#Seroprevalence of #SARS-CoV-2–Specific #Antibodies Among Adults in #LA County, #California, on April 10-11, 2020 (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

Seroprevalence of SARS-CoV-2–Specific Antibodies Among Adults in Los Angeles County, California, on April 10-11, 2020

Neeraj Sood, PhD1; Paul Simon, MD2; Peggy Ebner, BA3; et al. Daniel Eichner, PhD4; Jeffrey Reynolds, MA5; Eran Bendavid, MD6; Jay Bhattacharya, MD, PhD6

Author Affiliations: 1 Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles; 2 Los Angeles County Department of Public Health, Los Angeles, California; 3 Keck School of Medicine, University of Southern California, Los Angeles; 4 Sports Medicine Research and Testing Laboratory, Salt Lake City, Utah; 5 LRW Group, Los Angeles, California; 6 Stanford University School of Medicine, Palo Alto, California

JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8279

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Inadequate knowledge about the extent of the coronavirus disease 2019 (COVID-19) epidemic challenges public health response and planning. Most reports of confirmed cases rely on polymerase chain reaction–based testing of symptomatic patients.1 These estimates of confirmed cases miss individuals who have recovered from infection, with mild or no symptoms, and individuals with symptoms who have not been tested due to limited availability of tests. We conducted serologic tests in a community sample to estimate cumulative incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as serologic tests identify both active and past infections.

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Keywords: SARS-CoV-2; COVID-19; Serology; Seroprevalence; California; USA.

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Characteristics and #Outcomes of #Coronavirus Disease Patients under #Nonsurge #Conditions, Northern #California, #USA, March–April 2020 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 8—August 2020 | Synopsis

Characteristics and Outcomes of Coronavirus Disease Patients under Nonsurge Conditions, Northern California, USA, March–April 2020

Jessica Ferguson1, Joelle I. Rosser1, Orlando Quintero, Jake Scott, Aruna Subramanian, Mohammad Gumma, Angela Rogers, and Shanthi Kappagoda

Author affiliations: Stanford Health Care, Stanford, California, USA (J. Ferguson, J.I. Rosser, O. Quintero, J. Scott, A. Subramanian, A. Rogers, S. Kappagoda); Stanford University, Stanford (M. Gumma)

 

Abstract

Limited data are available on the clinical presentation and outcomes of coronavirus disease (COVID-19) patients in the United States hospitalized under normal-caseload or nonsurge conditions. We retrospectively studied 72 consecutive adult patients hospitalized with COVID-19 in 2 hospitals in the San Francisco Bay area, California, USA, during March 13–April 11, 2020. The death rate for all hospitalized COVID-19 patients was 8.3%, and median length of hospitalization was 7.5 days. Of the 21 (29% of total) intensive care unit patients, 3 (14.3% died); median length of intensive care unit stay was 12 days. Of the 72 patients, 43 (59.7%) had underlying cardiovascular disease and 19 (26.4%) had underlying pulmonary disease. In this study, death rates were lower than those reported from regions of the United States experiencing a high volume of COVID-19 patients.

Keywords: SARS-CoV-2; COVID-19; USA; California.

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#Identification and #Monitoring of #International #Travelers During the Initial Phase of an #Outbreak of #COVID19 — #California, February 3–March 17, 2020 (MMWR Morb Mortal Wkly Rep., abstract9

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Identification and Monitoring of International Travelers During the Initial Phase of an Outbreak of COVID-19 — California, February 3–March 17, 2020

Early Release / May 11, 2020 / 69

Jennifer F. Myers, MPH1; Robert E. Snyder, PhD1; Charsey Cole Porse, PhD1; Selam Tecle, MPH1; Phil Lowenthal, MPH1; Mary E. Danforth, PhD1; Edward Powers, DVM1; Amanda Kamali, MD1; Seema Jain, MD1; Curtis L. Fritz, DVM, PhD1; Shua J. Chai, MD1,2; Traveler Monitoring Team

Corresponding author: Shua J. Chai, shua.chai@cdph.ca.gov, 510-412-4679.

