Explore the vast range of titles available.

This surveillance report describes the epidemiology and clinical outcomes of carbapenem-resistant Enterobacterales (CRE) infections in Tennessee from 2016 to 2022, analysing 570 cases and 406 isolates. The incidence of CRE infections per 100 000 population showed an upward trend. Enterobacter species were the most common organisms, whereas Klebsiella species were the main carbapenemase-producing CRE (CP-CRE). Klebsiella pneumoniae carbapenemase was the most common mechanism contributing to this resistance. Demographic characteristics of patients with identified isolates demonstrated a median age of 69.5 years. There were no significant differences in CP-CRE infection by sex or race. Patients with CP-CRE were more likely to be hospitalized than those with non-CP-CRE, at 60.9% and 43.9%, respectively. Multivariable analysis indicated that patients with CP-CRE had significantly higher odds of 90-day mortality (odds ratio, 2.22; 95% confidence interval, 1.12–4.42; p < 0.0001) than non-CP-CRE patients. Individuals with a higher Charlson Comorbidity Index score exhibited an increased odds of dying within 30- and 90-day post-specimen collection and had a greater likelihood of requiring intensive care unit admission. This report underscores the need to understand the epidemiology and risk factors linked to CRE infections to improve prevention strategies and patient care.

Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. The prevalence of T2DM is increasing rapidly in China. Understanding the contribution of modifiable lifestyle factors on T2DM risk is imperative to prevent the development of T2DM in China. We examined associations between lifestyle factors including physical activity, smoking and alcohol consumption with incidence of T2DM among middle-aged and elderly men in urban Shanghai. Information on socio-demographics, lifestyle habits, dietary habits, and disease history was collected via in-person interviews. Anthropometric measurements were taken. A total of 51 464 Chinese men aged 40-74 years free of T2DM, coronary heart disease (CHD), and stroke at baseline were included in the current study. Incident T2DM was identified through follow-up surveys conducted every 2-3 years. Cox proportional hazard analyses were conducted to evaluate associations between lifestyle risk factors and incidence of T2DM. We documented 1304 new cases of T2DM during 276 929 person-years of follow-up (average: 5.4 years). Physical activity was inversely associated with T2DM risk. Daily living, commuting, and total physical activity METs had inverse negative dose-response relationships with T2DM (P-trend = 0.0033, 0.0022, and <0.0001, respectively). Regular participation in exercise or sports reduced T2DM risk (HR = 0.86, 95%CI: 0.76-0.98). Moderate alcohol intake (1-3 drinks/day) was inversely related to T2DM risk (HR = 0.80, 95%CI: 0.67-0.94). Cigarette smoking, on the other hand, was associated with increased T2DM risk; HRs were 1.25 (95%CI: 1.00-1.56) for smoking more than 20 cigarettes per day and 1.28 (95%CI: 1.04-1.57) for smoking more than 40 pack-years. Physical activity and moderate alcohol intake are inversely associated with T2DM risk, whereas smoking was positively associated with T2DM risk among middle-age and elderly Chinese men. Preventive measures should be developed to focus on these modifiable lifestyle habits to reduce the upward trend of T2DM.

Age related Antibiotic Prescribing Trends of Clostridioides Difficile Incident Cases within Davidson County Tennessee 2012-2020 Michael Norris, MSN, Priscilla Pineda, MPH, Malakai Miller, MPH, Raquel Villegas, PhD, MS Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States. Antibiotic use is considered a predisposing factor for CDI. The State of Tennessee collaborates with the CDC as part of an ongoing Emerging Infections Program (EIP). We sought to better understand the impact of antimicrobial use prior to the date of incident of CDI within the defined age groups of Davidson County, Tennessee. Methods: Surveillance data from the years 2012–2020 were examined for all positive CDI cases within Davidson County. A positive CDI case was defined as a laboratory confirmed case who is ≥ 1 year old living in Davidson County, Tennessee. Antibiotic use was assessed in the 12 weeks prior to CDI. Trends of overall antibiotic use, including the top five antibiotics prescribed by our defined age groups were examined. Analyses were performed using SAS version 9.4. Only fully abstracted cases are included in the study. Results: Among 7,346 positive CDI incident cases identified between 2012–2020, 5,467 (74.4%) received antibiotics 12 weeks prior to a confirmed infection. We looked at the trend of antibiotic prescription over time from 2012-2020 (77.0%, 76.7%, 74.3%, 80.7%, 76.3%, 75.1%, 73.7%, 74.8% and 71.5%) which has decreased since 2015. The prevalence of antibiotic use by age group 1-18 years, 19-44 years, 45-64 years, 65-74 years, and 75+ years was 53.4%, 68.8%, 74.5%, 79.2% and 83.1% respectively. The five most prescribed antibiotics were ceftriaxone ((11.1%), followed by vancomycin IV (10.9%), ciprofloxacin (10.2%), metronidazole (9.1%), and piperacillin (8.6%). Cases in the 45-64 years age group were more likely to be prescribed vancomycin IV, ciprofloxacin, metronidazole, and piperacillin-tazobactam compared to other age groups (p < 0.0001). There was no statistically significant association between ceftriaxone prescription and our defined age groups. Conclusion: In this study, almost three quarters of the CDI cases had received antimicrobial therapy in the 12 weeks prior to infection. Since antibiotic prescription is a potentially modifiable risk factor for CDI, a more in-depth study, combined with an antibiotic stewardship program implementation in all settings would be beneficial to reduce the risk of CDI complications of antibiotic usage.

