Public health antibiotic stewardship programs utilize different data sources to support antibiotic use (AU) surveillance and inform stewardship priorities. The Centers for Medicare and Medicaid Services (CMS) Medicare Part D Prescribers Public Use Files (PUFs) contain annual summaries of prescription drug claims by state and provider for all drugs, antibiotics, opioids, and antipsychotics. In 2022, the Centers for Disease Control and Prevention (CDC) initiated a community of practice on using PUFs for AU surveillance. We describe national and local use cases of PUFs to assess and inform public health stewardship activities.Figure 1:Summary of Tracking and Reporting Centers for Medicare and Medicaid Services (CMS) Part D Public Use Files National and Local Public Health Antibiotic Stewardship Use CasesFigure 2:Data Source and Population Related Limitations of Centers for Medicare and Medicaid Services Part D Public Use Files The CMS PUFs community of practice, comprised of 13 jurisdictions (11 state and 2 local health departments), met three times in 2024. CDC held nine one-on-one technical calls with jurisdictions. We summarized use cases and data limitations from analyses of CMS PUFs. We categorized national and local use cases under the Tracking and Reporting core elements as defined in the Core Elements of Antibiotic Stewardship for Health Departments guidance (released in 2023). CMS PUFs have been used for tracking antibiotic prescribing practices by provider type, antibiotic, and geography at national and local levels. Specifically, these data have been used to identify counties with high prescribing volume and evaluate predictors of high prescribing. AU rates were compared across region, state, and urban versus rural areas and validated with other data. Data have been shared publicly and internally with health department leadership, partners, and stakeholders, and used to inform education and peer-comparison feedback letters to prescribers. (Figure 1) Limitations associated with using PUFs for engaging prescribers included the lack of prescription indication, misclassification of practice location, data timeliness and representativeness. (Figure 2) CMS PUFs are no-cost data that can be leveraged at a national and local level to conduct AU surveillance for Medicare beneficiaries and support feedback interventions to improve prescribing. Minimizing time lag and providing county-level aggregations will help improve the utility of these data for public health antibiotic stewardship. Christine Kim, PhD, Moderna, Inc.: Epidemiologist|Moderna, Inc.: Stocks/Bonds (Public Company) Erica Stohs, MD MPH, bioMerieux, Inc.: Grant/Research Support|Merck Co, Inc: Grant/Research Support
Background: Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). Outbreaks of HBV infection in healthcare settings have been linked to lapses in infection control, including unsafe injection practices, such as reuse of needles, fingerstick devices, and syringes. In December 2024, an acute case of hepatitis B in a patient without traditional risk factors was reported to the Connecticut Department of Public Health (CTDPH). We investigated a potential healthcare exposure as part of a multidisciplinary investigation. Methods: Acute hepatitis B is reportable to CTDPH. Immunization Program staff interviewed the patient with hepatitis B to determine risk factors for infection. Immunization and Healthcare-Associated Infections and Antimicrobial Resistance (HAI-AR) team members assessed potential healthcare exposures via medical chart review. Upon identification of a potential healthcare exposure, HAI-AR staff conducted an on-site Infection Control Assessment and Response (ICAR). Results: Patient interview and medical chart review identified potential high-risk procedures at an outpatient clinic that performs aesthetic procedures. Among 15 procedures performed during the six months prior to HBV infection, the highest risk procedures were injection of platelet rich plasma and invasive hormone replacement therapy. ICAR identified the following breaches in infection prevention and control (IPC) practices: poor hand hygiene, failure to label and improper handling of blood products, and improper operation of a sterilizer. Environmental cleaning/disinfection practices were inconsistent, and disinfectants were improperly labeled and stored. HAI-AR staff recommended training on and auditing of hand hygiene, training on proper cleaning/disinfection practices for office staff and environmental services (EVS), and discontinuation of sterilizer use until such time that biologic monitoring could be performed and staff could be properly trained on use. The clinic stopped all operations until IPC oversight was in place, changed all equipment to single-use, and trained staff on disinfection. Providers received bloodborne pathogen training. In response to IPC breaches, the clinic also notified 118 patients who had received high-risk procedures in the prior year to recommend bloodborne pathogen testing. Conclusion: Outpatient healthcare environments where aesthetic procedures are performed may have limited regulatory oversight and no requirement for an individual responsible for IPC. In these settings, healthcare providers might perform a large number and variety of invasive procedures, which may require education and training on specialized equipment, such as sterilizers. Improved oversight of these settings with a focus on education and training of outpatient providers on IPC could improve infection prevention and patient safety.
