Annual estimates of the influenza disease burden provide information to evaluate programs and allocate resources. We used a multiplier method with routine population-based surveillance data on influenza hospitalization in the United States to correct for under-reporting and estimate the burden of influenza for seasons after the 2009 pandemic. Five sites of the Influenza Hospitalization Surveillance Network (FluSurv-NET) collected data on the frequency and sensitivity of influenza testing during two seasons to estimate under-detection. Population-based rates of influenza-associated hospitalization and Intensive Care Unit admission from 2010–2013 were extrapolated to the U.S. population from FluSurv-NET and corrected for under-detection. Influenza deaths were calculated using a ratio of deaths to hospitalizations. We estimated that influenza-related hospitalizations were under-detected during 2010-11 by a factor of 2.1 (95%CI 1.7–2.9) for age < 18 years, 3.1 (2.4–4.5) for ages 18-64 years, and 5.2 (95%CI 3.8–8.3) for age 65+. Results were similar in 2011-12. Extrapolated estimates for 3 seasons from 2010–2013 included: 114,192–624,435 hospitalizations, 18,491–95,390 ICU admissions, and 4,915–27,174 deaths per year; 54–70% of hospitalizations and 71–85% of deaths occurred among adults aged 65+. Influenza causes a substantial disease burden in the U.S. that varies by age and season. Periodic estimation of multipliers across multiple sites and age groups improves our understanding of influenza detection in sentinel surveillance systems. Adjusting surveillance data using a multiplier method is a relatively simple means to estimate the impact of influenza and the subsequent value of interventions to prevent influenza.

We challenge the notion that influenza B is milder than influenza A by finding similar clinical characteristics between hospitalized adult influenza-cases. Among patients treated with oseltamivir, length of stay and mortality did not differ by type of virus infection.

We describe a case of peritonitis caused by Aureobasidium pullulans in a patient on continuous ambulatory peritoneal dialysis (CAPD). This dematiaceous fungus rarely causes infection in humans and to date has not been reported as an etiology of CAPD-associated peritonitis. The patient was managed successfully with peritoneal catheter removal and a prolonged course of intravenous amphotericin B, allowing resumption of CAPD. In vitro susceptibility testing confirmed sensitivity of this organism to amphotericin B.

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A comparison between direct and standardized disk diffusion tests was made on a total of 300 urine specimens containing 105 organisms/ml. Of these, 246 represented pure cultures and 54 represented mixed cultures. The number of major discrepancies per organism tested in pure culture was 18 (7.3%) and in mixed cultures it was 23 (42.6%). The percentage of major discrepancies per total number of antimicrobial drug comparisons made was 1.4%. Although this procedure may be of value in selected cases with pure cultures of organisms present in quantities 2105/ml, its use on a routine basis is not recommended.It has recently been recommended by Kunin (7) that direct susceptibility tests be performed on urine specimens that contain bacteria in Gram-stained smears of the uncentrifuged specimen or in wet-mount preparations of centrifuged urinary sediments. Since two published reports (1, 9) of evaluations of direct susceptibility testing of urine have presented seemingly conflicting data about the procedure's reliability and accuracy, we performed a comparison between it and the standardized disk diffusion method in an attempt to reconcile these differences. MATERIALS AND METHODSClean catch, midstream urine specimens collected by a urine collection service were used throughout the study. Initially, urine specimens were randomly selected for testing; however, due to their low rate of positivity, urine specimens were screened on receipt in the laboratory. Uncentrifuged, well-mixed urine was Gram stained and examined microscopically (x 1,000). Only those specimens containing >2 organisms/field were selected for further study. Processing of urine specimens and identification procedures were performed as described by Washington (11).Susceptibility test procedures. Direct susceptibility tests were performed on undiluted urine by swabbing the surface of Mueller-Hinton agar plates (BBL) with a sterile, cotton-tipped swab. Excess urine was expressed by pressing the swab against the side of the collection container. The plates were air dried for a maximum of 15 min, and high-content antimicrobial disks were distributed by means of a multidisk dispenser (BBL). Individual disks were pressed firmly on the agar surface with alcoholflamed forceps. Plates were incubated at 37 C, and zone diameters were measured with calipers after 16 to 18 h of incubation.The standard disk diffusion method, as described by Bauer et al. Zone diameter interpretations obtained with each method were compared, and discrepancies were defined as follows: very major discrepancies represented by resistance by the standard method and susceptibility by the direct method, major discrepancies represented by susceptibility by the standard method and resistance by the direct method, and minor discrepancies represented by intermediate susceptibility by one method and susceptibility or resistance by the other.Ampicillin (10 ug), carbenicillin (100 ,ug), cephalothin (30 ILg), gentamicin (10 ,ug), kanamycin (30 ,ug), nitrofurantoin (300 Ag), nalidixic acid (30 ug), and tetr...