1 Division of Communicable Disease Control, California Department of Public Health; 2 Career Epidemiology Field Officer, Center for Preparedness and Response, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Myers JF, Snyder RE, Porse CC, et al. Identification and Monitoring of International Travelers During the Initial Phase of an Outbreak of COVID-19 — California, February 3–March 17, 2020. MMWR Morb Mortal Wkly Rep. ePub: 11 May 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e4

 

Summary

  • What is already known about this topic?
    • To reduce introductions of COVID-19 into the United States, travelers from selected countries were screened upon entry, and their contact information forwarded to states for monitoring.
  • What is added by this report?
    • During February 3–March 17, 2020, California received, corrected, and transmitted information on 11,574 travelers to local health jurisdictions for follow-up. Three travelers were matched to three of the 26,182 patients with COVID-19 reported to California by April 15.
  • What are the implications for public health practice?
    • Monitoring travelers was labor-intensive and limited by incomplete information, volume of travelers, and potential for asymptomatic transmission. Health departments need to weigh the resources needed for monitoring against those needed for implementing mitigation activities during the COVID-19 pandemic.

 

Abstract

The threat of introduction of coronavirus disease 2019 (COVID-19) into the United States with the potential for community transmission prompted U.S. federal officials in February 2020 to screen travelers from China, and later Iran, and collect and transmit their demographic and contact information to states for follow-up. During February 5–March 17, 2020, the California Department of Public Health (CDPH) received and transmitted contact information for 11,574 international travelers to 51 of 61 local health jurisdictions at a cost of 1,694 hours of CDPH personnel time. If resources permitted, local health jurisdictions contacted travelers, interviewed them, and oversaw 14 days of quarantine, self-monitoring, or both, based on CDC risk assessment criteria for COVID-19. Challenges encountered during follow-up included errors in the recording of contact information and variation in the availability of resources in local health jurisdictions to address the substantial workload. Among COVID-19 patients reported to CDPH, three matched persons previously reported as travelers to CDPH. Despite intensive effort, the traveler screening system did not effectively prevent introduction of COVID-19 into California. Effectiveness of COVID-19 screening and monitoring in travelers to California was limited by incomplete traveler information received by federal officials and transmitted to states, the number of travelers needing follow-up, and the potential for presymptomatic and asymptomatic transmission. More efficient methods of collecting and transmitting passenger data, including electronic provision of flight manifests by airlines to federal officials and flexible text-messaging tools, would help local health jurisdictions reach out to all at-risk travelers quickly, thereby facilitating timely testing, case identification, and contact investigations. State and local health departments should weigh the resources needed to implement incoming traveler monitoring against community mitigation activities, understanding that the priorities of each might shift during the COVID-19 pandemic.

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Keywords: SARS-CoV-2; COVID-19; USA; California; Traveler Health.

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Characteristics of Hospitalized Adults With #COVID19 in an Integrated Health Care System in #California (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California

Laura C. Myers, MD, MPH1; Stephen M. Parodi, MD1; Gabriel J. Escobar, MD1; et al. Vincent X. Liu, MD1

Author Affiliations: 1 The Permanente Medical Group, Kaiser Permanente Northern California, Oakland

JAMA. Published online April 24, 2020. doi:10.1001/jama.2020.7202

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Coronavirus disease 2019 (COVID-19) has resulted in increased hospital and intensive care unit (ICU) use. In the United States, few reports have characterized patients treated outside of the ICU.1 Northern California was an early epicenter of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community transmission in the United States. We report hospitalization and ICU admissions from Kaiser Permanente Northern California (KPNC), a regional integrated health care system serving 4.4 million members, constituting 30% of the area’s insured population.

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Keywords: SARS-CoV-2; COVID-19; USA; California; Intensive care.