Bacillus cereus is a foodborne pathogen of growing concern due to its persistence and antimicrobial resistance. To identify host determinants influencing susceptibility to phage BCP8-2, a mini-Tn10 transposon mutant library of B. cereus ATCC 14579 was constructed and screened for altered phage susceptibility. A mutant (BC2012) showing partial resistance carried an insertion in BC\_RS27090 (previously BC\_5432 ), encoding a putative GtrB-like bactoprenol glycosyltransferase. Complementation restored phage sensitivity, confirming its functional involvement. Adsorption and efficiency-of-plating assays revealed significantly reduced phage binding and infectivity in the mutant, particularly under cation-rich conditions. Microscopy showed altered surface morphology with thinner, smoother cell walls. These data indicate that gtrB affects surface properties essential for cation-dependent phage adsorption and infection and provide a foundation for future studies on the role of surface glycosylation and ionic interactions in Gram-positive phage biology.
BACKGROUND:In the United States, 66.7% of women who had a baby in the past year have returned to work, yet many struggle to maintain their breastfeeding goals after their return. Research identifies common barriers and facilitators to providing lactation accommodations, but these studies predate recent state and federal laws that strengthen workplace lactation protections. RESEARCH AIM:To identify what employers currently prioritize as the main barriers and facilitators to supporting breastfeeding employees in the workplace. METHODS:A cross-sectional study was conducted with 40 employers in a mid-sized city in Connecticut. Surveys were distributed via door-to-door outreach, email, and phone calls, and the Active Implementation Framework was used to inform survey questions. Data were analyzed both quantitatively and qualitatively. RESULTS:Employers identified "happy employees" as the top benefit of supporting breastfeeding employees in the workplace, while "finding a private space for employees to pump or breastfeed that's not a bathroom" was the top challenge. Employers mentioned themes like "increasing breastfeeding knowledge and communication" and "receiving funding and financial support" as the main ways to overcome challenges. However, only 40.0% and 32.5% of employers provided their employees with time and space to breastfeed, respectively, and fewer than 50% of employers acknowledged several known benefits of supporting breastfeeding employees in the workplace as benefits for their own business. CONCLUSION:Understanding what employers currently prioritize as the main barriers and facilitators to supporting breastfeeding employees in the workplace can help improve employer buy-in and refine strategies for public health intervention.
OBJECTIVE:Building on our prior Behavioral Risk Factor Surveillance System analysis identifying adults aged 18-39 as the primary driver of the national increase in self-reported cognitive disability, we examined factors associated with this rise using 2013-2024 U.S. BRFSS data. METHODS:We analyzed U.S. Behavioral Risk Factor Surveillance System data, excluding 2020 due to poor survey response, to assess trends in self-reported cognitive disability among adults aged 18-39, excluding and including respondents with depression. Cognitive disability was defined as serious difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition. We compared younger adults with versus without cognitive disability across sociodemographic, socioeconomic, health, and mental health characteristics. Analyses incorporated survey weighting to yield U.S. nationally representative estimates. RESULTS:Cognitive disability prevalence increased from 5.1% in 2013 to 9.8% in 2024 (93% increase; p < 0.001). Including respondents with depression, prevalence increased from 10.0% to 17.8% (16.2 million individuals). Among younger adults with cognitive disability, employment increased (55.6% to 65.1%), lack of health insurance declined (35.7% to 19.7%), smoking decreased (28.7% to 14.1%), and physical inactivity decreased (26.9% to 22.3%). Point estimates for hypertension, hyperlipidemia, asthma, diabetes, and stroke prevalence were also lower. In contrast, frequent poor mental health (≥ 14 days/month) increased from 26.6% to 33.2%. In sensitivity analyses excluding depression and any poor mental health days, prevalence still increased from 2.8% to 5.2% (p < 0.001). INTERPRETATION:From 2013-2024, self-reported cognitive disability among younger United States adults nearly doubled despite improving socioeconomic and cardiometabolic indicators, highlighting a growing burden of perceived or functional cognitive difficulty.
