Upper Respiratory Tract Colonization With Streptococcus pneumoniae in Adults

Introduction: Most of the current evidence regarding pneumococcal upper respiratory colonization in adults suggests that despite high disease burden, carriage prevalence is low. Contemporary studies on adult pneumococcal colonization have largely followed the pediatric approach by which samples are obtained mostly from the nasopharynx and bacterial detection is evaluated by routine culture alone. Recent evidence suggests that the ‘pediatric approach’ may be insufficient in adults and pneumococcal detection in this population may be improved by longitudinal studies that include samples from additional respiratory sites combined with more extensive laboratory testing. Areas covered: In this article, relevant literature published in peer review journals on adult pneumococcal colonization, epidemiology, detection methods, and recommendations were reviewed. Expert opinion: Respiratory carriage of Streptococcus pneumoniae has been underestimated in adults. Contemporary pneumococcal carriage studies in adults that collect samples from alternative respiratory sites such as the oropharynx, saliva, or nasal wash; are culture-enriched for pneumococcus; and use molecular diagnostic methods designed to target two pneumococcal DNA sequences should enhance pneumococcal detection in the adult respiratory tract. This finding may have implications for the interpretation of dynamics of pneumococcal transmission and vaccination

Smoking cessation and attempted cessation among adults in the United States.

With growing recognition of stagnant rates of attempted cigarette smoking cessation, the current study examined demographic and psychometric characteristics associated with successful and attempted smoking cessation in a nationally representative sample. This additional understanding may help target tobacco cessation treatments toward sub-groups of smokers in order to increase attempts to quit smoking.Data were used from the 2011 U.S. National Health and Wellness Survey (n = 50,000).Current smoking status and demographics, health characteristics, comorbidities, and health behaviors.In 2011, 18%, 29%, and 52% of U.S. adults were current, former, or never smokers, respectively. Over one quarter (27%) of current smokers were attempting to quit. Current smokers (vs. others) were significantly more likely to be poorer, non-Hispanic White, less educated, ages 45-64, and uninsured, and they had fewer health-conscious behaviors (e.g., influenza vaccination, exercise). Attempting quitters vs. current smokers were significantly less likely to be non-Hispanic White and more likely to be younger, educated, insured, non-obese, with family history of chronic obstructive pulmonary disease, and they had more health-conscious behaviors.Smokers, attempting quitters, and successful quitters differ on characteristics that may be useful for targeting and personalizing interventions aiming to increase cessation attempts, likelihood, and sustainability

Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the U.S.

Skin and soft tissue infections (SSTIs) are common infections occurring in ambulatory and inpatient settings. The extent of complications associated with these infections by diabetes status is not well established.Using a very large repository database, we examined medical and pharmacy claims of individuals aged 0-64 between 2005 and 2010 enrolled in U.S. health plans. Diabetes, SSTIs, and SSTI-associated complications were identified by ICD-9 codes. SSTIs were stratified by clinical category and setting of initial diagnosis.We identified 2,227,401 SSTI episodes, 10% of which occurred in diabetic individuals. Most SSTIs were initially diagnosed in ambulatory settings independent from diabetes status. Abscess/cellulitis was the more common SSTI group in diabetic and non-diabetic individuals (66% and 59%, respectively). There were differences in the frequencies of SSTI categories between diabetic and non-diabetic individuals (p<0.01). Among SSTIs diagnosed in ambulatory settings, the SSTI-associated complication rate was over five times higher in people with diabetes than in people without diabetes (4.9% vs. 0.8%, p<0.01) and SSTI-associated hospitalizations were 4.9% and 1.1% in patients with and without diabetes, respectively. Among SSTIs diagnosed in the inpatient setting, bacteremia/endocarditis/septicemia/sepsis was the most common associated complication occurring in 25% and 16% of SSTIs in patients with and without diabetes, respectively (p<0.01).Among persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization

