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Brandenburg JM, Stapleton GS, Kline KE, Khoury J, Mallory K, Machesky KD, Ladd-Wilson SG, Scholz R, Freiman J, Schwensohn C, Palacios A, Gieraltowski L, Ellison Z, Tolar B, Webb HE, Tagg KA, Salah Z, Nichols M. Salmonella Hadar linked to two distinct transmission vehicles highlights challenges to enteric disease outbreak investigations. Epidemiol Infect 2024:1-27. [PMID: 38736416 DOI: 10.1017/s0950268824000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
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Stapleton GS, Habrun C, Nemechek K, Gollarza L, Ellison Z, Tolar B, Koski L, Brandenburg JM, Salah Z, Palacios A, Basler C, Varela K, Nichols M, Benedict K. Multistate outbreaks of salmonellosis linked to contact with backyard poultry-United States, 2015-2022. Zoonoses Public Health 2024. [PMID: 38686950 DOI: 10.1111/zph.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
AIMS Contact with backyard poultry (i.e., privately-owned, non-commercial poultry) was first associated with a multistate outbreak of salmonellosis in 1955. In recent years, backyard poultry-associated salmonellosis outbreaks have caused more illnesses in the United States than salmonellosis outbreaks linked to any other type of animal. Here, we describe the epidemiology of outbreaks from 2015-2022 to inform prevention efforts. METHODS AND RESULTS During 2015-2022, there were 88 multistate backyard poultry-associated salmonellosis outbreaks and 7866 outbreak-associated illnesses caused by 21 different Salmonella serotypes. Salmonella Enteritidis accounted for the most outbreaks (n = 21) and illnesses (n = 2400) of any serotype. Twenty-four percent (1840/7727) of patients with available information were <5 years of age. In total, 30% (1710/5644) of patients were hospitalized, and nine deaths were attributed to Salmonella infection. Throughout this period, patients reported behaviours that have a higher risk of Salmonella transmission, including kissing or snuggling poultry or allowing poultry inside their home. CONCLUSIONS Despite ongoing efforts to reduce the burden of salmonellosis associated with backyard poultry, outbreak-associated illnesses have nearly tripled and hospitalizations more than quadrupled compared with those in 1990-2014. Because this public health problem is largely preventable, government officials, human and veterinary healthcare providers, hatcheries, and retailers might improve the prevention of illnesses by widely disseminating health and safety recommendations to the public and by continuing to develop and implement prevention measures to reduce zoonotic transmission of Salmonella by backyard poultry.
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Affiliation(s)
- G Sean Stapleton
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline Habrun
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaylea Nemechek
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Lauren Gollarza
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary Ellison
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- ASRT, Inc., Smyrna, Georgia, USA
| | - Beth Tolar
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lia Koski
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua M Brandenburg
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zainab Salah
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Palacios
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Colin Basler
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate Varela
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megin Nichols
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katharine Benedict
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ablan M, Canning M, Koski L, Landsman L, Stapleton GS, Nichols M, Robyn M. Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments. Zoonoses Public Health 2024. [PMID: 38396326 DOI: 10.1111/zph.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
AIMS Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk. METHODS AND RESULTS We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state. CONCLUSIONS The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption.