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#Transmission of #COVID19 to #HCWs During #Exposures to a Hospitalized #Patient — Solano County, #California, February 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County, California, February 2020

Early Release / April 14, 2020 / 69

Amy Heinzerling, MD1,2; Matthew J. Stuckey, PhD3; Tara Scheuer, MPH4; Kerui Xu, PhD2,3; Kiran M. Perkins, MD3; Heather Resseger, MSN5; Shelley Magill, MD, PhD3; Jennifer R. Verani, MD3; Seema Jain, MD1; Meileen Acosta, MPH4; Erin Epson, MD1

Corresponding author: Amy Heinzerling, ysf8@cdc.gov, 510-620-3711.

1 California Department of Public Health; 2 Epidemic Intelligence Service, CDC; 3 CDC COVID-19 Response Team; 4 Solano County Public Health, Fairfield, California; 5 NorthBay Healthcare, Fairfield, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Heinzerling A, Stuckey MJ, Scheuer T, et al. Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep. ePub: 14 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6915e5

 

Summary

  • What is already known about this topic?
    • Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.
  • What is added by this report?
    • Among 121 HCP exposed to a patient with unrecognized COVID-19, 43 became symptomatic and were tested for SARS-CoV-2, of whom three had positive test results; all three had unprotected patient contact. Exposures while performing physical examinations or during nebulizer treatments were more common among HCP with COVID-19.
  • What are the implications for public health practice?
    • Unprotected, prolonged patient contact, as well as certain exposures, including some aerosol-generating procedures, were associated with SARS-CoV-2 infection in HCP. Early recognition and isolation of patients with possible infection and recommended PPE use can help minimize unprotected, high-risk HCP exposures and protect the health care workforce.

 

Abstract

On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient’s transfer to hospital B, a real-time reverse transcription–polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.

Keywords: SARS-CoV-2; COVID-19; HCWs; PPE; USA; California.

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Rapid #Sentinel #Surveillance for #COVID19 — Santa Clara County, #California, March 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Rapid Sentinel Surveillance for COVID-19 — Santa Clara County, California, March 2020

Early Release / April 3, 2020 / 69

Marissa L. Zwald, PhD1; Wen Lin, MD, PhD2; Gail L. Sondermeyer Cooksey, MPH3; Charles Weiss, MD4; Angela Suarez, MD5; Marc Fischer, MD1; Brandon J. Bonin, MS2; Seema Jain, MD3; Gayle E. Langley, MD1; Benjamin J. Park, MD1; Danielle Moulia, MPH1; Rory Benedict4; Nang Nguyen, PhD5; George S. Han, MD2

Corresponding author: Marissa L. Zwald, MZwald@cdc.gov, 404-498-5774.

1 Santa Clara County COVID-19 Response Field Team, CDC; 2 County of Santa Clara Public Health Department, San Jose, California; 3 California Department of Public Health, Richmond, California; 4 Palo Alto Medical Foundation, Palo Alto, California; 5Santa Clara Valley Medical Center, San Jose, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Zwald ML, Lin W, Sondermeyer Cooksey GL, et al. Rapid Sentinel Surveillance for COVID-19 — Santa Clara County, California, March 2020. MMWR Morb Mortal Wkly Rep. ePub: 3 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6914e3

 

Summary

  • What is already known about this topic?
    • On February 27, 2020, Santa Clara County, California, identified its first case of coronavirus disease 2019 (COVID-19) associated with probable community transmission.
  • What is added by this report?
    • During March 5–14, among patients with respiratory symptoms evaluated at one of four Santa Clara County urgent care centers serving as sentinel surveillance sites, 23% had positive test results for influenza. Among a subset of patients with negative test results for influenza, 11% had positive test results for COVID-19.
  • What are the implications for public health practice?
    • COVID-19 cases identified through this sentinel surveillance system helped confirm community transmission in the county. Local health departments can use sentinel surveillance to understand the level of community transmission of COVID-19 and to better guide the selection and implementation of community mitigation measures.

