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Civil Military Cooperation through the Laboratory Response Network

Prehospital and Disaster Medicine 2017年第S1期18卷 S14-S15页

作者： Stephen A. Morse Bioterrorism Preparedness and Response Program Centers for Disease Control and Prevention Atlanta Georgia USA

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Impact of an Audit and Feedback program on Environmental Cleaning and Disinfection in Critical Access Hospitals and Long-Term Care Facilities

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American Journal of Infection control 2018年第6期46卷 S29-S29页

作者： Regina E. Nailon Jon Nguyen Kate Tyner Philip Carling Teresa Micheels Caitlin Pedati Mark Rupp Michelle Schwedhelm Maureen Tierney Muhammad Salman Ashraf Clinical Nurse Researcher CDC Grants Office Nebraska Medicine Administrator University of Nebraska Medical Center Infection Prevention Lead Nebraska Infection Control Assessment and Promotion Program Nebraska Medicine Hospital Epidemiologist Carney Hospital and Boston University School of Medicine Infection Control Manager Nebraska Medical Center Nebraska Medicine Medical Epidemiologist Nebraska Medicine Nebraska Department of Health and Human Services Professor University of Nebraska Medical Center Executive Director Infection Prevention & Emergency Preparedness Nebraska Medicine Director HAI/AR Program Nebraska DHHS Associate Professor University of Nebraska Medical Center

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Le potentiel inflammatoire du régime alimentaire : un facteur clé impliqué dans la promotion d’un vieillissement en bonne santé

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Nutrition Clinique et Métabolisme 2018年第4期32卷 332-333页

作者： K.E. Assmann M. Adjibade N. Shivappa J.R. Hébert M.D. Wirth M. Touvier T. Akbaraly S. Hercberg P. Galan C. Julia E. Kesse-Guyot Équipe de recherche en épidémiologie nutritionnelle (EREN) UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13 centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité Bobigny France Connecting Health Innovations LLC Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics Arnold School of Public Health University of South Carolina Columbia États-Unis Department of Epidemiology and Public Health University College London Londres Royaume-Uni MMDN EPHE Inserm U1198 université de Montpellier Montpellier Département de Santé publique hôpital Avicenne Bobigny France

Introduction et but de l’étude L’inflammation systémique de bas grade semble être impliquée dans l’étiologie de nombreuses maladies chroniques liées à l’âge, ainsi que dans ...

Introduction et but de l’étude L’inflammation systémique de bas grade semble être impliquée dans l’étiologie de nombreuses maladies chroniques liées à l’âge, ainsi que dans le déclin du fonctionnement physique et cognitif au cours du vieillissement. Pourtant, aucune étude n’a encore étudié l’association entre le potentiel inflammatoire du régime alimentaire et un modèle multidimensionnel du vieillissement en bonne santé (VBS). L’objectif de notre étude était ainsi d’examiner la relation entre le potentiel pro- ou anti-inflammatoire de l’alimentation en milieu de la vie, mesuré par le Dietary Inflammatory Index (DII), et le VBS évalué 13 ans plus tard. Matériel et méthodes Nous avons analysé des données de l’étude ***, qui était initialement un essai randomisé en double-aveugle, testant l’efficacité d’une supplémentation journalière, pendant 8 ans (1994–2002), en vitamines et minéraux antioxydants à doses nutritionnelles sur l’incidence de cancer et de maladies cardiovasculaires. Les données utilisées pour définir le statut du VBS ont été recueillies 5 ans après la fin de l’essai initial, (2007–2009). La population d’étude considérée pour nos recherches était constituée de 2796 participants sans diabète, ni maladies cardiovasculaires ou cancer à l’inclusion (1994–1995). Le VBS a été défini selon 8 critères : l’absence de maladie chronique majeure au cours du suivi, le bon fonctionnement physique et cognitif, l’absence de limitations dans les activités instrumentales de la vie quotidienne, l’absence de symptômes dépressifs, l’absence de limitations dans la vie sociale (liées à la santé), la bonne santé globale perçue et l’absence de douleurs entraînant des limitations du fonctionnement quotidien. Le Dietary Inflammatory Index (DII), a été calculé à partir de données issues d’enregistrements de 24 h (moyenne = 10 enregistrements/sujet entre 1994 et 1996). Afin d’estimer les risques relatifs (RR) caractérisant l’association entre le DII et le VBS, nous avons