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Affiliation(s)
- Michael Ablan
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Canning
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lia Koski
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Landsman
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - G Sean Stapleton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megin Nichols
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Misha Robyn
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Stapleton GS, Innes GK, Nachman KE, Casey JA, Patton AN, Price LB, Tartof SY, Davis MF. Assessing the difference in contamination of retail meat with multidrug-resistant bacteria using for-consumer package label claims that indicate on-farm antibiotic use practices- United States, 2016-2019. J Expo Sci Environ Epidemiol 2024:10.1038/s41370-024-00649-y. [PMID: 38374423 DOI: 10.1038/s41370-024-00649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Antibiotic use in food-producing animals can select for antibiotic resistance in bacteria that can be transmitted to people through contamination of food products during meat processing. Contamination resulting in foodborne illness contributes to adverse health outcomes. Some livestock producers have implemented antibiotic use reduction strategies marketed to consumers on regulated retail meat packaging labels ("label claims"). OBJECTIVE We investigated whether retail meat label claims were associated with isolation of multidrug-resistant organisms (MDROs, resistant to ≥3 classes of antibiotics) from U.S. meat samples. METHODS We utilized retail meat data from the U.S. Food and Drug Administration National Antimicrobial Resistance Monitoring System (NARMS) collected during 2016-2019 for bacterial contamination of chicken breast, ground turkey, ground beef, and pork chops. We used modified Poisson regression models to compare the prevalence of MDRO contamination among meat samples with any antibiotic restriction label claims versus those without such claims (i.e., conventionally produced). RESULTS In NARMS, 62,338 meat samples were evaluated for bacterial growth from 2016-2019. Of these, 24,446 (39%) samples had label claims that indicated antibiotic use was restricted during animal production. MDROs were isolated from 2252 (4%) meat samples, of which 71% (n = 1591) were conventionally produced, and 29% (n = 661) had antibiotic restriction label claims. Compared with conventional samples, meat with antibiotic restriction label claims had a statistically lower prevalence of MDROs (adjusted prevalence ratio: 0.66; 95% CI: 0.61, 0.73). This relationship was consistent for the outcome of any bacterial growth. IMPACT This repeated cross-sectional analysis of a nationally representative retail meat surveillance database in the United States supports that retail meats labeled with antibiotic restriction claims were less likely to be contaminated with MDROs compared with retail meat without such claims during 2016-2019. These findings indicate the potential for the public to become exposed to bacterial pathogens via retail meat and emphasizes a possibility that consumers could reduce their exposure to environmental reservoirs of foodborne pathogens that are resistant to antibiotics.
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Affiliation(s)
- G Sean Stapleton
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gabriel K Innes
- Yuma Center for Excellence in Desert Agriculture, Yuma, AZ, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for 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
| | - Joan A Casey
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Andrew N Patton
- Geospatial Analysis Lab, University of San Francisco, Harney Science Center, San Francisco, CA, USA
| | - Lance B Price
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sara Y Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - 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 & Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Paphitis K, Habrun CA, Stapleton GS, Reid A, Lee C, Majury A, Murphy A, McClinchey H, Corbeil A, Kearney A, Benedict K, Tolar B, Forrest RO. Salmonella Vitkin Outbreak Associated with Bearded Dragons, Canada and United States, 2020-2022. Emerg Infect Dis 2024; 30:225-233. [PMID: 38270159 PMCID: PMC10826748 DOI: 10.3201/eid3002.230963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
We identified 2 cases of Salmonella enterica serovar Vitkin infection linked by whole-genome sequencing in infants in Ontario, Canada, during 2022. Both households of the infants reported having bearded dragons as pets. The outbreak strain was also isolated from an environmental sample collected from a patient's bearded dragon enclosure. Twelve cases were detected in the United States, and onset dates occurred during March 2021-September 2022 (isolates related to isolates from Canada within 0-9 allele differences by core-genome multilocus sequence typing). Most US patients (66.7%) were <1 year of age, and most (72.7%) had reported bearded dragon exposure. Hospitalization was reported for 5 (38.5%) of 13 patients. Traceback of bearded dragons identified at least 1 potential common supplier in Southeast Asia. Sharing rare serovar information and whole-genome sequencing data between Canada and the United States can assist in timely identification of outbreaks, including those that might not be detected through routine surveillance.
