Archive for October 21, 2015

Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999–2012

Emerging Infectious Diseases NOV. 2015 V.21 N.11

Latania K. Logan, John P. Renschler, Sumanth Gandra, Robert A. Weinstein, Ramanan Laxminarayan, and for the Centers for Disease ControlPrevention Epicenters Program

Rush University Medical Center, Chicago, Illinois, USA (L.K. Logan, R.A. Weinstein); John H. Stroger, Jr. Hospital of Cook County, Chicago (L.K. Logan, R.A. Weinstein); Center for Disease Dynamics, Economics and Policy, Washington, DC, USA (J.P. Renschler, S. Gandra, R. Laxminarayan); Public Health Foundation of India, New Delhi, India (R. Laxminarayan); Princeton University, Princeton, New Jersey, USA (R. Laxminarayan)

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections is increasing in the United States. However, few studies have addressed their epidemiology in children.

To phenotypically identify CRE isolates cultured from patients 1–17 years of age, we used antimicrobial susceptibilities of Enterobacteriaceae reported to 300 laboratories participating in The Surveillance Network–USA database during January 1999–July 2012.

Of 316,253 isolates analyzed, 266 (0.08%) were identified as CRE. CRE infection rate increases were highest for Enterobacter species, blood culture isolates, and isolates from intensive care units, increasing from 0.0% in 1999–2000 to 5.2%, 4.5%, and 3.2%, respectively, in 2011–2012.

CRE occurrence in children is increasing but remains low and is less common than that for extended-spectrum β-lactamase–producing Enterobacteriaceae.

The molecular characterization of CRE isolates from children and clinical epidemiology of infection are essential for development of effective prevention strategies.



October 21, 2015 at 10:47 pm

USA300 Methicillin-Resistant Staphylococcus aureus, United States, 2000–2013

Emerging Infectious Diseases NOV. 2015 V.21 N.11


Margaret Carrel1, Eli N. Perencevich, and Michael Z. David1

University of Iowa, Iowa City, Iowa, USA (M. Carrel, E.N. Perencevich); Iowa Veterans Administration Health Care System, Iowa City (E.N. Perencevich); University of Chicago, Chicago, Illinois, USA (M.Z. David)

In the United States, methicillin-resistant Staphylococcus aureus (MRSA) with the USA300 pulsed-field gel electrophoresis type causes most community-associated MRSA infections and is an increasingly common cause of health care–associated MRSA infections.

USA300 probably emerged during the early 1990s. To assess the spatiotemporal diffusion of USA300 MRSA and USA100 MRSA throughout the United States, we systematically reviewed 354 articles for data on 33,543 isolates, of which 8,092 were classified as USA300 and 2,595 as USA100.

Using the biomedical literature as a proxy for USA300 prevalence among genotyped MRSA samples, we found that USA300 was isolated during 2000 in several states, including California, Texas, and midwestern states.

The geographic mean center of USA300 MRSA then shifted eastward from 2000 to 2013.

Analyzing genotyping studies enabled us to track the emergence of a new, successful MRSA type in space and time across the country.


October 21, 2015 at 10:45 pm

Effect of bivalent human papillomavirus vaccination on pregnancy outcomes: Long term observational follow-up in the Costa Rica HPV Vaccine Trial

BMJ 2015 Sep 7; 351:h4358.

Panagiotou OA et al.


To examine the effect of the bivalent human papillomavirus (HPV) vaccine on miscarriage.


Observational long term follow-up of a randomized, double blinded trial combined with an independent unvaccinated population based cohort.


Single center study in Costa Rica.


7466 women in the trial and 2836 women in the unvaccinated cohort enrolled at the end of the randomized trial and in parallel with the observational trial component.


Women in the trial were assigned to receive three doses of bivalent HPV vaccine (n=3727) or the control hepatitis A vaccine (n=3739). Crossover bivalent HPV vaccination occurred in the hepatitis A vaccine arm at the end of the trial. Women in the unvaccinated cohort received (n=2836) no vaccination.

Main outcome measure

Risk of miscarriage, defined by the US Centers for Disease Control and Prevention as fetal loss within 20 weeks of gestation, in pregnancies exposed to bivalent HPV vaccination in less than 90 days and any time from vaccination compared with pregnancies exposed to hepatitis A vaccine and pregnancies in the unvaccinated cohort.


