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We conducted surveillance for carbapenem-resistant Enterobacterales (CRE) during 2016–2020 at 10 US sites and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) during 2019–2020 at 6 US sites. Among 159 CRE cases in children (median age 5 years), CRE was isolated from urine for 131 (82.4%) and blood from 20 (12.6%). Annual CRE incidence rate (cases/100,000 population) was 0.47–0.87. Among 207 ESBL-E cases in children (median age 6 years), ESBL-E was isolated from urine of 196 (94.7%) and blood of 8 (3.9%). Annual ESBL-E incidence rate was 26.5 in 2019 and 19.63 in 2020. CRE and ESBL-E rates were >2-fold higher among infants than other age groups. Most CRE and ESBL-E cases were healthcare-associated community-onset (68 [43.0%] for CRE vs. 40 [23.7%] for ESBL-E) or community-associated (43 [27.2%] for CRE vs. 109 [64.5%] for ESBL-E). Programs to detect, prevent, and treat multidrug-resistant infections must include pediatric populations (particularly the youngest) and outpatient settings.

Background: The Centers for Disease Control and Prevention’s Emerging Infections Program conducts active laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE) and extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E). To better understand the U.S. epidemiology of these organisms among children, we determined the incidence of pediatric CRE and ESBL-E cases and described their clinical characteristics. Methods: Surveillance was conducted among children <18 years of age for CRE from 2016–2020 in 10 sites, and for ESBL-E from 2019–2020 in 6 sites. Among catchment-area residents, an incident CRE case was defined as the first isolation of Escherichia coli , Enterobacter cloacae complex, Klebsiella aerogenes , K. oxytoca , or K. pneumoniae in a 30-day period resistant to ≥1 carbapenem from a normally sterile site or urine. An incident ESBL-E case was defined as the first isolation of E. coli, K. pneumoniae , or K. oxytoca in a 30-day period resistant to any third-generation cephalosporin and non-resistant to all carbapenems from a normally sterile site or urine. Case records were reviewed. Results: Among 159 CRE cases, 131 (82.9%) were isolated from urine and 19 (12.0%) from blood; median age was 5 years (IQR 1–10) and 94 (59.1%) were female. Combined CRE incidence rate per 100,000 population by year ranged from 0.47 to 0.87. Among 207 ESBL-E cases, 160 (94.7%) were isolated from urine and 6 (3.6%) from blood; median age was 6 years (IQR 2–15) and 165 (79.7%) were female. Annual ESBL incidence rate per 100,000 population was 26.5 in 2019 and 19.63 in 2020. Incidence rates of CRE and ESBL-E were >2-fold higher in infants (children <1 year) than other age groups. Among those with data available, CRE cases were more likely than ESBL-E cases to have underlying conditions (99/158 [62.7%] versus 59/169 [34.9%], P<0.0001), prior healthcare exposures (74/158 [46.8%] versus 38/169 [22.5%], P<0.0001), and be hospitalized for any reason around time of their culture collection (75/158 [47.5%] versus 38/169 [22.5%], P<0.0001); median duration of admission was 18 days [IQR 3–103] for CRE versus 10 days [IQR 4–43] for ESBL-E. Urinary tract infection was the most frequent infection for CRE (89/158 [56.3%]) and ESBL-E (125/169 [74.0%]) cases. Conclusion: CRE infections occurred less frequently than ESBL-infections in U.S. children but were more often associated with healthcare risk factors and hospitalization. Infants had highest incidence of CRE and ESBL-E. Continued surveillance, infection prevention and control efforts, and antibiotic stewardship outside and within pediatric care are needed Disclosure: None

There's no obvious betting at the races. Instead, [Capobianco] matches each of his pigs with a cheerleader picked from the audience. The cheerleader of the winning pig gets a ribbon and a cap. Capobianco takes his pigs all over the continent for shows. At the Calgary Stampede, the pig races were so popular Capobianco had to double his daily shows from five to 10. Capobianco races his pigs for about six months, until they weigh about 220 pounds. After racing, the pigs usually begin new careers as bacon and footballs.

The mammogram debate resurfaced this month when a paper written by two doctors from Copenhagen's Nordic Cochrane Centre appeared in the British medical journal The Lancet. It concluded mammogram screening was \"unjustified.\" Internationally, the picture is equally murky. After a review of existing trials, the scientists at the Nordic Cochrane Centre in Copenhagen found \"screening for mammography is unjustified\" because there was no \"reliable evidence\" to say that screening reduces breast cancer mortality. In an editorial published in The Lancet clearly to balance the results of the Danish study, Harry J. de Koning, a member of the national evaluation team for breast cancer screening in the Netherlands, noted that in other European countries such as Britain, \"there has been a clear reduction in breast cancer mortality due partly to the national breast-screening program.\"

Stories by N.K. Jemisin, Dale Bailey, Peter S. Beagle, and more: \"Showcases the nuanced, playful, ever-expanding definitions of the genre.\" -TheWashington Post Science fiction and fantasy can encompass so much, from far-future deep-space sagas to quiet contemporary tales to unreal kingdoms and beasts. But what the best of these stories do is the same across the genres-they illuminate the whole gamut of the human experience, interrogating our hopes and our fears.   With a diverse selection of stories from major award winners, bestsellers, and rising stars, chosen by series editor John Joseph Adams and guest editor Charles Yu, The Best American Science Fiction and Fantasy 2017 continues to explore the ever- changing world of SFF today, with Yu bringing his unique view-literary, meta, and adventurous-to the series' third edition.   \"Superb…This mostly dystopic, sometimes darkly humorous collection of 20 hard-hitting stories feels timely, confronting contemporary cultural crises.\"-Publishers Weekly (starred review)