The spatial analysis of biota, particulate organic matter, and sediments for stable isotopes of carbon (δ13C), nitrogen (δ15N), and sulfur (δ34S) have proved useful for identifying patterns in productivity, nutrient pollution, and relationships between biological and physiochemical variables at the local and global scales. Yet such approaches are rarely applied to studies of lagoon or estuarine metabolism. Focusing on Bahía San Quintín, a heterotrophic seagrass-dominated lagoon on the Pacific coast of Baja California, México, we report on spatial patterns in surficial sediment CNS stable isotopic ratios as tracers of lagoon biogeochemical function. Stable nitrogen isotopes highlighted potential spatial variability in the balance between denitrification and nitrogen-fixation within the lagoon and identified an association between elevated δ15N levels and oyster culture, suggesting that oyster presence may be enhancing N2 production. Spatial patterns in δ34S covaried with sediment particle size, underlining the importance of sediment texture in determining the depth of sub-oxic-anoxic redox zones. Sediment carbon stable isotope ratios highlighted the lack of incorporation of seagrass carbon into seagrass meadow sediments, thus emphasizing the importance of phytoplankton or microphytobenthos for carbon accumulation in seagrass meadows. This report highlights the value of sediment isotopic values in corroborating spatial patterns in estuarine metabolism or macronutrient processing identified from chamber or flux-based studies. Stable isotope mapping can provide a useful addition to assessment of estuarine metabolism, or act as a stand-alone tool for generating hypotheses, identifying the influence of spatial gradients, and/or suggesting prime locations for investigation of microbial abundance or function.

Background: Clinical antibiotic susceptibility testing (AST) interpretations based on minimum inhibitory concentrations (MIC) breakpoints are important for both clinical decision making and some reportable condition criteria. Standardization of MIC breakpoints across clinical laboratories is lacking; AST instruments are often validated for outdated Clinical and Laboratory Standards Institute (CLSI) MIC breakpoint guidelines. In this study, we analyzed the agreement between the reported clinical laboratory AST interpretations and the guideline CLSI interpretation. Methods: Clinical laboratory AST data collected from the Multisite Gram-Negative Surveillance Initiative (MuGSI) carbapenem-resistant Enterobacterales (CRE) surveillance program in Tennessee between 2019 and 2021 were utilized. MIC values from the clinical instrument were used to calculate CLSI standard interpretations following the 2019–2021 CLSI M100 guidelines. Agreement between the clinical laboratory and CLSI interpretations of the reported MIC values were measured using a weighted Cohen κ calculated in SAS version 9.4 software. Total matches were isolates with identical CLSI and clinical laboratory interpretations. Results: In total, 14 antibiotics were assessed. Of those, 9 antibiotics had at least moderate agreement (κ > 0.41) between interpretations. Agreement between the clinical laboratory and the CLSI interpretations were near perfect (κ > 0.81) for 3 antibiotics. Agreement between the clinical laboratory and the CLSI interpretations were poor for cefazolin (0.06) and ertapenem (0.14). Cefotaxime (−0.07) was the only antibiotic that suggested no agreement. Conclusions: Of the antibiotics included in the analysis, 36% had less than moderate agreement between clinical laboratory and CLSI AST interpretations. Given the increases in antimicrobial resistance globally and the emphasis placed on antibiotic stewardship, standardization across clinical AST panels should be prioritized. Inconsistencies have the potential to contribute to inappropriate antibiotic use in addition to under- or overidentification of reportable conditions, including CRE. Disclosures: None