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Frey E, Stapleton GS, Nichols MC, Gollarza LM, Birhane M, Chen JC, McCullough A, Carleton HA, Trees E, Hise KB, Tolar B, Francois Watkins L. Antimicrobial resistance in multistate outbreaks of nontyphoidal Salmonella infections linked to animal contact-United States, 2015-2018. J Clin Microbiol 2024; 62:e0098123. [PMID: 38084949 PMCID: PMC10793259 DOI: 10.1128/jcm.00981-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024] Open
Abstract
Animal contact is an established risk factor for nontyphoidal Salmonella infections and outbreaks. During 2015-2018, the U.S. Centers for Disease Control and Prevention (CDC) and other U.S. public health laboratories began implementing whole-genome sequencing (WGS) of Salmonella isolates. WGS was used to supplement the traditional methods of pulsed-field gel electrophoresis for isolate subtyping, outbreak detection, and antimicrobial susceptibility testing (AST) for the detection of resistance. We characterized the epidemiology and antimicrobial resistance (AMR) of multistate salmonellosis outbreaks linked to animal contact during this time period. An isolate was considered resistant if AST yielded a resistant (or intermediate, for ciprofloxacin) interpretation to any antimicrobial tested by the CDC or if WGS showed a resistance determinant in its genome for one of these agents. We identified 31 outbreaks linked to contact with poultry (n = 23), reptiles (n = 6), dairy calves (n = 1), and guinea pigs (n = 1). Of the 26 outbreaks with resistance data available, we identified antimicrobial resistance in at least one isolate from 20 outbreaks (77%). Of 1,309 isolates with resistance information, 247 (19%) were resistant to ≥1 antimicrobial, and 134 (10%) were multidrug-resistant to antimicrobials from ≥3 antimicrobial classes. The use of resistance data predicted from WGS increased the number of isolates with resistance information available fivefold compared with AST, and 28 of 43 total resistance patterns were identified exclusively by WGS; concordance was high (>99%) for resistance determined by AST and WGS. The use of predicted resistance from WGS enhanced the characterization of the resistance profiles of outbreaks linked to animal contact by providing resistance information for more isolates.
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Affiliation(s)
- Erin Frey
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - G. Sean Stapleton
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Megin C. Nichols
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren M. Gollarza
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meseret Birhane
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica C. Chen
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andre McCullough
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC Inc., Atlanta, Georgia, USA
| | - Heather A. Carleton
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eija Trees
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley B. Hise
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Beth Tolar
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Louise Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nemechek K, Sean Stapleton G, Waltenburg MA, Low M, Gollarza L, Adams J, Peralta V, Lopez K, Morrison A, Schnitzler H, Kline KE, McGinnis S, Nichols M. Multistate outbreak of turtle-associated salmonellosis highlights ongoing challenges with the illegal sale and distribution of small turtles. Zoonoses Public Health 2023; 70:684-691. [PMID: 37772367 PMCID: PMC10878351 DOI: 10.1111/zph.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/07/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
The sale and distribution of small turtles (shell length <4 inches) as pets has been banned in the United States since 1975 because of the risk of Salmonella transmission, especially to children. Despite this 48-year-old ban, salmonellosis outbreaks continue to be linked to contact with small turtles. During investigations of turtle-associated outbreaks, information regarding the turtle farm of origin is difficult to obtain because turtles are commonly sold by transient vendors. During 2020-2021, public health officials investigated a multistate illness outbreak caused by Salmonella enterica serotype Typhimurium linked to pet small turtles. Cases were defined as a laboratory-confirmed Salmonella Typhimurium infection highly related (within 0-6 allele differences) to the outbreak strain based on whole-genome sequencing analysis by core-genome multilocus sequence typing with illness onset occurring during 27 August 2020-14 May 2021. Forty-three patients were identified from 12 states; of these, 35% (15/43) were children <5 years old. Among patients with available information, 37% (14/38) were hospitalized, and one death was reported. Seventy-four percent (25/34) of patients reported turtle exposure in the week before illness onset, and 84% (16/19) specified exposure to small turtles. The outbreak strain was isolated from samples collected from a Pennsylvania patient's small turtle tank. Two patients reported purchasing their small turtles from pet stores. Salmonella Braenderup was isolated from samples collected from small turtles and their habitat at one of these stores; however, at that time, this strain was not associated with any human illnesses. This investigation was notable because of the documented sale of small turtles from several pet stores combined with the identification of a single small turtle supplier to these pet stores. The high proportion of children involved in this outbreak highlights the continued need to educate the pet industry as well as parents and caregivers about the risk of turtle-associated salmonellosis especially in children. Understanding and addressing the persisting challenges related to the illegal sale and distribution of small turtles could reduce the burden of turtle-associated salmonellosis.