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Dietary patterns and cardio-metabolic risk in a population of Guatemalan young adults

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BMC Nutrition 2017年第1期3卷 1-18页

作者： Ford, Nicole D. Jaacks, Lindsay M. Martorell, Reynaldo Mehta, Neil K. Perrine, Cria G. Ramirez-Zea, Manuel Stein, Aryeh D. Nutrition and Health Sciences Program Laney Graduate School Emory University Atlanta GA United States Department of Global Health and Population Harvard T.H. Chan School of Public Health Harvard University Boston MA United States Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA United States Department of Health Management and Policy University of Michigan Ann Arbor MI United States Division of Nutrition Physical Activity and Obesity U.S. Centers for Disease Control and Prevention Atlanta GA United States Incap Research Center for the Prevention of Chronic Diseases (CIIPEC) Institute of Nutrition of Central America and Panama Guatemala City Guatemala Cnr 7007 1518 Clifton Road NE Atlanta 30033 GA United States

Background: Latin America is facing an increasing burden of nutrition-related non-communicable disease. Little is known about dietary patterns in Guatemalan adults and how dietary patterns are associated with cardio-m... 详细信息

Background: Latin America is facing an increasing burden of nutrition-related non-communicable disease. Little is known about dietary patterns in Guatemalan adults and how dietary patterns are associated with cardio-metabolic disease (CMD) risk. Methods: This analysis is based on data from a 2002-04 follow-up study of the INCAP Nutrition Supplementation Trial Longitudinal Cohort. Diet data were collected using a validated, semi-quantitative food frequency questionnaire. We derived dietary patterns using principal components analysis. CMD risk was assessed by anthropometry (body mass index, waist circumference), biochemistry (fasting blood glucose and lipids), and clinical (blood pressure) measures. We used sex-stratified multivariable log binomial models to test associations between dietary pattern tertile and CMD risk factors. The sample included 1428 participants (681 men and 747 women) ages 25-43 years. Results: We derived three dietary patterns (traditional, meat-based modern, and starch-based modern), collectively explaining 24.2% of variance in the diet. Dietary patterns were not associated with most CMD risk factors;however, higher starch-based modern tertiles were associated with increased prevalence of low highdensity lipoprotein cholesterol (HDL-c) in men (Prevalence Ratio (PR) 1.17, 95% Confidence Interval (CI) 1.01, 1.20 for tertile 2;PR 1.20, 95% CI 1.00, 1.44 for tertile 3;p trend 0.04). Higher traditional tertiles were associated with increased prevalence of abdominal obesity in women (PR 1.24, 95% CI 1.07, 1.43 for tertile 2;PR 1.19, 95% CI 1.02, 1.39 for tertile 3;p trend 0.02) but marginally significant reduced prevalence of low HDL-c in men (PR 0.88, 95% CI 0.76, 1.00 for tertile 2;PR 0.85, 95% CI 0.72, 1.00 for tertile 3;p trend 0.05). Conclusion: Our findings suggest the presence of two 'modern' dietary patterns in Guatemala - one of which was associated with increased prevalence of low HDL-c in men. The association between the traditional dieta

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Correction to: 2021 Taxonomic update of phylum Negarnaviricota (Riboviria: Orthornavirae), including the large orders Bunyavirales and Mononegavirales

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Archives of virology 2021年第12期166卷 3567-3579页