 

Abstract

On February 27, 2020, the Santa Clara County Public Health Department (SCCPHD) identified its first case of coronavirus disease 2019 (COVID-19) associated with probable community transmission (i.e., infection among persons without a known exposure by travel or close contact with a patient with confirmed COVID-19). At the time the investigation began, testing guidance recommended focusing on persons with clinical findings of lower respiratory illness and travel to an affected area or an epidemiologic link to a laboratory-confirmed COVID-19 case, or on persons hospitalized for severe respiratory disease and no alternative diagnosis (1). To rapidly understand the extent of COVID-19 in the community, SCCPHD, the California Department of Public Health (CDPH), and CDC began sentinel surveillance in Santa Clara County. During March 5–14, 2020, four urgent care centers in Santa Clara County participated as sentinel sites. For this investigation, county residents evaluated for respiratory symptoms (e.g., fever, cough, or shortness of breath) who had no known risk for COVID-19 were identified at participating urgent care centers. A convenience sample of specimens that tested negative for influenza virus was tested for SARS-CoV-2 RNA. Among 226 patients who met the inclusion criteria, 23% had positive test results for influenza. Among patients who had negative test results for influenza, 79 specimens were tested for SARS-CoV-2, and 11% had evidence of infection. This sentinel surveillance system helped confirm community transmission of SARS-CoV-2 in Santa Clara County. As a result of these data and an increasing number of cases with no known source of transmission, the county initiated a series of community mitigation strategies. Detection of community transmission is critical for informing response activities, including testing criteria, quarantine guidance, investigation protocols, and community mitigation measures (2). Sentinel surveillance in outpatient settings and emergency departments, implemented together with hospital-based surveillance, mortality surveillance, and serologic surveys, can provide a robust approach to monitor the epidemiology of COVID-19.

Keywords: SARS-CoV-2; COVID-19; USA; California.

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#Community #Prevalence of #SARS-CoV-2 Among Patients With #Influenza-like Illnesses Presenting to a #LA Medical Center in March 2020 (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

Community Prevalence of SARS-CoV-2 Among Patients With Influenzalike Illnesses Presenting to a Los Angeles Medical Center in March 2020

Brad Spellberg, MD1; Meredith Haddix, MPH2; Rebecca Lee, MPH2; et al. Susan Butler-Wu, PhD1; Paul Holtom, MD1; Hal Yee, MD, PhD3; Prabhu Gounder, MD2

Author Affiliations: 1 Los Angeles County + University of Southern California Medical Center, Los Angeles; 2 Los Angeles County Department of Public Health, Los Angeles, California; 3 Los Angeles County Department of Health Services, Los Angeles, California

JAMA. Published online March 31, 2020. doi:10.1001/jama.2020.4958

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Until recently, diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), was only available through public health laboratories.1-3 This limited testing was prioritized for persons who had severe illness or identifiable risk factors, such as travel to an area with ongoing transmission. Thus, the incidence of community transmission by persons with mild illness and without risk factors remains ill-defined.

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Section Editor: Jody W. Zylke, MD, Deputy Editor.

Corresponding Author: Brad Spellberg, MD, Los Angeles County + University of Southern California Medical Center, 2051 Marengo St, Los Angeles, CA 90033 (bspellberg@dhs.lacounty.gov).

Published Online: March 31, 2020. doi:10.1001/jama.2020.4958

Author Contributions: Dr Spellberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Spellberg, Haddix, Holtom, Yee, Gounder.

Acquisition, analysis, or interpretation of data: Spellberg, Haddix, Lee, Butler-Wu, Holtom, Gounder.

Drafting of the manuscript: Spellberg, Gounder.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Gounder.

Administrative, technical, or material support: All authors.

Supervision: Spellberg, Holtom, Yee, Gounder.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We acknowledge the tireless surveillance efforts of Bessie Hwang, MD, MPH, and Emily Kajita, MS, MPH (both with the Department of Public Health Acute Communicable Disease Control Syndromic Surveillance Unit), and Elizabeth Traub, MPH (with the Department of Public Health Acute Communicable Disease Control Syndromic Respiratory Diseases Unit). None received additional compensation beyond salary.

