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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_410"
                     title="Most Adults Are Not Getting Necessary Vaccinations"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/Pneumonia/tb/18317?impressionId=1265781162670"
                     
      &lt;p&gt;Public health experts say they&apos;re concerned about the low number of U.S. adults who receive recommended vaccinations  --  and in particular about seniors who aren&apos;t immunized against pneumonia.&lt;/p&gt;
&lt;p&gt;As of 2008, one-third of people 65 and older had not received the pneumococcal vaccine, according to a report issued by the Trust for America&apos;s Health (TFAH), the Infectious Diseases Society of America (IDSA), and the Robert Wood Johnson Foundation.&lt;/p&gt;
&lt;p&gt;In 36 states, 30% or more of their older residents had not received the vaccine.&lt;/p&gt;
&lt;p&gt;The worst coverage was in the District of Columbia, where 45.6% of seniors had not been vaccinated. Even in the best performing state, Oregon, more than a quarter (26.8%) of older people had not received the one-time shot.&lt;/p&gt;
&lt;p&gt;Among all adults, the investigators also found extremely low rates of immunization against tetanus, diphtheria, and pertussis (2.1%), shingles (&amp;lt;2%), human papillomavirus (10%), and seasonal influenza (36.1%).&lt;/p&gt;
&lt;p&gt;&quot;The vaccination efforts around the 2009 H1N1 outbreak actually showed how well our public health system can react to vaccinate millions of people in a very short amount of time,&quot; L.J. Tan, PhD, director of medicine and public health for the American Medical Association, told reporters in a conference call.&lt;/p&gt;
&lt;p&gt;&quot;But I think our response also clearly demonstrated that we do have a lack of a strategy and a system for vaccinating adults.&quot;&lt;/p&gt;
&lt;p&gt;Added Jeffrey Levi, PhD, executive director of TFAH, &quot;We need a national strategy to make vaccines a regular part of medical care and to educate Americans about the effectiveness and safety of vaccines.&quot;&lt;/p&gt;
&lt;p&gt;Doing so could avoid 40,000 to 50,000 deaths from vaccine-preventable illnesses and save about $10 billion in healthcare costs each year, he said.&lt;/p&gt;
&lt;p&gt;But, according to William Schaffner, MD, chair of IDSA&apos;s immunization working group and a co-author of the report, there are many obstacles to adult vaccination efforts.&lt;/p&gt;
&lt;p&gt;First, unlike children in school, adults lack widespread institutional access to immunizations nor is there a way to require most adults to undergo vaccination.&lt;/p&gt;
&lt;p&gt;In addition, there are limited interactions with the healthcare system because, also unlike in children, care in adults generally revolves around acute care and not well care visits.&lt;/p&gt;
&lt;p&gt;Insurance coverage also plays a major role in low vaccination rates among adults, and not just in the uninsured or underinsured.&lt;/p&gt;
&lt;p&gt;Most insurance plans do not cover routine vaccination, Schaffner said, a situation that would change under pending healthcare reform legislation in Congress. That would require insurers to pay for all vaccinations recommended by the CDC&apos;s Advisory Committee on Immunization Practices.&lt;/p&gt;
&lt;p&gt;Schaffner also cited what he called misunderstandings and misinformation regarding the safety and effectiveness of vaccines, and the limited support for research, development, and production of vaccines as reasons for low immunization rates among adults.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s a shame that we aren&apos;t focusing enough resources on the science to prevent disease and we don&apos;t have a system where we can better protect people by getting them all of the vaccines that are currently available,&quot; he said.&lt;/p&gt;
&lt;p&gt;Tan outlined several recommendations the report makes to increase adult vaccination rates, starting with the creation of a program to provide vaccine coverage to uninsured individuals.&lt;/p&gt;
&lt;p&gt;Also, he said, the CDC and local and state health departments should be given more funding to conduct public education campaigns to increase awareness about the importance of vaccination.&lt;/p&gt;
&lt;p&gt;For their part, physicians should adopt practices to enable them to offer their adult patients vaccines at appropriate visits, like general physicals and cancer screenings, and to make a review of vaccination history a part of standard care.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_255"
