]
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GRADEL KIMO, DETHLEFSEN CLAUS, SCHØNHEYDER HENRIKC, NIELSEN HENRIK. Magnitude of bacteraemia is associated with increased mortality in non-typhoid salmonellosis: a one-year follow-up study. APMIS 2008; 116:147-53. [DOI: 10.1111/j.1600-0463.2008.00886.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lordan G. What determines a patient’s treatment? Evidence from out of hours primary care co-op data in the Republic of Ireland. Health Care Manag Sci 2007; 10:283-92. [PMID: 17695138 DOI: 10.1007/s10729-007-9020-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study explores consistency in healthcare. It investigates whether vulnerable groups in the population receive the most appropriate care. This is achieved by considering the case study of individuals who present to out of hours (OOH) primary care services in the Republic of Ireland with gastroenteritis. Specifically an individual can potentially receive four services; nurse advice, doctor advice, a treatment centre consultation or a home visit. Results show that service choice is influenced by patient, call and seasonal characteristics to varying degrees. Patient symptoms are the primary driver of the type of service the patients receives. Results also indicate that the OOH primary care facilities individual characteristics do not affect service choice. This suggests a degree of consistent care across these organisations. It also provides evidence that service choice is exogenous to the organisation.
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Affiliation(s)
- Grace Lordan
- Department of Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
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