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.
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...
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