作者： Jens H Kuhn Scott Adkins Bernard R Agwanda Rim Al Kubrusli Sergey V Alkhovsky Gaya K Amarasinghe Tatjana Avšič-Županc María A Ayllón Justin Bahl Anne Balkema-Buschmann Matthew J Ballinger Christopher F Basler Sina Bavari Martin Beer Nicolas Bejerman Andrew J Bennett Dennis A Bente Éric Bergeron Brian H Bird Carol D Blair Kim R Blasdell Dag-Ragnar Blystad Jamie Bojko Wayne B Borth Steven Bradfute Rachel Breyta Thomas Briese Paul A Brown Judith K Brown Ursula J Buchholz Michael J Buchmeier Alexander Bukreyev Felicity Burt Carmen Büttner Charles H Calisher Mengji Cao Inmaculada Casas Kartik Chandran Rémi N Charrel Qi Cheng Yuya Chiaki Marco Chiapello Il-Ryong Choi Marina Ciuffo J Christopher S Clegg Ian Crozier Elena Dal Bó Juan Carlos de la Torre Xavier de Lamballerie Rik L de Swart Humberto Debat Nolwenn M Dheilly Emiliano Di Cicco Nicholas Di Paola Francesco Di Serio Ralf G Dietzgen Michele Digiaro Olga Dolnik Michael A Drebot J Felix Drexler William G Dundon W Paul Duprex Ralf Dürrwald John M Dye Andrew J Easton Hideki Ebihara Toufic Elbeaino Koray Ergünay Hugh W Ferguson Anthony R Fooks Marco Forgia Pierre B H Formenty Jana Fránová Juliana Freitas-Astúa Jingjing Fu Stephanie Fürl Selma Gago-Zachert George Fú Gāo María Laura García Adolfo García-Sastre Aura R Garrison Thomas Gaskin Jean-Paul J Gonzalez Anthony Griffiths Tony L Goldberg Martin H Groschup Stephan Günther Roy A Hall John Hammond Tong Han Jussi Hepojoki Roger Hewson Jiang Hong Ni Hong Seiji Hongo Masayuki Horie John S Hu Tao Hu Holly R Hughes Florian Hüttner Timothy H Hyndman M Ilyas Risto Jalkanen Dàohóng Jiāng Gilda B Jonson Sandra Junglen Fujio Kadono Karia H Kaukinen Michael Kawate Boris Klempa Jonas Klingström Gary Kobinger Igor Koloniuk Hideki Kondō Eugene V Koonin Mart Krupovic Kenji Kubota Gael Kurath Lies Laenen Amy J Lambert Stanley L Langevin Benhur Lee Elliot J Lefkowitz Eric M Leroy Shaorong Li Longhui Li Jiànróng Lǐ Huazhen Liu Igor S Lukashevich Piet Maes William Marciel de Souza Marco Marklewitz Sergio H Marshall Shin-Yi L Marzano Se Integrated Research Facility at Fort Detrick National Institute of Allergy and Infectious Diseases National Institutes of Health Frederick MD USA. kuhnjens@mail.nih.gov. United States Department of Agriculture Agricultural Research Service US Horticultural Research Laboratory Fort Pierce FL USA. Zoology Department National Museums of Kenya Nairobi Kenya. Jomo Kenyatta University of Agriculture & Technology Nairobi Kenya. Division Phytomedicine Faculty of Life Sciences Humboldt-Universität zu Berlin Berlin Germany. D.I. Ivanovsky Institute of Virology of N.F. Gamaleya National Center on Epidemiology and Microbiology of Ministry of Health of Russian Federation Moscow Russia. Department of Pathology and Immunology Washington University School of Medicine St. Louis MO USA. Faculty of Medicine University of Ljubljana Ljubljana Slovenia. Centro de Biotecnología y Genómica de Plantas Universidad Politécnica de Madrid-Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria Campus de Montegancedo Pozuelo de Alarcón Madrid Spain. Departamento de Biotecnología-Biología Vegetal Escuela Técnica Superior de Ingeniería Agronómica Alimentaria y de Biosistemas Universidad Politécnica de Madrid Madrid Spain. Center for Ecology of Infectious Diseases Department of Infectious Diseases Department of Epidemiology and Biostatistics Insitute of Bioinformatics University of Georgia Athens GA USA. Institute of Novel and Emerging Infectious Diseases Friedrich-Loeffler-Institut Federal Research Institute for Animal Health Greifswald-Insel Riems Germany. Department of Biological Sciences Mississippi State University Mississippi State MS USA. Center for Microbial Pathogenesis Institute for Biomedical Sciences Georgia State University Atlanta GA USA. Edge BioInnovation Consulting and Mgt Frederick MD USA. Institute of Diagnostic Virology Friedrich-Loeffler-Institut Greifswald-Insel Riems Germany. UFyMA INTA-CONICET Cordoba Argentina. Genomics and Bioinformatics D

