Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole.

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Thirty-three isolates of Legionella pneumophila, all except one of which were clinical isolates, were tested against 20 antimicrobial agents by using an agar dilution technique. Erythromycin, rifampin, and rosaramycin were the most active agents tested. Aminoglycosides, chloramphenicol, and cefoxitin also inhibited the organisms at low concentrations. Other agents, including moxalactam, cefoperazone, and cephalosporins, exhibited moderate to little activity. Tetracycline, doxycycline, and minocycline were apparently inactivated by charcoal-yeast extract medium. There was slight inoculum dependence noted with most of the antimicrobials tested, particularly the /3-lactam agents. There was no consistent difference in susceptibility between Center for Disease Control-supplied stock strains and recent clinical isolates, but there were marked differences with some agents. Susceptibility testing needs to be standardized in view of the influence of inoculum size, strain variation, and the medium used.Susceptibility testing of Legionella pneumophila, the etiological agent of Legionnaires disease, has been previously reported only with small numbers of isolates (8,9,12,14,16,17) and not with charcoal-yeast extract (CYE) agar, which has become the standard medium for L. pneumophila (6). In addition, most strains tested have been passaged multiple times after isolation on media which do not optimally support their growth. Because of the availability of a large number of clinical isolates, which were almost entirely recently isolated and had not been passaged multiple times on nonoptimal media, susceptibility testing was performed with 20 antimicrobial agents; these include some new agents, e.g., moxalactam and cefoperazone, which have not been reported in previous studies. MATERLALS AND METHODS Md.) and 1% hemoglobin (MHIH).The remainder of the strains had not been passaged on MHIH and had been passaged from 2 to 10 times on CYE agar only. All strains were kept at 5°C on CYE slants and subcultured monthly. Before the susceptibility studies were done, the strains were subcultured onto CYE agar plates and incubated for 48 h at 35°C in 2.5% CO2 and 65% relative humidity.Inocula were prepared by harvesting growth from a 48-h plate with a sterile wooden stick into approximately 1 ml of Mueller-Hinton broth. The turbidity was adjusted to that of 0.5 MacFarland barium sulfate standard (18). We have found previously that such a suspension of L. pneumophila contains from 7 x 10' to 1 x 108 colony-forming units (CFU)/ml. Dilutions, 1:10 and 1:100, of this suspension were then made with Mueller-Hinton broth and mixed with a Vortex mixer before transfer. Assuming that the volume delivered to each spot by the Steers replicator was 0.001 ml and that a suspension of L. pneumophila adjusted to the turbidity of a 0.5 MacFarland barium sulfate standard contains -10' CFU/ml, the final plate inoculum sizes were -105 CFU/spot for the largest inoculum, i104 CFU/spot for the 1:10 dilution, and -103 CFU/spot for the 1:100 dilution. All