Background: Healthcare workers (HCWs) are at increased risk of influenza exposure and represent a potential transmission source. The Department of Health and Human Services (HHS) set a goal for 2020 to have 90% of all HCWs in acute-care hospitals (ACHs) vaccinated. Vaccination against influenza decreases symptomatic illness and absenteeism and protects HCWs and their contacts. We assessed characteristics of facility intervention programs based on their success in meeting this benchmark. Methods: Data from the NHSN were utilized, including answers to the Annual Flu Survey for 2014–2022 and the rate of vaccine compliance by facility. Flu surveys detail facility-specific programs implemented for each influenza season, from October to March. We used SAS version 9.4 software for univariate analyses to determine factors significantly associated with meeting the HHS benchmark target of ≥90% vaccination among all HCWs, split into categories for employees, students or volunteers, and licensed independent practitioners. Facilities were excluded if they were not ACHs or Critical Access Hospitals (CAH), did not complete the Annual Flu Survey for at least 1 year, or required vaccination as a condition of employment. Results: From 2014 to 2022, 745 surveys were completed. Overall, 48.58% of respondents succeeded in meeting the HHS benchmark. Also, 306 surveys completed noted that their facility did not require influenza vaccination. Among those, only 19.93% respondents succeeded. Moreover, 80.33% of successful respondents for all HCWs required personal protective equipment (PPE) upon vaccination refusal compared to 34.29% of unsuccessful respondents ( P < .0001). Furthermore, 98.36% successful respondents required documentation of offsite vaccination, compared to 89.39% of unsuccessful respondents ( P = .027). For employees, 64.56% of successful respondents tracked vaccination rates in some or all units compared to 45.81% of unsuccessful respondents ( P = .004). Also, 63.29% successful respondents had visible vaccination of leadership, compared to 43.61% of unsuccessful respondents ( P = .003). Furthermore, 86.08% of successful respondents had mobile vaccination carts, compared to 73.57% unsuccessful respondents ( P = .023). For the student- or volunteer-specific benchmark, 24.59% of successful respondents provided vaccination incentives compared to 14.63% of unsuccessful respondents ( P = .035). Conclusions: Facilities with ≥90% vaccination among HCWs were more likely to require PPE after vaccination refusal and documentation for offsite vaccination. Other strategies for vaccination were differentially associated by employee type for Tennessee facilities. For future outreach, a multipronged approach is more likely to be successful in addressing vaccine uptake among employees with lagging rates. Strategies for influenza vaccine uptake could also improve other occupational vaccinations. More research is needed on the barriers to vaccination among HCWs specifically. Disclosures: None

Background: Clostridioides difficile infections (CDI) are a crucial public health threat becoming a worldwide problem. In 2017, there were 223,900 incident cases and 12,800 deaths in the United States. Underlying conditions, such as diabetes mellitus (DM), put individuals at a greater risk for developing an infection. Whereas CDI was once believed to be mostly healthcare-associated, increasing evidence points to transmission in community settings (CA). We investigated characteristics of CA CDI and associations between pre-existing conditions and CA incident CDI cases using data from Tennessee’s CDI surveillance program, an active population- and laboratory-based surveillance system conducted through CDC’s Emerging Infections Program. CA incident CDI case data were downloaded from the Incident Case Management System from 2017 to 2021. Count and percentages were determined for each underlying condition, number of underlying conditions, and biological sex. Chi-square analyses determined associations between underlying conditions and sex. Statistical analyses were conducted using SAS v9.4. 2,326 CA incident CDI cases were identified from the catchment area. The case rates per 100,000 population between 2017 and 2021 were 79.7, 81.9, 73.7, 50.7, and 49.6. A total of 39% of the cases were 65 years or older. Most cases were women (64.8%). The overall prevalence for any underlying condition among CA CDI cases was 67.4%. A total of 29.4% of incident cases had one condition, 18.5% had two conditions, and 19.4% had three or more conditions. The most frequently reported pre-existing conditions was DM (22.9%) and gastrointestinal disease (21.7%). We looked at the prevalence of underlying conditions separated in men and women. Men with CA CDI were more likely to have chronic kidney disease (CKD) (19.1% vs 12.7%), DM (26.0% vs 21.2%), immunocompromised conditions (6.4% vs 3.6%), liver diseases (6.5% vs 2.8%), and plegias (1.0% vs 0.2%) than women with CA CDI. Women with CA CDI were more likely to have chronic lung diseases (17.4% vs 12.6%) and connective tissue diseases (4.9% vs 2.2%) than men with CA CDI. Although the incident CA CDI case rate in Davidson County decreased from 2018 to 2021, it remains a significant threat. In this analysis, underlying conditions in persons with CA CDI were highly prevalent. Men were more likely to have underlying conditions in general, and specifically CKD and DM, than women. Improving understanding of the prevalence of these conditions with CA CDI cases, along with their antibiotic use and community exposures, can help drive prevention strategies to mitigate CA CDI transmission.