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1230. Epidemiology and Risk Factors for Recurrent Invasive Methicillin-ResistantStaphylococcus aureusInfection: nine US States, 2006–2013

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S373–S374页

作者： Kracalik, Ian Jackson, Kelly Nadle, Joelle Bamberg, Wendy Petit, Susan Ray, Susan M Lynfield, Ruth Harrison, Lee H Townes, John M Dumyati, Ghinwa Schaffner, William Lake, Jason See, Isaac Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia California Emerging Infections Program Oakland California Colorado Department of Public Health and Environment Denver Colorado Connecticut Department of Public Health New Haven Connecticut Emory University School of Medicine Atlanta Georgia State Epidemiologist and Medical Director for Infectious Diseases Epidemiology and Community Health Minnesota Department of Health St. Paul Minnesota University of Pittsburgh Pittsburgh Pennsylvania Infectious Diseases Oregon Health and Science University Portland Oregon NY Emerging Infections Program Center for Community Health and Prevention University of Rochester Medical Center Rochester New York Vanderbilt University School of Medicine Nashville Tennessee Centers For Disease Control and Prevention Atlanta Georgia

BackgroundMethicillin-resistantStaphylococcus aureus(MRSA) causes >70,000 invasive infections annually in the United States, and recurrent infections pose a major clinical challenge. We examined risk factors for re...

Background Methicillin-resistant Staphylococcus aureus (MRSA) causes >70,000 invasive infections annually in the United States, and recurrent infections pose a major clinical challenge. We examined risk factors for recurrent MRSA infections. Methods We identified patients with an initial invasive MRSA infection (isolation from a normally sterile body site) from 2006 to 2013, through active, population-based surveillance in selected counties in nine states through the Emerging Infections program. Recurrence was defined as invasive MRSA isolation >30 days after initial isolation. We used logistic regression with backwards selection to evaluate adjusted odds ratios (aOR) associated with recurrence within 180 days, prior healthcare exposures, and initial infection type, controlling for patient demographics and comorbidities. Results Among 24,478 patients with invasive MRSA, 3,976 (16%) experienced a recurrence, including 61% (2,438) within 180 days. Risk factors for recurrence were: injection drug use (IDU) (aOR; 1.38, 95% confidence interval [CI]: 1.15–1.65), central venous catheters (aOR; 1.35, 95% CI: 1.22–1.51), dialysis (aOR; 2.00, 95% CI: 1.74–2.31), and history of MRSA colonization (aOR; 1.35, 95% CI: 1.22–1.51) (figure). Recurrence was more likely for bloodstream infections (BSI) without another infection (aOR; 2.08, 95% CI: 1.74–2.48), endocarditis (aOR; 1.46, 95% CI: 1.16–1.55), and bone/joint infections (aOR; 1.38, 95% CI: 1.20–1.59), and less likely for pneumonia (aOR: 0.75, 95% CI: 0.64–0.89), compared with other initial infection types. When assessed separately, the presence of a secondary BSI with another infection increased the odds of recurrence over that infection without a BSI (aOR: 1.96, 95% CI: 1.68–2.30). Conclusion Approximately one in six persons with invasive MRSA infection had recurrence. We identified potential opportunities to prevent recurrence through infection control (e.g., management and early removal of central catheters). Other possibl

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1860. Small State, Big Collaboration: Creation of First New Hampshire Statewide Antibiogram Guides Stewardship Efforts

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S531–S531页

作者： Leeman, Hannah Chan, Benjamin Hansen, Katrina Talbot, Elizabeth Zimmermann, Carly Calderwood, Michael Dave, Apara Santos, Paul Bureau of Infectious Disease Control New Hampshire Department of Health and Human Services Concord New Hampshire Public Health Associates Program Centers for Disease Control and Prevention Concord New Hampshire Infectious Disease and International Health Dartmouth Hitchcock Medical Center Lebanon New Hampshire Exeter Hospital Exeter New Hampshire Lakes Region General Hospital Laconia New Hampshire

BackgroundAntibiotic-resistant infections have been identified as an urgent national health threat. In response, the New Hampshire Division of Public Health Services (DPHS) sought to develop a system for tracking anti...