Of 3394 pregnancies conceived at any time since bivalent HPV vaccination, 381 pregnancies were conceived less than 90 days from vaccination. Unexposed pregnancies comprised 2507 pregnancies conceived after hepatitis A vaccination and 720 conceived in the unvaccinated cohort. Miscarriages occurred in 451 (13.3%) of all exposed pregnancies, in 50 (13.1%) of the pregnancies conceived less than 90 days from bivalent HPV vaccination, and in 414 (12.8%) of the unexposed pregnancies, of which 316 (12.6%) were in the hepatitis A vaccine group and 98 (13.6%) in the unvaccinated cohort. The relative risk of miscarriage for pregnancies conceived less than 90 days from vaccination compared with all unexposed pregnancies was 1.02 (95% confidence interval 0.78 to 1.34, one sided P=0.436) in unadjusted analyses. Results were similar after adjusting for age at vaccination (relative risk 1.15, one sided P=0.17), age at conception (1.03, P=0.422), and calendar year (1.06, P=0.358), and in stratified analyses. Among pregnancies conceived at any time from bivalent HPV vaccination, exposure was not associated with an increased risk of miscarriage overall or in subgroups, except for miscarriages at weeks 13-20 of gestation (relative risk 1.35, 95% confidence interval 1.02 to 1.77, one sided P=0.017).


There is no evidence that bivalent HPV vaccination affects the risk of miscarriage for pregnancies conceived less than 90 days from vaccination. The increased risk estimate for miscarriages in a subgroup of pregnancies conceived any time after vaccination may be an artifact of a thorough set of sensitivity analyses, but since a genuine association cannot totally be ruled out, this signal should nevertheless be explored further in existing and future studies.


Trial registration NCT00128661 and NCT01086709.




October 21, 2015 at 10:11 pm

Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants

Journal of the American Medical Association – Pediatrics OCT 15, 2015

Jessica E. Ericson, MD1,2,3; Victor O. Popoola, MBBS, MPH, ScM4; P. Brian Smith, MD, MPH, MHS1,2; Daniel K. Benjamin, PhD5; Vance G. Fowler, MD, MHS1,6; Daniel K. Benjamin Jr, MD, PhD1,2; Reese H. Clark, MD7; Aaron M. Milstone, MD, MHS4

1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

2Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina

3currently with the Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania

4Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland

5Department of Economics, Clemson University, Clemson, South Carolina

6Department of Medicine, Duke University School of Medicine, Durham, North Carolina

7Pediatrix Medical Group, Sunrise, Florida


Staphylococcus aureus is a frequent cause of infection in hospitalized infants. These infections are associated with increased mortality and morbidity and longer hospital stays, but data on the burden of S aureus disease in hospitalized infants are limited.


To compare demographics and mortality of infants with invasive methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA), to determine the annual proportion of S aureus infections that were MRSA, and to contrast the risk of death after an invasive MRSA infection with the risk after an invasive MSSA infection.

Design, Setting, and Participants 

Multicenter retrospective study of a large, nationally representative cohort at 348 neonatal intensive care units managed by the Pediatrix Medical Group. Participants were 3888 infants with an invasive S aureus infection who were discharged from calendar year 1997 through calendar year 2012.


Invasive S aureus infection.

Main Outcomes and Measures 

The incidence of invasive S aureus infections, as well as infant characteristics and mortality after MRSA or MSSA infection.


The 3888 infants had 3978 invasive S aureus infections (2868 MSSA and 1110 MRSA). The incidence of invasive S aureus infection was 44.8 infections per 10.000 infants. The yearly proportion of invasive infections caused by MRSA increased from calendar year 1997 through calendar year 2006 and has moderately decreased since then. Infants with invasive MRSA or MSSA infections had similar gestational ages and birth weights. Invasive MRSA infections occurred more often at a younger postnatal age. For infants with available mortality data, more infants with invasive MSSA infections (n=237) died before hospital discharge than infants with invasive MRSA infections (n=110). The proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2474 (9.6%) and 110 of 926 (11.9%), respectively (P=.05). The adjusted risk of death before hospital discharge was similar after invasive MSSA and MRSA infections (risk ratio, 1.19; 95% CI, 0.96-1.49). The risks of death at 7 and 30 days after invasive infection were similar between infants with invasive MSSA infection and infants with invasive MRSA infection.

Conclusions and Relevance

Infant mortality after invasive MRSA and MSSA infections is similar, but MSSA causes more infections and more deaths in infants than MRSA. Measures to prevent S aureus infection should include MSSA in addition to MRSA.



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October 21, 2015 at 8:28 am


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