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Affiliation(s)
- Kaylea Nemechek
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - G. Sean Stapleton
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Michelle A. Waltenburg
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mabel Low
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Gollarza
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Adams
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | - Vi Peralta
- California Department of Public Health, Richmond, California, USA
| | - Karen Lopez
- Delaware Department of Agriculture, Dover, Delaware, USA
| | - Atisha Morrison
- Texas Department of State Health Services, Austin, Texas, USA
| | | | - Kelly E. Kline
- Pennsylvania Department of Health, Bureau of Epidemiology, Harrisburg, Pennsylvania, USA
| | - Shannon McGinnis
- Pennsylvania Department of Health, Bureau of Epidemiology, Harrisburg, Pennsylvania, USA
| | - Megin Nichols
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Innes GK, Patton AN, Nachman KE, Casey JA, Stapleton GS, Abraham AG, Price LB, Tartof SY, Davis MF. Distance and destination of retail meat alter multidrug resistant contamination in the United States food system. Sci Rep 2023; 13:21024. [PMID: 38030674 PMCID: PMC10687246 DOI: 10.1038/s41598-023-48197-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023] Open
Abstract
Antibiotic-resistant infections are a global concern, especially those caused by multidrug-resistant (MDR) bacteria, defined as those resistant to more than three drug classes. The animal agriculture industry contributes to the antimicrobial resistant foodborne illness burden via contaminated retail meat. In the United States, retail meat is shipped across the country. Therefore, understanding geospatial factors that influence MDR bacterial contamination is vital to protect consumers and inform interventions. Using data available from the United States Food and Drug Administration's National Antimicrobial Resistance Monitoring System (NARMS), we describe retail meat shipping distances using processor and retailer locations and investigated this distance as a risk factor for MDR bacteria meat contamination using log-binomial regression. Meat samples collected during 2012-2014 totaled 11,243, of which 4791 (42.61%) were contaminated with bacteria and 835 (17.43%) of those bacteria were MDR. All examined geospatial factors were associated with MDR bacteria meat contamination. After adjustment for year and meat type, we found higher prevalence of MDR contamination among meat processed in the south (relative adjusted prevalence ratio [aPR] 1.35; 95% CI 1.06-1.73 when compared to the next-highest region), sold in Maryland (aPR 1.12; 95% CI 0.95-1.32 when compared to the next-highest state), and shipped from 194 to 469 miles (aPR 1.59; 95% CI 1.31-1.94 when compared to meats that traveled < 194 miles). However, sensitivity analyses revealed that New York sold the meat with the highest prevalence of MDR Salmonella contamination (4.84%). In this secondary analysis of NARMS data, both geographic location where products were sold and the shipping distance were associated with microbial contamination on retail meat.
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Affiliation(s)
- Gabriel K Innes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Yuma Center for Excellence in Desert Agriculture, Yuma, AZ, USA.
| | - Andrew N Patton
- University of San Francisco Geospatial Analysis Lab, San Francisco, CA, USA
| | - Keeve E Nachman
- 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
| | - Joan A Casey
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - G Sean Stapleton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison G Abraham
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lance B Price
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Sara Y Tartof
- Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Meghan F Davis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Patel K, Stapleton GS, Trevejo RT, Tellier WT, Higa J, Adams JK, Hernandez SM, Sanchez S, Nemeth NM, Debess EE, Rogers KH, Mete A, Watson KD, Foss L, Low MSF, Gollarza L, Nichols M. Human Salmonellosis Outbreak Linked to Salmonella Typhimurium Epidemic in Wild Songbirds, United States, 2020-2021. Emerg Infect Dis 2023; 29:2298-2306. [PMID: 37877570 PMCID: PMC10617330 DOI: 10.3201/eid2911.230332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Salmonella infection causes epidemic death in wild songbirds, with potential to spread to humans. In February 2021, public health officials in Oregon and Washington, USA, isolated a strain of Salmonella enterica serovar Typhimurium from humans and a wild songbird. Investigation by public health partners ultimately identified 30 illnesses in 12 states linked to an epidemic of Salmonella Typhimurium in songbirds. We report a multistate outbreak of human salmonellosis associated with songbirds, resulting from direct handling of sick and dead birds or indirect contact with contaminated birdfeeders. Companion animals might have contributed to the spread of Salmonella between songbirds and patients; the outbreak strain was detected in 1 ill dog, and a cat became ill after contact with a wild bird. This outbreak highlights a One Health issue where actions like regular cleaning of birdfeeders might reduce the health risk to wildlife, companion animals, and humans.