Background Antibiotic-resistant infections have been identified as an urgent national health threat. In response, the New Hampshire Division of Public Health Services (DPHS) sought to develop a system for tracking antibiotic resistance statewide through use of hospital antibiograms to (1) proactively monitor resistance trends over time and geographic region, (2) promote antimicrobial stewardship in NH healthcare facilities, and (3) provide a tool for providers to help guide appropriate antibiotic prescribing. Methods Through statutory legislative authority, DPHS requires hospital laboratories to report antibiogram data annually. DPHS formed an advisory group, consisting of infectious disease, medical and pharmacy subject matter experts to develop a standardized data collection tool. DPHS validated reported data to confirm accuracy, and clarify aberrant data by comparing the susceptibilities among all hospitals. Any questionable data were verified with the respective laboratory. The combined data were reviewed by the clinical advisory group and recommendations were created from the antibiogram data to highlight appropriate antibiotic prescribing and the need for coordinated stewardship. The antibiogram and clinical recommendations were disseminated widely throughout the state. Results All 26 hospitals in New Hampshire submitted data. A total of 42,519 and 21,306 bacteria were cultured from urine and non-urine sources, respectively. The clinical advisory group’s recommendations included interpretations and antibiotic therapy directives for common clinical syndromes. Dissemination was accomplished through a health alert, partnership with a state working group of stakeholders, widespread email communication and online publication. Conclusion The small size of New Hampshire, centralized public health structure, and close working relationships with all hospitals allowed for efficient collection of these data. Our process may serve as a model for other states, and will inf

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Frequently Identified Infection prevention and control Gaps in Critical Access Hospitals

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American Journal of Infection control 2018年第6期46卷 S15-S15页

作者： Margaret Drake Regina E. Nailon Kate Tyner Sue Beach Teresa Fitzgerald Elizabeth Lyden Mark Rupp Michelle Schwedhelm Maureen Tierney Muhammad Salman Ashraf State HAI Infection Preventionist Nebraska DHHS/Nebraska Medicine Clinical Nurse Researcher CDC Grants Office Nebraska Medicine Infection Prevention Lead Nebraska Infection Control Assessment and Promotion Program Nebraska Medicine Administrative Senior Assistant Nebraska Medicine Infection Preventionist Nebraska ICAP Program Nebraska Medicine Associate Director Center for Collaboration on Research Design and Analysis UNMC Professor University of Nebraska Medical Center Executive Director Infection Prevention & Emergency Preparedness Nebraska Medicine Director HAI/AR Program Nebraska DHHS Associate Professor University of Nebraska Medical Center

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Author Correction: Evidence for SARS-CoV-2 related coronaviruses circulating in bats and pangolins in Southeast Asia

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Nature communications 2021年第1期12卷 1430页

作者： Supaporn Wacharapluesadee Chee Wah Tan Patarapol Maneeorn Prateep Duengkae Feng Zhu Yutthana Joyjinda Thongchai Kaewpom Wan Ni Chia Weenassarin Ampoot Beng Lee Lim Kanthita Worachotsueptrakun Vivian Chih-Wei Chen Nutthinee Sirichan Chanida Ruchisrisarod Apaporn Rodpan Kirana Noradechanon Thanawadee Phaichana Niran Jantarat Boonchu Thongnumchaima Changchun Tu Gary Crameri Martha M Stokes Thiravat Hemachudha Lin-Fa Wang Thai Red Cross Emerging Infectious Diseases Health Science Centre WHO Collaborating Centre for Research and Training on Viral Zoonoses King Chulalongkorn Memorial Hospital Faculty of Medicine Chulalongkorn University Bangkok Thailand. Programme in Emerging Infectious Diseases Duke-NUS Medical School Singapore Singapore. Department of National Parks Wildlife and Plant Conservation Ministry of Natural Resources and Environment Bangkok Thailand. Forest Biology Department Faculty of Forestry Kasetsart University Bangkok Thailand. Changchun Veterinary Research Institute Chinese Academy of Agricultural Sciences Changchun China. Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonosis Yangzhou University Yangzhou China. CSIRO Australian Animal Health Laboratory Geelong VIC Australia. Biological Threat Reduction Program Defense Threat Reduction Agency Fort Belvoir VA USA. Thai Red Cross Emerging Infectious Diseases Health Science Centre WHO Collaborating Centre for Research and Training on Viral Zoonoses King Chulalongkorn Memorial Hospital Faculty of Medicine Chulalongkorn University Bangkok Thailand. fmedthm@***. Programme in Emerging Infectious Diseases Duke-NUS Medical School Singapore Singapore. linfa.wang@duke-nus.edu.sg. SingHealth Duke-NUS Global Health Institute Singapore Singapore. linfa.wang@duke-nus.edu.sg.

