The US Department of Agriculture's (USDA) Food Safety and Inspection Service (FSIS) wants to declare that Salmonella be considered a contaminant in breaded, stuffed raw chicken products when the bacteria exceed a very low level.

In a statement released yesterday, the USDA said the determination would build on FSIS' 2022 proposed regulatory framework to reduce poultry-linked Salmonella infections. Since 1998, FSIS has been involved in investigating 14 Salmonella outbreaks and about 200 related illnesses associated with these products, most recently a 2021 outbreak that sickened people in 11 states.

Chicken may appear cooked

Under its proposal, FSIS would sample and test the chicken component of these products before stuffing and breading, considering it contaminated if it tested positive for Salmonella at the low level of 1 colony-forming unit per gram.

If deemed adulterated, "the chicken component represented by the sampled lot would need to be diverted to a use other than breaded stuffed raw chicken products," the notice said.

The products are typically cooked by consumers from a frozen state, which increases the risk.

These products are browned and thus may appear cooked, but the chicken is raw. They are stuffed with ingredients such as raw vegetables, butter, cheese, or meat.

"The products are typically cooked by consumers from a frozen state, which increases the risk of the product not reaching the internal temperature needed to destroy Salmonella," FSIS said. "In addition, it may be difficult for a consumer to determine an accurate internal temperature of these products because they contain multiple ingredients that may cook at different rates."

Over time, labels on these products have changed to better reflect their raw nature and give instructions on their safe preparation, but they continue to be linked to Salmonella outbreaks, said FSIS, which is seeking public comments on its proposal.

A survey of patients at urgent-care centers (UCCs) in five states suggests patient satisfaction scores are associated with higher expectation for antibiotics, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

For the survey, conducted by researchers with George Washington University's Milken Institute School of Public Health, patients and guardians of pediatric patients at 27 UCCs and 5 pediatric UCCS in Colorado, Florida, Georgia, New Jersey, and Texas were asked to complete an anonymous questionnaire that asked about their demographics, expectation for antibiotics (expectation score), treatment plan, and level of satisfaction with their care (satisfaction score).

The expectation score and satisfaction score were measured using a 5-point Likert scale, with 5 representing the highest belief in the need for antibiotics and the highest level of satisfaction. A total of 2,279 questionnaires from general UCCs and 431 from pediatric UCCs were included in the analysis.

The median expectation score was 3.37 among adults and 3.26 among guardians of pediatric patients. Expectation scores did not differ by age, ethnicity, race, or education level for general UCCs, while guardians aged 30 to 49 years had the highest expectation scores at pediatric UCCs. The median satisfaction score was 4.23 for adults and 4.18 for guardians of pediatric patients, with similar scores across sex, age group, ethnicity, and education level.

Antibiotics were prescribed for 53.4% of adult patients and 36.0% of pediatric patients. Logistic regression analysis found that antibiotic prescription had no effect on patient satisfaction among adult patients reporting low expectation scores, but medium-to-very-high expectation scores were associated with higher levels of satisfaction upon receiving antibiotics and with lower levels of satisfaction when antibiotics were not prescribed. No statistically significant association was found for pediatric visits.

Decreasing urgent-care patient expectations and beliefs regarding the need for antibiotics ... may decrease unnecessary prescriptions.

"Our findings suggest that decreasing urgent-care patient expectations and beliefs regarding the need for antibiotics (eg, thoroughly educating patients on the clinical applicability and risks of antibiotic use) may decrease unnecessary prescriptions without negatively impacting patient satisfaction," the study authors wrote.

The UK Health Security Agency (UKHSA) is launching a new study to assess the level of antimicrobial resistance (AMR) in healthy people across England and what drives it.

The study will invite 2,000 people to submit stool samples and nose and throat swabs for analysis by UKHSA scientists, who will be looking to gain a better understanding of the prevalence of antibiotic-resistant bacteria in the general population, including carbapenemase-producing Enterobacteriaceae, extended-spectrum beta-lactamases (ESBLs), and methicillin-resistant Staphylococcus aureus. Scientists will also assess the prevalence of the multidrug-resistant fungus Candida auris.

We will be able to design better ways to tackle AMR in different populations.

The study will also explore whether AMR levels vary by demographics and assess different risk factors for carrying resistant pathogens, including travel, diet, healthcare contact, and household transmission.

"By understanding more about the burden of AMR in healthy people in the general population and the factors that mean someone is more likely to be carrying a resistant organism, we will be able to design better ways to tackle AMR in different populations," Russell Hope, PhD, deputy director of the AMR Division at UKHSA, said in a press release.

A similar study conducted by Public Health England in 2014 found that 7.3% of adults in England carried ESBL-producing Enterobacteriaceae.

Yesterday the World Health Organization (WHO) confirmed three new H9N2 avian flu cases in China, all involving children living in or with connections to Hunan province. The agency also noted two variant H1N1 (H1N1v) flu cases in young Chinese girls.

One H9N2 patient is a 10-year-old girl from Hunan province who fell ill in October 2022. The second is a 2-year-old boy from Hunan province whose symptoms began on February 5 and who had been exposed to backyard poultry before he became sick.

The third child with H9N2 flu is a 3-year-old girl from Jiangxi province who had suspected exposure to backyard poultry in Hunan province. Her symptoms first developed on January 31.

"Avian influenza A(H9N2) viruses are enzootic in poultry in Asia and increasingly reported in poultry in Africa," the WHO said.

H1N1v in preschoolers

The WHO also reported that a 3-year-old girl in Sichuan province and a 1-year-old girl in Jiangsu province contracted H1N1v flu. The older girl became ill December 27, 2022, while the younger one first had symptoms on January 30.

No information on the likely source of exposure to the virus was available.

The agency says the girls were infected with a "Eurasian avian-like swine influenza" strain. Both girls had mild illness and did not require hospital care.

The WHO said, "No information on the likely source of exposure to the virus was available at the time of reporting and no suspected cases among family contacts of the cases were reported."