                     title="Biomarker Guideline Reduced Antibiotic Use (CME/CE)"
                     score="-0"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/18114?impressionId=1265781162670"
                     
      &lt;p&gt;A biomarker-guided strategy for antibiotics in intensive care units reduced drug use without increasing mortality, French researchers said.&lt;/p&gt;
&lt;p&gt;In a randomized, open-label study, the biomarker procalcitonin allowed physicians to reduce the quantity of antibiotics they prescribed, according to Michel Wolff, MD, of H&amp;#244;pital Bichat-Claude-Bernard in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;In principle, the approach could slow the emergence of antibiotic resistance, Wolff and colleagues concluded online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Procalcitonin is thought to be a &quot;fairly specific marker for severe bacterial infection in patients with suspected sepsis,&quot; the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;As well, serum procalcitonin concentrations have been shown to be a useful guide to reducing antibiotic use in patients with lower-respiratory-tract infections, they said.&lt;/p&gt;
&lt;p&gt;But the value of the biomarker in reducing inappropriate antibiotic use has not been shown in all intensive care patients, they said. To fill the gap, they conducted a prospective study of 630 patients in eight French ICUs.&lt;/p&gt;
&lt;p&gt;Patients were randomly assigned to be treated according to usual antibiotic protocols or to have their therapy guided by procalcitonin levels.&lt;/p&gt;
&lt;p&gt;For patients in the procalcitonin group, doctors were encouraged to start antibiotics at inclusion if the levels were 0.5 micrograms per liter or greater. Otherwise, they were discouraged from doing so.&lt;/p&gt;
&lt;p&gt;They were also encouraged to stop antibiotics, once started, if the procalcitonin concentration fell by 80% or more from its peak, or if the concentration was below 0.5 micrograms per liter.&lt;/p&gt;
&lt;p&gt;The primary endpoints were death from any cause at 28 and 60 days and differences in antibiotic use.&lt;/p&gt;
&lt;p&gt;The researchers reported: &lt;ul&gt; &lt;li&gt;At 30 days, mortality in the procalcitonin group was 21.2%, compared with 20.4% in the control group, for an absolute difference of 0.8%. That was well below the pre-set 10% difference for non-inferiority.&lt;/li&gt; &lt;li&gt;At 60 days, the comparable figures were 30% and 26.1%, for an absolute difference of 3.8%, which also established non-inferiority.&lt;/li&gt; &lt;li&gt;Patients in the procalcitonin group had 14.3 days without antibiotics, on average, compared with 11.6 days in the control group. The absolute difference of 2.7 days was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers cited a number of limitations, including the open design, which might have permitted bias, and a low number of surgical patients, which may limit how widely the findings can be applied.&lt;/p&gt;
&lt;p&gt;As well, they noted, 53% of patients in the procalcitonin group did not get therapy guided by the study protocol. Despite that, Wolff and colleagues said, the results remained statistically significant if those patients were excluded.&lt;/p&gt;
&lt;p&gt;Various studies have shown that it&apos;s possible to curtail unnecessary antibiotic use in hospitals, according to Marin Kollef, MD, of Washington University School of Medicine in St Louis.&lt;/p&gt;
&lt;p&gt;But because of the limitations of the French study, it remains unclear whether using procalcitonin is the best approach, he wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;&quot;Whether the ideal strategy involves the use of a serum marker such as procalcitonin or a locally applied practice protocol remains to be established,&quot; Kollef concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Assistance Publique-H&amp;#244;pitaux de Paris, France, and Brahms, Germany. Wolff reported financial links with Merck Sharp &amp;amp; Dohme-Chibret, Janssen-Cilag, Gilead, and AstraZeneca.&lt;/p&gt;&lt;p&gt;Kollef reported no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1637"
                     title="Anti-acid Drugs Linked to Pneumonia"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/14386?impressionId=1265781162670"
                     
      TORONTO, May 27 -- Inpatients treated with acid-suppressing medications have a 30% increase in the risk of getting pneumonia while hospitalized, Boston researchers said. 