Keywords: SARS-CoV-2; COVID-19; USA; California.

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#Carbapenem and #Cephalosporin #Resistance among #Enterobacteriaceae in #Healthcare-Associated #Infections, #California, #USA (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 7—July 2019 / Dispatch

Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA1

Kyle Rizzo  , Sam Horwich-Scholefield, and Erin Epson

Author affiliations: California Department of Public Health, Richmond, California, USA

 

Abstract

We analyzed antimicrobial susceptibility test results reported in healthcare-associated infections by California hospitals during 2014–2017. Approximately 3.2% of Enterobacteriaceae reported in healthcare-associated infections were resistant to carbapenems and 26.9% were resistant to cephalosporins. The proportion of cephalosporin-resistant Escherichia coli increased 7% (risk ratio 1.07, 95% CI 1.04–1.11) per year during 2014–2017.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Cephalosporins; Nosocomial Outbreraks; California; USA.

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#Plague in #SanFrancisco: #rats, #racism and #reform (Nature, summary)

[Source: Nature, full page: (LINK). Summary, edited.]

Plague in San Francisco: rats, racism and reform

Tilli Tansey

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An urban outbreak of a deadly infectious disease with no known cause is a disaster planner’s worst nightmare. In his rousing book Black Death at the Golden Gate, journalist David Randall describes just that: the bubonic-plague epidemic that struck San Francisco, California, in 1900. The race to identify, isolate and halt the disease is set against a rich background of official complacency, financial malfeasance, political intrigues and scientific disputes.

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Nature 568, 454-455 (2019) / doi: 10.1038/d41586-019-01239-x

Keywords: Plague; USA; California; History.

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#Antimicrobial susceptibility of 260 #Clostridium botulinum types A, B, Ba and Bf strains and a #neurotoxigenic Clostridium baratii type F strain isolated from #California infant #botulism patients (AAC, abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Antimicrobial susceptibility of 260 Clostridium botulinum types A, B, Ba and Bf strains and a neurotoxigenic Clostridium baratii type F strain isolated from California infant botulism patients

Jason R. Barash, Joe B. Castles, III, Stephen S. Arnon

DOI: 10.1128/AAC.01594-18

 

ABSTRACT

Infant botulism is an infectious intestinal toxemia that results from colonization of the infant large bowel by Clostridium botulinum (or rarely, by neurotoxigenic C. baratii or C. butyricum), with subsequent intraintestinal production and absorption of botulinum neurotoxin that then produces flaccid paralysis. The disease is often initially misdiagnosed as suspected sepsis or meningitis, diagnoses that require prompt empiric antimicrobial therapy. Antibiotics may also be needed to treat infectious complications of infant botulism, such as pneumonia or urinary tract infection. Clinical evidence suggests (see included case report) that broad-spectrum antibiotics that are eliminated by biliary excretion may cause progression of the patient’s paralysis by lysing C. botulinum vegetative cells in the large bowel lumen and thereby increasing the amount of botulinum neurotoxin available for absorption. The purpose of this antimicrobial susceptibility study was to identify an antimicrobial agent with little or no activity against C. botulinum that could be used to treat infant botulism patients initially diagnosed with suspected sepsis or meningitis, or who acquired secondary infections, without lysing C. botulinum. Testing of 12 antimicrobial agents indicated that almost all California infant botulism patient isolates are susceptible to most clinically utilized antibiotics and are also susceptible to newer antibiotics not previously tested against large numbers of C. botulinum patient isolates. No antibiotic with little or no activity against C. botulinum was identified. These findings reinforce the importance of promptly treating infant botulism patients with Human Botulism Immune Globulin (BIG-IV; BabyBIG®).

Copyright © 2018 American Society for Microbiology. All Rights Reserved.

Keywords: Infant botulism; Antibiotics; USA; California; Clostridium botulinum.

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