1432. Estimating the Incubation Period of Salmonella Urinary Tract Infection (UTI) Using Foodborne Outbreak Data.

Background Urinary tract infections (UTI) are common bacterial infections that may occur as a part of foodborne outbreaks. Salmonella, a less common cause of UTI, has been identified during foodborne outbreaks, but the epidemiology and pathogenesis are poorly understood. Methods PulseNet, the United States national molecular subtyping network for foodborne disease surveillance, was used to identify Salmonella isolates associated with outbreaks from 2004 to 2013 containing at least one urine and one stool isolate in which the duration was ≤1 year and a food vehicle was suspected or confirmed. We standardized isolation dates across outbreaks by calculating the mean date for stool isolation within an outbreak and subtracting this from the date of each stool/urine isolate in that outbreak. A linear-mixed model with random effect for stool/urine was used to estimate the difference in incubation periods between stool/urine isolates. We also surveyed patients from a 2012 Salmonella Cubana outbreak with many urinary isolates and associated with sprouts, to ask about diarrhea, UTI symptoms, diagnosis, and treatment. Descriptive statistics were calculated. Results Urine isolates had later isolation dates than stool isolates for 102 of the 110 outbreaks identified. The average difference between stool and urine isolates was 10.6 days (95% CI: 6.0, 15.2). Seven women from the Salmonella Cubana outbreak were reached. All women were diagnosed with either a UTI (6/7 = 86%) and/or kidney infection (2/7 = 29%) and were treated with antibiotics (7/7 = 100%). All six women completing the survey reported multiple signs and/or symptoms including frequency, urgency, dysuria, and hematuria with only two women reporting diarrhea prior to UTI. Conclusion Salmonella UTI seen during foodborne outbreaks are symptomatic foodborne infections not associated with diarrhea and appear to have a longer incubation period than Salmonella gastrointestinal (GI) illness. A 13- to 16-day incubation period for Salmonella UTI may be more appropriate, calculated by adding a 3- to 4-day GI illness incubation period plus delay in obtaining a stool isolate. Foodborne UTI investigation may need to change as the current method of obtaining a food history for the 6–72 hours prior to illness does not accurately reflect the incubation period for Salmonella UTI. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

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