A continuous African green monkey kidney cell line, designated BGM, was compared with primary cynomolgus monkey kidney cells and human embryonic lung cells for efficiency of enterovirus isolation. A selective enhanced sensitivity of BGM cells both in terms of isolation rate and speed of isolation was found for group B coxsackieviruses but could not be demonstrated for a number of other nonpolio enteroviruses.

The Autobac IDX system was evaluated for its ability to accurately identify 290 gram-negative bacilli from 18 different genera. Excluding isolates with a low identification probability, the overall sensitivity of the system was found to be 95.8%. Late lactose-fermenting Escherichia coli, Citrobacter freundii, and Proteus mirabilis accounted for over 90% of the misidentifications. The Autobac IDX system offers a rapid and reliable method for the identification of gram-negative bacilli. An increased emphasis has been placed on the rapid identification and susceptibility testing of microorganisms. To this end, the Autobac system (General Diagnostics, Warner-Lambert Co., Morris Plains, N.J.) was introduced for rapid susceptibility testing of bacteria (6). Subsequently, the Autobac system was adapted for determination of minimum inhibitory concentrations (4), urine screening (3), and more recently for testing salt tolerance of streptococci (2). Additionally, the Autobac system has recently been updated and modified to include bacterial identification capabilities. Along with rapid identification of Enterobacteriaceae, the system has also been reported to rapidly identify nonfermentative gram-negative bacilli. Early reports delineating the data base indicated 88.4% (7) and 95.3% (1) agreement with conventional biochemical identification. Two recent reports have substantiated the accuracy of the Autobac identification system (N. M.

The API ZYM system was used to investigate enzymatic activities of Legionella pneumophila and other Legionella-like organisms. Leucine aminopeptidase, alkaline and acid phosphatase, butyrate and caprylate esterase, and phosphoamidase activities were consistently detected in all strains tested. No evidence of myristate lipase, trypsin, chymotrypsin, or glycosidase activity was found. Legionella pneumophila and Legionella-like organisms have emerged as significant respiratory pathogens in certain patient populations. There exist relatively few biochemical tests based on positive reactions for identification of this group of organisms (9, 11). Biochemical characterization is complicated by the fact that these organisms have an unusual metabolism characterized by the ability to use amino acids as the major source of energy and carbon (8). They also do not grow on standard laboratory media. Definitive identification of an isolate as one of the described species requires gas-liquid chromatography of cellular fatty acids (14) or direct immunofluorescent staining (3). We examined the enzymatic profiles of nonproliferating cells by using the 19 chromogenic substrates comprising the API ZYM system (Analytab Products, Plainview, N.Y.). While this study was in progress, Muller (16) published the enzymatic profiles of four strains of L. pneumophila, using the API ZYM system. We expand upon his observation with L. pneumophila and extend it to other described species, considered by some to be in the genus Legionella (1, 2, 10, 12, 13) and by others to be in the genera Tatlockia and Fluoribacter (7). Nine strains of L. pneumophila, designated Bellingham 1 (serogroup 1), California 1 (serogroup 1), Knoxville 1 (serogroup 1), Philadelphia 2 (serogroup 1), Togus 1 (serogroup 2), Bloomington 2 (serogroup 3), Los Angeles 1 (serogroup 4), Dallas I-E (serogroup 5), and Chicago 2 (serogroup 6), and one strain each of L. micdadei (Tatlock), L. gormanii (LS-13), L. bozemanii (WIGA), L. dumoffii (TEX-KL), and L. longbeachae (Longbeach 4), were studied. L.