We report on a carbapenemase-producing hypervirulent Klebsiella pneumoniae (CP-hvKP) isolate collected from a U.S. patient at an outpatient clinic. The isolate was identified as K. pneumoniae serotype K1 sequence type 23 and included both a hypervirulence (with rmpA, rmpA2 iroBCDN, peg-344, and iucABCD-iutA genes) and a carbapenemase-encoding (bla KPC-2 ) plasmid. The emergence of CP-hvKP underscores the importance of clinical awareness of this pathotype and the need for continued monitoring of CP-hvKP in the United States.

Carbapenem-resistant Enterobacterales (CRE) are a growing public health concern due to resistance to multiple antibiotics and potential to cause health care-associated infections with high mortality. Carbapenemaseproducing CRE are of particular concern given that carbapenemase-encoding genes often are located on mobile genetic elements that may spread between different organisms and species. In this study, we performed phenotypic and genotypic characterization of CRE collected at eight U.S. sites participating in active population-and laboratory-based surveillance of carbapenem-resistant organisms. Among 421 CRE tested, the majority were isolated from urine (n = 349, 83%). Klebsiella pneumoniae was the most common organism (n = 265, 63%), followed by Enterobacter cloacae complex (n = 77, 18%) and Escherichia coli (n = 50, 12%). Of 419 isolates analyzed by whole genome sequencing, 307 (73%) harbored a carbapenemase gene; variants of bla KPC predominated (n = 299, 97%). The occurrence of carbapenemase-producing K. pneumoniae, E. cloacae complex, and E. coli varied by region; the predominant sequence type within each genus was ST258, ST171, and ST131, respectively. None of the carbapenemase-producing CRE isolates displayed resistance to all antimicrobials tested; susceptibility to amikacin and tigecycline was generally retained.

Results suggest that these students may not receive adequate exposure to oral cancer prevention and detection knowledge and practices. Additional training to increase knowledge of risk factors and cessation counseling, and knowledge of signs and symptoms and examination skills may improve oral cancer prevention and detection. The implication is that additional education for the medical students in prevention and detection may lead to improvements in South Carolina oral cavity and pharyngeal cancer incidence and mortality rates.

The purpose of this study was to assess the South Carolina (SC) dentists' and physicians' oral cancer knowledge and practices and interest in training in oral cancer screening and tobacco cessation counseling. Method used was a cross-sectional survey of SC dentists and selected physician specialties with responses to mailed questionnaires summarized by descriptive statistics and chi-square tests for comparisons. Overall response rates were 58%for dentists and 44% for physicians. Dentists (81%) and 13% of the physicians reported conduct of oral cancer examinations at least half of the time over the past 12 months. Dentists (41%) and 83% of physicians assisted patients to quit smoking. Few dentists (19%) and 53% of physicians were aware of SC tobacco cessation resources. Dentists (40%) and physicians (37%) were interested in receiving training in oral cancer screening, and 36% and 49%, respectively, in training in tobacco cessation counseling. Results support the development of tailored education for SC dentists and physicians to achieve Healthy People 2010 Oral Health Objectives for Oral Cancer.

The expanded testing Initiative yielded ROI values of >$1 under a broad range of sensitivity analyses and provides further support for large-scale HIV testing programs.