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Whitehill FM, Stapleton GS, Koski L, Sievert D, Nichols M. Risk factors for hospitalization among adults aged ≥65 years with non-typhoidal Salmonella infection linked to backyard poultry contact. Zoonoses Public Health 2022; 69:215-223. [PMID: 35060679 PMCID: PMC10866372 DOI: 10.1111/zph.12911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We describe the epidemiology of live poultry-associated salmonellosis (LPAS) and investigate potential risk factors associated with hospitalization among adults aged ≥65 years in the United States during 2008-2017. LPAS is a public health concern in the United States, especially among people with increased risk for hospitalization, such as older adults. SAMPLE We analysed data from people aged ≥65 years with non-typhoidal salmonellosis who reported live poultry contact within seven days prior to illness onset. PROCEDURE We used logistic regression to estimate the odds of hospitalization associated with several risk factors including types of live poultry contact exposures. RESULTS LPAS among older adults in this analysis resulted in high hospitalization rates. Salmonella Hadar infection was associated with increased hospitalization. Among older adults with LPAS, 109 individuals of 127 (86%) reported contact with live poultry at their or someone else's residence, and 85 of 105 with available information (81%) reported owning poultry. CONCLUSIONS AND CLINICAL RELEVANCE Additional infection prevention information and education targeted at poultry-owning older adults are needed to prevent illness and hospitalization.
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Affiliation(s)
- Florence M. Whitehill
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - G. Sean Stapleton
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Lia Koski
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- CAITTA Inc., Herndon, VA, USA
| | - Dawn Sievert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megin Nichols
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Cherry CC, Sureda MEN, Gibbins JD, Hale CR, Stapleton GS, Jones ES, Nichols MC. Large animal veterinarians' knowledge, attitudes, and practices regarding livestock abortion-associated zoonoses in the United States indicate potential occupational health risk. J Am Vet Med Assoc 2022; 260:780-788. [PMID: 35175930 PMCID: PMC9524364 DOI: 10.2460/javma.21.09.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To understand large animal veterinarians' knowledge of select zoonotic diseases that cause livestock abortions and identify barriers to using personal protective equipment (PPE). SAMPLE A convenience sample of 469 veterinarians currently working with livestock. PROCEDURES We sent an electronic survey invitation to large animal veterinarians through various veterinary organizations. Respondents answered questions addressing knowledge and prior experience with select abortion-associated zoonotic diseases, resources available for infection control, attitudes and barriers to PPE use, and demographics. RESULTS Median participant age was 49 years (range, 22 to 82 years), and 54% (235/438) were male. Half of veterinarians (185/348) were contacted 5 or fewer times per year to consult on livestock abortions. No veterinarians surveyed answered all questions on zoonotic disease transmission correctly. Personal protective equipment access varied, from 99% (289/290) having access to gloves to 20% (59/290) having access to respirators. Concerns for spreading disease to other animals (136/289 [47%]) and to other humans (108/287 [38%]) ranked as the most common reported motivators for PPE use. Reported barriers to PPE use among survey participants were the inconvenience of taking PPE into the field (101/286 [35%]) and the inconvenience of wearing PPE (97/286 [34%]). Access to PPE was not correlated with PPE use. CLINICAL RELEVANCE Surveyed veterinarians had limited knowledge of transmission of select abortion-associated zoonotic diseases. Incomplete understanding might lead to inappropriate PPE selection, preventable disease exposure, or missed opportunities for client education. Inconvenience was a primary reason PPE was not used.