              &lt;br&gt; 
              &lt;br&gt;In a prospective cohort study, patients receiving either proton pump inhibitors or histamine&lt;sub&gt;2&lt;/sub&gt; receptor antagonists were more likely to get pneumonia than patients who got neither, according to Shoshana Herzig, M.D., and colleagues at Beth Israel Deaconess Medical Center.
              &lt;br&gt; 
              &lt;br&gt;But when researchers examined the two types of medications separately, only the proton pump inhibitors were significantly associated with the disease, Dr. Herzig and colleagues said in the May 27 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;. 
              &lt;br&gt; 
              &lt;br&gt;The use of acid-suppressing medications has been on the increase in hospitals, mainly to prevent such conditions as stress ulcers in low-risk patients, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;Many such uses are not supported by research, Dr. Herzig and colleagues said. Also, there is evidence in outpatient settings that the medications increase the risk for community-acquired pneumonia.
              &lt;p&gt; 
              &lt;p&gt;&quot;No large prospective study has yet examined the association between acid-suppressive medication and hospital-acquired pneumonia in nonventilated patients,&quot; they noted.
              &lt;p&gt; 
              &lt;p&gt;To clarify the issue, they studied what happened to all patients admitted to their institution from January 2004 through December 2007 who met three criteria: they were at least 18, spent at least three days in hospital, and were not treated in the intensive care unit.
              &lt;p&gt; 
              &lt;p&gt;The final cohort included 63,878 admissions, some of them multiple.
              &lt;p&gt; 
              &lt;p&gt;Acid-suppressing medication was ordered in 52% of admissions, and hospital-acquired pneumonia occurred in 3.5% of those cases, or 2,219 admissions, Dr. Herzig and colleagues found.
              &lt;p&gt; 
              &lt;p&gt;The unadjusted incidence of hospital-acquired pneumonia was 4.9% in the group exposed to the medications and 2.0% in the unexposed group (OR 2.6, 95% CI 2.3 to 2.8).
              &lt;p&gt; 
              &lt;p&gt;When the researchers adjusted for confounders such as comorbidities, the odds ratio fell, but remained significant (OR 1.3, 95% CI 1.1 to 1.4).
              &lt;p&gt; 
              &lt;p&gt;In a preplanned subgroup analysis, the researchers examined the effect of each type of medication.
              &lt;p&gt; 
              &lt;p&gt;For proton pump inhibitors, there was no change in the odds ratio or confidence intervals  (OR 1.3, 95% CI 1.1 to 1.4), but the risk increase was no longer significant for histamine&lt;sub&gt;2&lt;/sub&gt; receptor antagonists (OR 1.2, 95% CI 0.98 to 1.4).
              &lt;p&gt; 
              &lt;p&gt;The researchers cautioned that unmeasured confounders might have skewed the results, especially in light of the large difference between unadjusted and adjusted odds ratios.
              &lt;p&gt; 
              &lt;p&gt;They also noted that the study was performed in a single center, which may limit its application elsewhere.
