APHL 2020 POSTER ABSTRACTS
Infectious Disease endocarditis or meningitis . Due to increasing antibiotic resistance for N . gonorrhea , CDC has classified drug-resistant cases to be an urgent threat in the 2019 antibiotic resistant threats report . Currently , there is no routine surveillance for N . gonorrhea DGI cases in Michigan .
Methods : Since August 2019 , there have been 16 DGI cases in Michigan associated with an ongoing investigation . Whole genome sequencing was performed on a total of 22 N . gonorrhea isolates ; ten isolates from the ongoing investigation , ten additional DGI and N . gonorrhea cases from 2019 , and two historic isolates from 2018 . Bioinformatic analyses were performed to examine relatedness of isolates based on pan genome and single nucleotide polymorphism ( SNP ) analysis . Extraction of antimicrobial resistance genes and multi-locus sequence typing genes was performed using Abricate .
Results : Phylogenetic trees based on pan genome and SNP analysis identified two clusters of isolates . A large cluster of 11 related isolates that were 0-20 SNP different and a smaller cluster of four isolates with 0-6 SNP difference . Within the large cluster , ten isolates are part of the ongoing investigation and were typed as ST- 7822 . Antimicrobial profiles identified a high frequency of penicillin ( 100 %) resistance genes , as well as , resistance genes present for tetracycline ( 4.5 %) and ampicillin ( 18.2 %).
Discussion : This data highlights a rare ongoing outbreak of DGI cases . The relatedness of DGI isolates and the presence of a diverse range of antimicrobial resistance genes supports the need for DGI surveillance and sequencing analysis to help identify cases that should be pursued for epidemiological linkage and monitor the presence of antibiotic resistance genes .
Presenter : Heather Blankenship , Michigan Department of Health and Human Services , Lansing , MI , blankenshiph @ michigan . gov
Increased Prevalence of Bovis Bacille Calmette-Guérin Strain Isolates from Sterile Sites : A 2010 – 2019 Michigan Study
K . McCullor , S . Church , J . Vanneste , R . Kramer , L . Vibber , K . Wells , D . Gard , A . Schooley , N . Balakrishnan , and M . Soehnlen , Michigan Department of Health and Human Services , Lansing , MI
Background : The attenuated Mycobacterium bovis strain Bacille Calmette-Guérin ( BCG ) is widely known as the vaccine strain used for tuberculosis ( TB ) prevention . BCG is also used therapeutically for the treatment of non-muscle invasive bladder cancer . While literature describes disseminated BCG infections as rare phenomenon , there has been an observable increase in isolates cultured from sterile sites such as bone and whole blood submitted to the Michigan Bureau of Laboratories , suggesting dissemination . A BCG isolate retrospective review of laboratory records from 2010 to 2019 was performed in order to determine the prevalence of isolates collected from disseminated cases .
Methods : A BCG disseminated case was defined as a positive culture originating from any site excluding urine or vaccination injection sites ( i . e . arm wound ). Initial identification to the Mycobacterium tuberculosis complex level was performed by HPLC or MALDI-TOF . M . bovis identification was made through biochemical testing of niacin , nitrate reduction , pyrazinamidase , and TCH growth characteristics . The designation of BCG was given when MIRU pattern 2y2324253322 and MIRU2 pattern 051352253205 was observed . Source , age at time of culture , and gender were determined using the information system STARLIMS . If duplicate cultures were submitted , only the first per source type was included .
Results : Within the nine-year retrospective study , 43 BCG isolates were identified . The patient profile was predominantly male ( 41 male and 2 female ) with a median age of 73 ( ranging from 2 to 95 years of age ). Of the 43 isolates , 47 % ( 20 of 43 ) were from disseminated sites such as blood , spinal tissue , and bone . A steady increase in isolates was observed , topping to a total annual number of 9 in 2019 . Interestingly , half of the BCG isolates cultured from disseminated sites occurred within 2018 and 2019 alone . For both years , disseminated infections comprised of 67 % of the total BCG isolates received .
Conclusion : Males are described as having a higher prevalence of non-muscle invasive bladder cancer which likely explains the disproportionately high male representation within the review . An interesting and unexpected find was the rise in disseminated infections particularly within the last two years of the study . This observed phenomenon may be due to multiple factors including an ageing population that may be receiving more bladder cancer treatment . Unfortunately , there was incomplete data as to whether the isolates captured from disseminated sites were from current or prior BCG immunotherapy patients . Other potential explanations include increased usage of immunomodulating biologics that may increase the risk of disseminated BCG in those patients receiving BCG therapeutically . Further work is currently being conducted to gather more patient history data from our retrospective investigation . Overall , our findings emphasize the importance of identifying previous BCG therapy recipients for the consideration of disseminated infection .
Presenter : Kimberly McCullor , Michigan Department of Health and Human Services , Bureau of Laboratories , Lansing , MI , mccullork @ michigan . gov
Molecular Characterization of Neisseria gonorrhoeae Strains in High Prevalence Jurisdiction Exhibits Clonal Lineage with Decreased Susceptibility to Azithromycin
J . Weiner 1 , M . Khubbar 1 , R . Gomez 1 , K . Keuler 1 , H . Hermus 1 , P . Hunter 2 , J . Dalby 2 , L . Amsterdam 3 , T . Dasu 1 , S . Bhattacharyya 1 ; 1 City of Milwaukee Health Department , Milwaukee , WI , 2 University of Wisconsin – Madison , Madison , WI , 3 Wisconsin Division of Public Health , Madison , WI
Background : N . gonorrhoeae ( GC ) has emerged as a global threat with an estimated 550,000 drug resistant Gonorrhea infections per year in the U . S . GC has developed resistance to almost all antimicrobials , including third-generation cephalosporins and azithromycin . Antibiotic resistant N . gonorrhoeae ( ARGC ) are associated with key molecular traits ; e . g . accepting / integrating exogenous DNA into genome , acquisition of macrolide resistance from commensal Neisseria , low level resistance by mutation and enzymatic modification , upregulation of Efflux pumps , and high level resistance by point mutation , thus contributes to emergence of resistance . GC strains with evidence of evolution of ARGC , antimicrobial resistant variants with elevated MICs , and those collected from same patient at different body sites or repeat infection yields distinct strains were analyzed .
Methods : A subset of N . gonorrhoeae clinical isolates ( n = 97 ) received during the period of 2017 – 18 was selected based on phenotypic antibiotic susceptibility ( AST ) profiles , specimen sources ,