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1759. High Proportion of Discordant Results in Culture-Independent Diagnostic Tests (CIDT) for Shiga Toxin, Foodborne Disease Active Surveillance Network (FoodNet), 2012−2017

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S61-S61页

作者： Barrett, Kelly A Tack, Danielle Medus, Carlota Garman, Katie N Dunn, John Hurd, Sharon Hatch, Julie Parada, Karleys Wilson, Siri Wilson, Elisha Wymore, Kathryn Griffin, Patricia M Geissler, Aimee L National Center for Emerging and Zoonotic Infectious Diseases Division of Foodborne Waterborne and Environmental Diseases Centers for Disease Control and Prevention Atlanta Georgia Centers for Disease Control and Prevention Atlanta Georgia Minnesota Dept Health St. Paul Minnesota Tennessee Department of Health Nashville Tennessee Division of Communicable and Environmental Diseases and Emergency Preparedness Tennessee Department of Health Nashville Tennessee CT EIP New Haven CT OR Dept of Human Services Portland Oregon Georgia Emerging Infections Program Atlanta Georgia Georgia Department of Public Health Atlanta Georgia Colorado Department of Public Health and Environmental Denver Colorado California Emerging Infections Program Oakland California Division of Foodborne Waterborne and Environmental Diseases CDC Atlanta Georgia National Center for Emerging Zoonotic Infectious Diseases Division of Foodborne Waterborne and Environmental Diseases Centers for Disease Control and Prevention Atlanta Georgia

BackgroundFoodNet conducts active laboratory-based surveillance for 9 pathogens transmitted commonly through food, including Shiga toxin-producingE. coli(STEC). Adoption of CIDTs has allowed for rapid identification o...

Background FoodNet conducts active laboratory-based surveillance for 9 pathogens transmitted commonly through food, including Shiga toxin-producing E. coli (STEC). Adoption of CIDTs has allowed for rapid identification of Shiga toxin or Shiga toxin genes, but incorporating multiple test results with differing sensitivity and specificity complicates treatment decisions and public health surveillance. Between 2007 and 2017, FoodNet reported increases in the use of CIDTs and decreases in rates of confirmation by culture. Methods We examined STEC cases reported to FoodNet during 2012−2017 with a positive immunoassay (IA) or polymerase chain reaction (PCR) test performed at a clinical laboratory, followed by positive or negative test at a state public health laboratory. Three test type combinations were assessed (IA/IA, PCR/PCR, and IA/PCR) by state, symptoms, test discordance, and culture (cx) result. Results During 2012 − 2017, 8,298 (76% of all STEC reported) specimens were tested by IA or PCR at both a clinical and a public health laboratory, 58% by IA/PCR, 27% by IA/IA, and 25% by PCR/PCR; some specimens had more than one test at each laboratory. Among these, 8,132 (98%) were also tested by cx. Among the IA/PCR test results, 20% were discordant and 75% of these were cx-negative. Even more of IA/IA (27%) and PCR/PCR (24%) results were discordant, and 75% of these were cx-negative. A median of 24% of test results were discordant (range by state, 13%–44%). Persons with discordant test results were less likely to have diarrhea (91% vs. 97%) and bloody diarrhea (33% vs. 57%). During 2012–2017, discordant results increased for IA/PCR (14% to 22%), IA/IA (17% to 34%), and PCR/PCR (6% to 25%). Most (85%) specimens with discordant results were cx-negative and 8% did not have a cx. Conclusion Almost a quarter of results were discordant, with marked variation by state, and most of these infections could not be confirmed by culture at the public health laboratory. Discordant re

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