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Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program
Emerging Infections Program

Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance

Gayle LangleyComments to Author , John Besser, Martha Iwamoto, Fernanda C. Lessa, Alicia Cronquist, Tami H. Skoff, Sandra Chaves, Dave Boxrud, Robert W. Pinner, and Lee H. Harrison
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (G. Langley, J. Besser, M. Iwamoto, F.C. Lessa, T.H. Skoff, S. Chaves, R.W. Pinner); Colorado Department of Public Health and Environment, Denver, Colorado, USA (A. Cronquist); Minnesota Department of Health, St. Paul, Minnesota, USA (D. Boxrud); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (L.H. Harrison)

Main Article

Table 1

Case definitions and status of microbiological testing, by Emerging Infections Program activity and pathogen, 2010–2014*

Program, pathogen (year surveillance started) Case definition criteria Cases identified by culture, % FDA-approved CIDTs related to EIP case definitions, by test type/% laboratories offering test (year data collected)† Laboratories offering laboratory-developed NATs (year data collected), %† Additional cases, %‡
Active Bacterial Core surveillance
Streptococcus pneumoniae (1995) Isolation from sterile site 100 ABT on sterile site specimens/13 (2012) 1% (2014) Not available
Haemophilus influenzae (1995) Isolation from sterile site 100 ABT on sterile site specimens/7 (2012) <1 (2014) Not available
Neisseria meningitidis (1995) Isolation from sterile site 100 ABT on sterile sites specimens/8 (2012) 1 (2014) 9§
Group A Streptococcus (1995) Isolation from sterile site 100 None on direct specimen from sterile site 1 (2014) Not available
Group B Streptococcus(1995) Isolation from sterile site 100 None on direct specimen from sterile site 1 (2014) Not available
Methicillin-resistant Staphylococcus aureus (2005) Isolation from sterile site 100 None on direct specimen from sterile site 1 (2014) Not available
Pertussis (2011) Clinical criteria plus isolation from clinical specimen or PCR positive <1 None Not available Not available
Legionellosis (2011)
 Isolation, positive urine antigen or rise in serologic titers¶
 5
 Urine antigen test/92 (2010–2011)#
 47.5 (2010–2011)#
 <1
FoodNet
Campylobacter Isolation from clinical specimen 100 ABT/14 (2014)
NAT multiplex/1 (2014) 1 (2014) 13
Salmonella Isolation from clinical specimen 100 NAT multiplex/1 (2014) 1 (2014) 1.3
Shigella Isolation from clinical specimen 100 NAT multiplex/0.5 (2014) 0.5 (2014) 5
Vibrio Isolation from clinical specimen 100 NAT multiplex/0 (2014) 0.6 (2014) 2
Yersinia Isolation from clinical specimen 100 NAT multiplex/0 (2014) 0.5 (2014) 2
Listeria Isolation from sterile site 100 NAT-based multiplex/0 (2014) 0 (2014) 0
Cryptosporidium Detection of organism, antigen, or nucleic acid 0 ABT/88 (2014); NAT multiplex/1 (2014) 2 (2014) Not applicable
Cyclospora Detection of organism or nucleic acid 0 NAT multiplex/0 (2014) 0 Not applicable
Shiga toxin–producing Escherichia coli
Isolation of E. coli O157:H7; or, isolation of E. coli with detection of Shiga toxin or genes that encode the toxins
 100
 ABT/57 (2014); NAT multiplex/1 (2014)
 1
 8
Health care–associated infections
Gram-negative bacilli
E. coli, Klebsiella pneumoniae, K. oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Acinetobacter baumannii Isolation from a sterile site or urine determined to be not susceptible to certain antimicrobial organisms** 100 None on direct specimen from sterile site Not available Not available
Candida spp. Isolation from blood 100 Magnetic resonance test for multiple species/offering unknown Not available Not available
Clostridium difficile
 Positive toxin or molecular assay from stool specimen
 0
 NAT for C. difficile/58 (2013)
NAT multiplex/1 (2013)
toxin-based ABT/37 (2013)
 2 (2013)
 Not applicable
Influenza-associated hospitalizations
Influenza virus Isolation or detection from fluorescent antibody staining, antigen test or RT-PCR <2†† ABTs
NAT (singleplex or multiplex)/24 (2013)‡‡ 2 Not applicable

*Data from EIP laboratory surveys. ABT, antigen-based test; CIDT, culture-independent diagnostic test; EIP, Emerging Infections Program; FDA, Food and Drug Administration; NAT, nucleic acid test; RT-PCR, reverse transcription PCR.
†Laboratory tests may be offered either onsite or offsite.
‡Estimated additional cases that could be captured by CIDTs in use. These infections are not counted in EIP surveillance because they represent a positive CIDT result that is not part of current case definitions.
§Data from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6117a3.htm.
¶Includes confirmed cases only.
#Data from http://journals.cambridge.org/abstract_S0195941700093735.
**E. coli, K. pneumoniae, K. oxytoca, E. cloacae, and E. aerogenes nnot susceptible to doripenem, meropenem or imipenem and resistant to all third-generation cephalosporins; A. baumannii not susceptible to doripenem, meropenem, or imipenem.
††In 2003, 12% of influenza cases were identified by culture; whereas in 2013, <2% were identified by culture.
‡‡Most samples tested by ABTs at clinical laboratories are sent to public health laboratories for results confirmation by PCR.

Main Article

Page created: August 12, 2015
Page updated: August 12, 2015
Page reviewed: August 12, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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