Patients with antimicrobial-resistant nontyphoidal Salmonella infection were more likely to have bloodstream infection and to be hospitalized than were patients with pansusceptible infection. Mitigation of antimicrobial resistance in Salmonella will likely benefit human health.

We summarize antimicrobial resistance surveillance data in human and chicken isolates of Campylobacter . Isolates were from a sentinel county study from 1989 through 1990 and from nine state health departments participating in National Antimicrobial Resistance Monitoring System for enteric bacteria (NARMS) from 1997 through 2001. None of the 297 C. jejuni or C. coli isolates tested from 1989 through 1990 was ciprofloxacin-resistant. From 1997 through 2001, a total of 1,553 human Campylobacter isolates were characterized: 1,471 (95%) were C. jejuni , 63 (4%) were C. coli , and 19 (1%) were other Campylobacter species. The prevalence of ciprofloxacin-resistant Campylobacter was 13% (28 of 217) in 1997 and 19% (75 of 384) in 2001; erythromycin resistance was 2% (4 of 217) in 1997 and 2% (8 of 384) in 2001. Ciprofloxacin-resistant Campylobacter was isolated from 10% of 180 chicken products purchased from grocery stores in three states in 1999. Ciprofloxacin resistance has emerged among Campylobacter since 1990 and has increased in prevalence since 1997.

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The indoor pool where the lifeguards worked was located in a large municipal recreation center. The swimming area consisted of 3 separate pools joined by two 4-foot (120-cm) waterfalls. The pool area contained 3 wall spouts, 4 fan sprays, 4 bridge sprays, a large and a small water slide, a leviXjpi! tator pump, a "bubbler," and a "mushroom" fountain. Two hot tubs located in an alcove behind the lap pool were disinfected with hydrogen peroxide and a bromine solution. Pool water was disinfected with chlorine and recirculated through the water spray features.Discussion with aquatics supervisors revealed persistently increased combined chlorine levels and alkaline pool water, but review of logs showed that water chemistry parameters consistently met current standards. Water spray features ran continuously when the pool first opened in November 1986. Within several months, the guards complained of oppressive humidity when water spray features were in use, and an hourly rotation system was devised to keep some of the features on at all times and others on intermittently. Despite this system, the lifeguards frequently turned off the water spray features in an effort to improve air quality. Employee health records indicated that at least 10 lifeguards had experienced pool-related respiratory and systemic symptoms during the 3 years since the pool had opened. A number of lifeguards had quit as a result ofthese symptoms.Following extensive ventilation system and engineering improvements, the pool reopened in May 1990. Within 3 months, we recognized a second outbreak ofgranulomatous lung disease among both newly hired and

In June 1992, 13 (38%) of 34 resort guests experienced illness that met a symptom-based case definition of Pontiac fever. Each ill guest reported using an indoor hot tub compared with 6 (29%) of 21 nonill guests (P < .001). Water samples from the indoor hot tub were culture-negative for legionellae using standard techniques, coculture with amebae, and intraperitoneal inoculation of guinea pigs. However, polymerase chain reaction (PCR) testing of the water samples indicated the presence of Legionella pneumophila. Direct fluorescent antibody testing identified the organism as serogroup 6. Seroconversion to L. pneumophila serogroup 6 occurred in 7 (64%) of 11 ill guests and none of 5 nonill guests (P = .03). These results suggest that in certain circumstances, culture of environmental samples should be supplemented with additional tests such as PCR. These results are also consistent with the concept that Pontiac fever can be caused by nonviable legionellae.

Coxiella burnetii is a bacterium located worldwide that can cause Q fever when inhaled. We describe an outbreak of Q fever associated with a horse-boarding ranch that had acquired two herds of goats. We conducted case finding and cohort studies among persons who boarded horses on the ranch and ranchers and among residents in the surrounding community, and conducted sampling of the goats and environment, to determine risk factors for infection and guide public health interventions. Sixty-six ranchers and persons who boarded horses on the ranch were interviewed; 62 (94%) were not professional ranchers. Twenty persons (53%) of 38 persons tested had evidence of infection with C. burnetii. Contact with goats was associated with seropositivity, including having helped birth goats (relative risk [RR] 2.4, 95% confidence interval [CI] 1.6-3.6), having had contact with newborn goats (RR 2.3, CI 1.2-4.3), having vaccinated goats (RR 2.1, CI 1.3-3.5), having had contact with stillbirths or newborns that died (RR 2.1, CI 1.2-3.7), and having fed goats (RR 2.1, CI 1.0-4.3). Among 138 tested persons living within 1 mile of the ranch, 11 (8%) demonstrated evidence of C. burnetii infection; eight seropositive persons (73%) had no direct contact with the ranch. Testing of the soil and goats with an IS1111 polymerase chain reaction (PCR) assay confirmed the presence of C. burnetii among the herd and in the environment. This outbreak of Q fever was caused by exposure to infected goats, but exposure to the environment likely played a secondary role. Laypersons should not participate in the birthing process of goats; professionals who come into contact with birthing goats should be educated on reducing their infection risk. This is the first time an IS1111 PCR assay has been used in an outbreak investigation in the United States.

On June 13, 2012, a group of key stakeholders, leaders, and national experts on tuberculosis (TB), occupational health, and laboratory science met in Atlanta, Georgia, to focus national discussion on the higher than expected positive results occurring among low-risk, unexposed healthcare workers undergoing serial testing with interferon-γ release assays (IGRAs). The objectives of the meeting were to present the latest clinical and operational research findings on the topic, to discuss evaluation and treatment algorithms that are emerging in the absence of national guidance, and to develop a consensus on the action steps needed to assist programs and physicians in the interpretation of serial testing IGRA results. This report summarizes its proceedings.