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Affiliation(s)
- Cara C. Cherry
- Rickettsial Zoonoses Branch, Division of Vector-borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - María E. Negrón Sureda
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - John D. Gibbins
- Hazard Evaluations and Technical Assistance Branch, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, CDC, Cincinnati, OH
| | - Christa R. Hale
- Western States Division, National Institute for Occupational Safety and Health, CDC, Denver, CO
| | - G. Sean Stapleton
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN,Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - Emma S. Jones
- Office of the Director, Division of Vector-borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, CO
| | - Megin C. Nichols
- Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA,Corresponding author: Dr. Nichols (Outbreak Response and Prevention Branch, CDC, 1600 Clifton Rd NE, Atlanta, GA 30329; )
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Hoff C, Nichols M, Gollarza L, Scheftel J, Adams J, Tagg KA, Francois Watkins L, Poissant T, Stapleton GS, Morningstar-Shaw B, Signs K, Bidol S, Donovan D, Basler C. Multistate outbreak of Salmonella Typhimurium linked to pet hedgehogs, United States, 2018-2019. Zoonoses Public Health 2022; 69:167-174. [PMID: 35048538 DOI: 10.1111/zph.12904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
In December 2018, PulseNet, the national laboratory network for enteric disease surveillance, identified an increase in Salmonella Typhimurium isolates with an uncommon pulsed-field gel electrophoresis pattern which was previously isolated from hedgehogs. CDC, state, and local health partners interviewed patients with a questionnaire that focused on hedgehog exposures, conducted traceback of patients' hedgehog purchases, and collected hedgehog faecal pellets and environmental samples. Isolates in this outbreak were analysed using core-genome multi-locus sequence typing (cgMLST) and compared to sequence data from historic clinical isolates from a 2011-2013 outbreak of Salmonella Typhimurium illnesses linked to pet hedgehogs. Fifty-four illnesses in 23 states were identified between October 2018 and September 2019. Patients ranged from <1 to 95 years, and 65% were female. Eight patients were hospitalized. Eighty-one per cent (29/36) of patients interviewed reported contact with a hedgehog before becoming ill; of these, 21 (72%) reported owning a hedgehog. Analysis of 53 clinical, 11 hedgehog, and two hedgehog bedding isolates from this outbreak, seven hedgehog isolates obtained prior to this outbreak, and two clinical isolates from the 2011-2013 outbreak fell into three distinct groupings (37 isolates in Clade 1 [0-10 alleles], 28 isolates in Clade 2 [0-7 alleles], and eight isolates in Clade 3 [0-12 alleles]) and were collectively related within 0-31 alleles by cgMLST. Purchase information available from 20 patients showed hedgehogs were purchased from multiple breeders across nine states, a pet store, and through an online social media website; a single source of hedgehogs was not identified. This outbreak highlights the ability of genetic sequencing analysis to link historic and ongoing Salmonella illness outbreaks and demonstrates the strain of Salmonella linked to hedgehogs might continue to be a health risk to hedgehog owners unless measures are taken to prevent transmission.