Postoperative <i>Staphylococcus aureus</i> Infections in Medicare Beneficiaries

<div><p><i>Staphylococcus aureus (S. aureus)</i> infections are important because of their increasing frequency, resistance to antibiotics, and high associated rates of disabilities and deaths. We examined the incidence and correlates of <i>S. aureus</i> infections following 219,958 major surgical procedures in a 5% random sample of fee-for-service Medicare beneficiaries from 2004–2007. Of these surgical patients, 0.3% had <i>S. aureus</i> infections during the hospitalizations when index surgical procedures were performed; and 1.7% and 2.3%, respectively, were hospitalized with infections within 60 days or 180 days following admissions for index surgeries. <i>S. aureus</i> infections occurred within 180 days in 1.9% of patients following coronary artery bypass graft surgery, 2.3% following hip surgery, and 5.9% following gastric or esophageal surgery. Of patients first hospitalized with any major infection reported during the first 180 days after index surgery, 15% of infections were due to <i>S. aureus</i>, 18% to other documented organisms, and no specific organism was reported on claim forms in 67%. Patient-level predictors of <i>S. aureus</i> infections included transfer from skilled nursing facilities or chronic hospitals and comorbid conditions (e.g., diabetes, congestive heart failure, chronic obstructive pulmonary disease, and chronic renal disease). In a logarithmic regression, elective index admissions with <i>S. aureus</i> infection stayed 130% longer than comparable patients without that infection. Within 180 days of the index surgery, 23.9% of patients with <i>S. aureus</i> infection and 10.6% of patients without this infection had died. In a multivariate logistic regression of death within 180 days of admission for the index surgery with adjustment for demographics, co-morbidities, and other risks, <i>S. aureus</i> was associated with a 42% excess risk of death. Due to incomplete documentation of organisms in Medicare claims, these statistics may underestimate the magnitude of <i>S. aureus</i> infection. Nevertheless, this study generated a higher rate of <i>S. aureus</i> infections than previous studies.</p></div

Comparison of characteristics across smoking groups based on the 2011 National Health and Wellness Survey (NHWS).

<p><i>Note</i>. Superscripts represent columns whose percentage is significantly different from the column (A) at p<.05. The reference group for statistical tests was column A, Current Smokers. Superscripts for significant differences across columns B–C only are not shown. SD  =  standard deviation.</p>†<p>Respiratory/cardiovascular conditions include diagnoses of any of the following: COPD, asthma, emphysema, chronic bronchitis, hypertension, and heart attack.</p>‡<p>Mental health conditions include any of the following: diagnoses of bipolar disorder, depression, GAD, anxiety, and OCD; and experiences of insomnia and alcoholism.</p>‡‡<p>Headache/migraine conditions include diagnoses of any of the following: headache and migraine.</p

Skin and soft tissue infections (SSTI) by group, clinical condition, and ICD-9 code.

a<p>This group also includes Erysipelas (ICD-9 code: 035.x).</p>b<p>In this study, decubitus ulcer and non-healing surgical wound is considered as having an active infection if: a) clinical diagnosis is associated with prescription of any of the following antibiotics: dicloxacillin, vancomycin, cefalexin, cefazolin, linezolid, daptomycin, clindamycin, trimethoprim-sulfamethoxazole, doxycycline, minocycline, quinupristin-dalfopristin within ±10 days of the index diagnosis; and b) if there is no other concomitant clinical diagnosed infection.</p

Demographic characteristics of respondents age 18+ years by smoking status.

<p>Comparison between the 2010 National Health Interview Survey (NHIS) and the 2011 National Health and Wellness Survey (NHWS).</p><p><i>Note</i>. Presented are row percentages (summing to 100% across columns), and in brackets are 95% confidence intervals for the row percentages. Data in this table are based on two questions in the NHIS: “Have you smoked at least 100 cigarettes in your entire life?” and “Do you now smoke cigarettes every day, some days, or not at all?”</p>†<p>Source: Schiller et al., 2012 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0093014#pone.0093014-Schiller1" target="_blank">[15]</a>. Race/ethnicity was recoded from variables (HISPAN_I; RACERPI2) to create mutually exclusive groups, summing to total adults. Percentages were from Table XV. Confidence intervals were manually calculated based on the standard errors as noted in Table XV; they could not be determined for non-Hispanic Asian and non-Hispanic Other, as standard errors were not available for these subgroups.</p>‡<p>Current smokers have smoked at least 100 cigarettes in their lifetime and still currently smoke. Every day smokers are current smokers who smoke every day, while some day smokers are current smokers who smoke on some days.</p>‡‡<p>Former smokers are persons who have smoked at least 100 cigarettes in their lifetime but currently do not smoke at all.</p>‡‡‡<p>Nonsmokers are persons who have never smoked at least 100 cigarettes in their lifetime.</p>§<p>Current smokers defined as those who responded, “Yes, I smoke” or, “Yes, but I am trying to quit.”</p>§§<p>Former smokers defined as those who responded, “No, I quit smoking” or, “No, I am in the process of quitting.”</p>§§§<p>Nonsmokers defined as those who responded, “No” to the question, “Have you ever smoked cigarettes?”</p