This research covers the study of the first month of data from a local seismological network deployed after the MW 6.4, January 18, 2021, San Juan earthquake, over the central Chilean-Pampean flat slab. Almost 1000 seismic events were detected in the first month after the MW 6.4 earthquake occurred, with ML magnitude ranging from -0.2 to 4.3. The majority of the seismic events were relocated at a depth of around 14 km and distributed in a northeast-southwest direction. The focal mechanism solutions obtained represent the rupture main process with one of their nodal planes according to the epicentral distribution, from which we can define the rupture dip to 61°. On the other hand, quickly after the MW 6.4 earthquake occurred, a nearby region at shallower depths became activated, from which Differential Synthetic Aperture Radar Interferometry results show vertical movements. In the epicentral area and concordance with the northeast-southwest rupture region, we found a low of the analytical signal which extends in the same strike by approximately 80 km to the most populated region in the San Juan Province. Considering the closeness of the greatest earthquakes that shocked the eastern sector of the San Juan Province to the subducted Juan Fernandez Ridge track, and the direction of the rupture process, we infer its influence as one of the significant factors that contributes to the high seismic activity in this region.

Background: Carbapenem-resistant Enterobacterales (CRE) have become an increasing public health challenge in the United States over the past two decades. Carbapenemase-producing CREs (CP-CREs) significantly contribute to the spread of antimicrobial-resistant pathogens in healthcare settings. Tennessee has been conducting surveillance of CRE since 2011. As part of the Emerging Infections Program (EIP), the state has participated in population-based surveillance in Davidson and seven surrounding counties, collaborating with the Centers for Disease Control and Prevention (CDC) since 2014. Methods: The data collected through the Muti-site Gram-negative Surveillance Initiative (MuGSI) project, a collaboration between Tennessee and CDC as part of EIP, was used for this study. The analysis was performed on a subset of CRE isolates tested for carbapenemase production (CP) among all incident CRE cases collected from 2016 to 2022. Incident CRE cases are defined as the identification of carbapenem-resistant E. coli, Enterobacter cloacae complex, and Klebsiella species (K. aerogenes, K. oxytoca, K. pneumoniae, and K. variicola) from urine or normally sterile specimens (e.g., blood) from the residents of the surveillance area in a 30-day period. The mortality data was obtained from the Tennessee Vital Registry and merged with the surveillance data. Cox regression analysis was performed to evaluate if there is a difference in the 90-day survival rate based on the CP status of the pathogen, gender, age group, and the Charlson comorbidity index (CCI) score. Data analysis was done using SAS version 9.4. Results: There were 570 CRE cases reported during the study period (2016-2022). Of these, 406 were tested for carbapenemase production and 87 (21.4%) were positive for CP. There were 269 (66.3%) females and 137 (33.7%) males. Patients with higher Charlson comorbidity index score (> = 5) have significantly higher hazard ratios compared to those with low scores (HR 4.17; p-value) Conclusion: This study indicates that patients infected with CP-CRE, females, and those with high Charlson comorbidity index score have a significantly higher probability of dying within 90 days. These factors are worth considering when conducting a risk assessment of patients infected with drug-resistant gram-negative bacilli. The significantly increased risk of death among patients infected with CP-CRE highlights the need for timely carbapenemase testing and use of the test result for appropriate antimicrobial therapy and infection prevention.

We evaluated the validity and reproducibility of the FFQ used in the Shanghai Men's Health Study (SMHS). The study included 195 randomly selected participants of the SMHS who completed one FFQ at baseline, twelve 24-hour dietary recalls (24-HDR) (once a month for twelve consecutive months) and a second FFQ at the end of the study. The FFQ accounted for 88·78 % of the foods recorded in the 24-HDR surveys. The validity of the FFQ was evaluated by comparing nutrient and food group intake levels from the second FFQ and the multiple 24-HDR. Correlation coefficients ranged from 0·38 to 0·64 for macronutrients, 0·33 to 0·58 for micronutrients and 0·35 to 0·72 for food groups. Misclassification to opposite quartiles for nutrients and food groups was rare, ranging from 1·5 to 7·7 %, while exact agreement rates were between 31·8 and 53·3 %. The reliability of the FFQ was assessed by comparing the intake levels from the two FFQ. Correlation coefficients were 0·39 to 0·53 for macronutrients, 0·38 to 0·52 for micronutrients and 0·39 to 0·64 for food groups. Exact agreement rates for quartile distribution were between 31·8 and 49·2 %, while misclassification to opposite quartiles was between 1·5 and 6·2 %. These data indicate that the SMHS FFQ can reasonably categorise usual intake of nutrients and food groups among men living in urban Shanghai.