              &lt;p&gt; 
              &lt;p&gt;Dr. Herzig and colleagues said the results suggest a need for more study, but added that a randomized controlled trial would need to be prohibitively large, with about 17,000 patients.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the Department of Health and Human Services. The researchers reported no conflicts.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
             
    </recommendedItem>
    <recommendedItem id="20090101_19_2878"
                     title="Much Childhood Mortality Blamed on Neglected Bugs (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/Pneumonia/tb/15940?impressionId=1265781162670"
                     
      &lt;p&gt;Two often-neglected pathogens cause as much child mortality as HIV, malaria, and tuberculosis combined, researchers said.&lt;/p&gt;
&lt;p&gt;In companion papers in the Sept. 12 issue of &lt;em&gt;The Lancet,&lt;/em&gt; scientists reported that the mortality associated with &lt;em&gt;Streptococcus pneumoniae&lt;/em&gt; and &lt;em&gt;Haemophilus influenzae&lt;/em&gt; type b (Hib) reached about 1.2 million among children younger than five in the year 2000.&lt;/p&gt;
&lt;p&gt;The findings are &quot;shocking&quot; because safe, effective vaccines are readily available, according to Igor Rudan, MD, and Harry Campbell, MD, both of the University of Edinburgh Medical School.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, they said research and development into diseases such as HIV and malaria has benefited from years of advocacy, while such conditions as pneumonia, meningitis, and diarrhea &quot;have attracted less international attention and support.&quot;&lt;/p&gt;
&lt;p&gt;Yet, they argued, the disease burden among children under five is much the same despite the availability of vaccines against the two pathogens that have been shown to be &quot;consistently safe and effective&quot; in trials in the developing world.&lt;/p&gt;
&lt;p&gt;The two studies - performed by the Hib and Pneumococcal Global Burden of Disease Study Team - reveal for the first time the extent of the mortality caused by &lt;em&gt;S. pneumoniae&lt;/em&gt; and Hib, Rudan and Campbell said.&lt;/p&gt;
&lt;p&gt;In both studies, researchers used clinical trial data, country statistics, literature searches, and other data to estimate the proportion of child deaths associated with each pathogen.&lt;/p&gt;
&lt;p&gt;Globally, they found, 10.6 million children under five died in the year 2000.&lt;/p&gt;
&lt;p&gt;In that year, about 14.5 million episodes of serious disease caused by &lt;em&gt;S. pneumoniae&lt;/em&gt; were estimated to occur, according to Katherine O&apos;Brien, MD, of the Johns Hopkins Center for American Indian Health in Baltimore, and colleagues.&lt;/p&gt;
&lt;p&gt;Those episodes led to about 826,000 deaths, including 91,000 in HIV-positive and 735,000 in HIV-negative children, O&apos;Brien and colleagues concluded.&lt;/p&gt;
&lt;p&gt;The pathogen is thus responsible for about 11% of all deaths in the under-five age group, they said, if deaths among HIV-positive children are excluded.&lt;/p&gt;
&lt;p&gt;Also in 2000, Hib caused about 8.13 million serious illnesses worldwide, according to James Watt, MD, also of the Johns Hopkins Center, and colleagues.&lt;/p&gt;
&lt;p&gt;Those cases ended in death 371,000 times, they said, including 8,100 in HIV-positive and 363,000 in HIV-negative children.&lt;/p&gt;
&lt;p&gt;That rate works out to about 3.5% of all deaths in the age group.&lt;/p&gt;
&lt;p&gt;In comparison, the World Health Organization estimated in 2005 that HIV/AIDS caused 3% of such deaths and malaria 8%, with TB as part of a general category of other causes that totaled 10%.&lt;/p&gt;
&lt;p&gt;It is likely, the researchers said, that the mortality rates associated with the two pathogens are under-estimated.&lt;/p&gt;
&lt;p&gt;The effect of vaccines can be seen from figures comparing countries where they are widely used to those where they are either not available or not widely used, O&apos;Brien and colleagues said.&lt;/p&gt;
&lt;p&gt;By August 2008, 24 high-income and two middle-income countries had routine pneumococcal conjugate vaccination, but there were none in Africa or Asia, they said.&lt;/p&gt;
&lt;p&gt;In 2000, those 26 countries accounted for less than 0.2% of deaths caused by &lt;em&gt;S. pneumoniae&lt;/em&gt;, and the risk of death caused by the pathogen averaged 1.5 fatalities per 100,000, versus 58 per 100,000 in countries where the vaccine was not in use, the researchers said.&lt;/p&gt;