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Affiliation(s)
- Connor Hoff
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Megin Nichols
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Gollarza
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joni Scheftel
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Jennifer Adams
- Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | - Kaitlin A Tagg
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Weems Design Studio Inc., Decatur, Georgia, USA
| | - Louise Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - G Sean Stapleton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Brenda Morningstar-Shaw
- Diagnostic Bacteriology and Pathobiology Laboratory, National Veterinary Services Laboratories, United States Department of Agriculture, Ames, Iowa, USA
| | - Kim Signs
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Sally Bidol
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Danielle Donovan
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Colin Basler
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jimenez IA, Vega Mariño PA, Stapleton GS, Prieto JB, Bowman DD. Canine vector-borne disease in domestic dogs on Isla Santa Cruz, Galápagos. Vet Parasitol Reg Stud Reports 2020; 19:100373. [PMID: 32057400 DOI: 10.1016/j.vprsr.2020.100373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
Vector-borne diseases result in significant morbidity and mortality in domestic dogs in tropical and subtropical regions and also pose a potential threat to wildlife species and humans. Ehrlichia canis, the causative agent of canine monocytic ehrlichiosis (CME), has a high reported seroprevalence in dogs on Santa Cruz in the Galápagos Islands, Ecuador. Veterinary diagnostic and treatment resources are often scarce and clinical follow-up is lacking in the Galápagos. This study evaluated 58 dogs presenting to the Darwin Animal Doctors clinic in the city of Puerto Ayora on Santa Cruz Island during August of 2018. The seroprevalence of E. canis/Ehrlichia ewingii (48.3%), Anaplasma phagocytophilum/Anaplasma platys (12.1%), and Borrelia burgdorferi (0%), as well as the proportion of dogs actively infected with E. canis (12.1%) and E. ewingii (0%), are reported. Active infection was defined as the identification of antigen by PCR. Dogs with a packed cell volume (PCV) ≤ 30% had a 10-fold risk of active infection with E. canis compared to dogs with a PCV ≥ 31% (p = .0124). A PCV cutoff of 30% may be a useful screening tool for active E. canis infection in regions with high Ehrlichia seroprevalence, in the absence of other apparent causes of anemia. Dirofilaria immitis antigen was present in 6.9% of examined dogs, with the highest prevalence in the barrio Las Ninfas. PCR and Sanger sequencing were used to provide the first molecular identification of D. immitis in the Galápagos. This study updates the seropositivity and prevalence data of these canine vector-borne pathogens and highlights the need for continued surveillance in the region.
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Affiliation(s)
- Isabel Angelica Jimenez
- Cornell University, College of Veterinary Medicine, 602 Tower Road, Ithaca, NY 14850, United States of America; Animal Medical Center, 510 E. 62nd Street, New York, NY 10065, United States of America.
| | - Patricio Alejandro Vega Mariño
- Agencia de Regulación y Control de la Bioseguridad y Cuarentena para Galápagos, Avenida Baltra, Puerto Ayora, Santa Cruz, Galápagos 200102, Ecuador
| | - G Sean Stapleton
- Cornell University, College of Veterinary Medicine, 602 Tower Road, Ithaca, NY 14850, United States of America
| | - Jennifer Battista Prieto
- Cornell University, College of Veterinary Medicine, 602 Tower Road, Ithaca, NY 14850, United States of America
| | - Dwight Douglas Bowman
- Cornell University, College of Veterinary Medicine, 602 Tower Road, Ithaca, NY 14850, United States of America
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Lee SW, Gleason NR, Stapleton GS, Zhai C, Huang EH, Bessler M, Whelan RL. Increased platelet-derived growth factor (PDGF) release after laparotomy stimulates systemic tumor growth in mice. Surg Endosc 2001; 15:981-5. [PMID: 11443442 DOI: 10.1007/s004640080012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2000] [Accepted: 12/07/2000] [Indexed: 10/26/2022]
Abstract
