Author:
Ashbaugh Hayley,Pomeroy Connor D.,Baishya Mona,Creppage Kathleen,Bazaco Sara,Johnson Myles,Matsumoto Kenji,Bhattarai Upendra,Seliga Nicholas,Graf Paul,Chukwuma Uzo
Abstract
Abstract
Background
Acute diarrhea (AD) can have significant impacts on military troop readiness. Medical providers must understand current trends of enteropathogen antimicrobial resistance (AMR) in service members (SMs) to inform proper, timely treatment options. However, little is known of enteric pathogen profiles across the Military Health System (MHS). The primary objectives of this study were to identify gaps in enteric pathogen surveillance within the MHS, describe the epidemiology of AMR in enteric pathogens, and identify trends across the MHS both within the Continental United States (CONUS) and outside of the Continental United States (OCONUS).
Methods
Health Level 7 (HL7)-formatted laboratory data were queried for all specimens where Salmonella, Shigella, and Campylobacter species, as well as Shiga toxin-producing Escherichia coli (E. coli) (STEC) were isolated and certified between 1 January 2009 - 31 December 2019. Antibiotic susceptibility testing (AST) results were queried and summarized where available. Descriptive statistics were calculated for each organism by specimen source, year, and susceptibility testing availability.
Results
Among a total of 13,852 enteric bacterial isolates, 11,877 (86%) were submitted from CONUS locations. Out of 1479 Shigella spp. and 6755 Salmonella spp. isolates, 1221 (83%) and 5019 (74%), respectively, reported any susceptibility results through the MHS. Overall, only 15% of STEC and 4% of Campylobacter spp. specimens had AST results available. Comparing AST reporting at CONUS versus OCONUS locations, AST was reported for 1175 (83%) and 46 (78%) of Shigella isolates at CONUS and OCONUS locations, respectively, and for 4591 (76%) and 428 (63%) of Salmonella isolates at CONUS and OCONUS locations, respectively.
Conclusions
This study revealed inconsistent enteropathogen AST conducted across the MHS, with differing trends between CONUS and OCONUS locations. Additional work is needed to assess pathogen-specific gaps in testing and reporting to develop optimal surveillance that supports the health of the force.
Funder
Oak Ridge Institute for Science and Education
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health
Reference35 articles.
1. Jones TF, McMillian MB, Scallan E, Frenzen PD, Cronquist AB, Thomas S, et al. A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996-2003. Epidemiol Infect. 2007;135(2):293–301.
2. Brooks KM, Zeighami R, Hansen CJ, McCaffrey RL, Graf PCF, Myers CA. Surveillance for norovirus and enteric bacterial pathogens as etiologies of acute gastroenteritis at U.S. military recruit training centers, 2011-2016. MSMR. 2018;25(8):8–12.
3. LaRocque R, Harris J. Patient education: acute diarrhea in adults (beyond the basics)2020 8 2020. Available from: https://www.uptodate.com/contents/acute-diarrhea-in-adults-beyond-the-basics.
4. CDC. Burden of Norovirus Illness in the U.S. U.S. Department of Health and Human Services: CDC; 2018. Available from: https://www.cdc.gov/norovirus/trends-outbreaks/burden-US.html
5. Porter CK, Olson S, Hall A, Riddle MS. Travelers' diarrhea: an update on the incidence, etiology, and risk in military deployments and similar travel populations. Mil Med. 2017;182(S2):4–10.