&lt;p&gt;The Hib vaccine, on the other hand, is making inroads, Watt and colleagues said, with 108 countries representing more than 55% of the world&apos;s children now routinely vaccinating the young.&lt;/p&gt;
&lt;p&gt;Despite progress, Rudan and Campbell argued, &quot;current immunization coverage with these vaccines is a striking example of global inequity.&quot;&lt;/p&gt;
&lt;p&gt;Children in countries that don&apos;t use the vaccines have about 40 times the risk of dying from pneumococcus or Hib than children in countries that use them routinely, they said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The&lt;em&gt; S. pneumoniae&lt;/em&gt; study was supported by the GAVI Alliance and the Vaccine Fund. The researchers reported no conflicts.&lt;/p&gt;&lt;p&gt;The&lt;em&gt; H. influenzae&lt;/em&gt; type b study was supported by the GAVI Alliance and the Vaccine Fund. The researchers reported no conflicts.&lt;/p&gt;&lt;p&gt;The editorialists said they had no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2928"
                     title="ICAAC: Testing for HCAP Pathogens Has Limited Success (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICAAC/tb/16004?impressionId=1265781162670"
                     
      &lt;p&gt;SAN FRANCISCO  --  Testing for pathogens in patients with healthcare-associated pneumonia provides results in less than a third of cases, a researcher said here.&lt;/p&gt;
&lt;p&gt;In a six-year retrospective study, a pathogen was isolated from 31% of samples taken from nearly 1,600 patients with healthcare-associated pneumonia, according to Karl Madaras-Kelly, MD, of the VA Medical Center in Boise, Idaho.&lt;/p&gt;
&lt;p&gt;The finding is important because guidelines for treatment in such cases suggest broad antibiotic therapy with several drugs, followed by adjustment once a pathogen is identified, Madaras-Kelly said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.&lt;/p&gt;
&lt;p&gt;&quot;If you can&apos;t identify a pathogen,&quot; Madaras-Kelly said, &quot;you can&apos;t really stop (inappropriate) drugs.&quot;&lt;/p&gt;
&lt;p&gt;The study period  --  from 2003 through 2008  --  covers the period before and after the 2005 guidelines were issued by the Infectious Diseases Society of America.&lt;/p&gt;
&lt;p&gt;The researchers studied records of all patients admitted for pneumonia at six VA medical centers in the northwestern U.S., finding 1,568 who met criteria for healthcare-associated pneumonia.&lt;/p&gt;
&lt;p&gt;Of those, Madaras-Kelly said, 92.6% provided one or more cultures, including 81.8% of the total from blood, 49.7% from sputum, and 1.5% from bronchoscopy.&lt;/p&gt;
&lt;p&gt;But of those 1,452 patients with a culture, only 486  --  or 31%  --  had a pathogen isolated, he said.&lt;/p&gt;
&lt;p&gt;There was no significant year-by-year difference in the proportions with an isolated pathogen, Madaras-Kelly said.&lt;/p&gt;
&lt;p&gt;However, some of the six study sites did a better job in collecting quality cultures  --  with result ranges from 6.3% to 43.6%. The differences were significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;Madaras-Kelly said doctors &quot;do adjust treatment when they have a quality culture, but the majority of patients don&apos;t have a good culture.&quot;&lt;/p&gt;
&lt;p&gt;The implications, he said, include a need to pay attention to getting good quality cultures. &quot;And we also need better methods to diagnose pneumonia because cultures are expensive,&quot; he added.&lt;/p&gt;
&lt;p&gt;The results have to be interpreted in light of other studies suggesting that a pathogen is isolated only 40% of the time in community-acquired pneumonia, according to Lindsay Grayson, MD, of the Austin Hospital in Melbourne, Australia.&lt;/p&gt;
&lt;p&gt;Grayson, one of the meeting&apos;s program co-chairs, was not part of the research.&lt;/p&gt;
&lt;p&gt;One reason for the failure rate is that patients are often given antibiotics before the testing.&lt;/p&gt;
&lt;p&gt;&quot;[It&apos;s] not enough to cure them but enough to confuse the cultures,&quot; he said, and a similar issue may arise with healthcare-associated pneumonia.&lt;/p&gt;
&lt;p&gt;He said the study calls into question &quot;the timing of cultures in relation to any recent antibiotics&quot; and highlights the importance of accurate samples.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institute of Allergies and Infectious Diseases. Madaras-Kelly did not report any conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>