BACKGROUND Our laboratory has demonstrated that tumors grow larger and are more easily established following laparotomy than after carbon dioxide (CO2) pneumoperitoneum or anesthesia alone. We have also shown that tumor cells incubated with serum from laparotomized mice proliferated significantly faster in vitro than those incubated with plasma from mice that underwent laparoscopy or anesthesia alone. We hypothesized that differing levels of a plasma-soluble growth factor(s) postoperatively causes tumors to proliferate faster after laparotomy. This study's purpose was to isolate and characterize the plasma growth factor(s) responsible for the increased growth of systemic tumors after laparotomy. METHODS Female Balb/C mice (n = 100) were randomized to two groups: anesthesia control (AC) or midline sham laparotomy (4 cm) (Open). Plasma was collected on Postoperative day 4. For the tumor proliferation assay, C-26 colon cancer cells were incubated in media with either 10% AC or Open "raw" plasma (not passed through column), or AC or Open plasma that had been passed through the column. For elution of heparin-binding proteins, plasma from each group was passed through a heparin-sepharose column. Elution of bound proteins was accomplished with a 0.1-2 M NaCl gradient. Each fraction was examined for protein content. For the anti-platelet-derived growth factor (PDGF) neutralizing antibody study, C-26 cells were incubated with one of four plasma preparations: AC or Open plasma alone, or AC or Open plasma incubated with anti-PDGF antibody. For both studies, tumor proliferation was determined after 2 days with an MTS/PMS assay. Results from each group were compared and differences determined using analysis of variance (ANOVA) and Tukey-Kramer tests. RESULTS On heparin chromatography, a single elution peak consistent with PDGF was present in both AC and Open plasma and was 1.5 times greater in the Open plasma. The first tumor proliferation assay showed that tumor cells incubated with Open plasma proliferated 2.5 times faster than those with AC plasma (p < 0.0001). Passage of AC plasma through the column did not alter its mitogenic activity, but Open plasma thus treated demonstrated significantly decreased mitogenic activity. The second tumor proliferation assay showed that anti-PDGF antibody had no effect on the mitogenic activity of the AC plasma but decreased the mitogenic activity of the Open plasma to the AC plasma level. CONCLUSIONS Laparotomy is associated with higher levels of a heparin-binding plasma factor, consistent with PDGF. The enhanced mitogenic activity of the OP plasma was neutralized with anti-PDGF antibody. Increased plasma levels of PDGF after laparotomy may be responsible for accelerated tumor growth following laparotomy in mice.
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Affiliation(s)
- S W Lee
- Department of Surgery, Columbia University College of Physicians & Surgeons, 161 Fort Washington Ave, New York, NY 10032, USA
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Vithiananthan S, Cooper Z, Betten K, Stapleton GS, Carter J, Huang EH, Whelan RL. Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection. Dis Colon Rectum 2001; 44:927-35. [PMID: 11496070 DOI: 10.1007/bf02235478] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Laparoscopic-assisted, sphincter-saving resection (largest incision < 7 cm) of the middle and distal rectum is technically very difficult and, with regard to cancers, has not been demonstrated to be oncologically safe. The hypothesis of this retrospective study is that a hybrid operation that combines laparoscopic and open methods would be associated with short-term outcome benefits compared with open surgery results for patients undergoing sphincter-saving proctectomy. METHODS A total of 31 hybrid and 25 fully open rectal resection patients were compared in this retrospective review. All patients had splenic flexure takedown and rectal anastomosis. The hybrid approach consisted of laparoscopic splenic flexure takedown (with or without partial rectal mobilization and devascularization) followed by completion of the procedure via infraumbilical midline laparotomy. The indication was neoplasm in 87 percent of hybrid patients and in 68 percent of open patients. The majority of tumors were located between 4 and 10 cm from the dentate line. RESULTS Fifty-eight percent of hybrid and 68 percent of open patients had low anterior or coloanal resections, and 48 percent of hybrid and 64 percent of open patients underwent temporary diversion via ileostomy. The mean hybrid midline incision length was 11 cm compared with 24 cm for open patients (P < 0.0001). The neoplastic specimens were similar with regard to margins and lymph node harvest. Similar complication rates were noted in both groups. Nonsignificant benefits for hybrid patients (0.9-1.2 days) were seen with regard to length of time until toleration of liquid or solid diet and first flatus. Hybrid patients experienced their first bowel movements 4.1 days vs. 5.7 days for the open group (P = 0.03). Mean length of stay was significantly shorter for hybrid patients (6.1. days) than for open patients (11.1 days; P = 0.0006). CONCLUSION This preliminary retrospective study suggests that a combined hybrid laparoscopic and open approach to sphincter-saving proctectomy permits a similar resection as open methods and may be associated with a length-of-stay benefit and more rapid return of bowel function. Prospective studies will be needed before any firm conclusions can be drawn.
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Affiliation(s)
- S Vithiananthan
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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