Males 65 and older at higher risk for bacterial pneumonia
In a study of all Medicare recipients aged 65 and older who were hospitalized for bacterial pneumonia (community-acquired pneumonia) during 1997, researchers found that men had a higher incidence of the disease, their cases tended to be more complex, and their chances of death from the disease were higher than for women. For the research, investigators examined 623,718 hospital admission records of patients with community acquired pneumonia (CAP). Although more women were part of the study group, the incidence rate was higher for men (19.4 cases per 1,000 men versus 15.6 cases per 1,000 women). Men were more likely to be managed as a “complex case,” both from an overall standpoint (24.4 percent versus 20.8 percent), and across all age groups. (Complex cases were those who were managed in the intensive care unit,with or without mechanical ventilation.) Men also had a higher mortality rate. The researchers said that as the elderly population grows over time, the burden of CAP will increase substantially, with 750,000 cases projected for 2010 and 1 million for 2020. The research appears in the second issue for March of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.
Limited spread of multidrug-resistant tuberculosis in Los Angeles county
Researchers studying pulmonary multidrug-resistant tuberculosis (MDR-TB) in Los Angeles County, California, between August 1993 and 1998 showed that, although a high percentage of these cases were infectious, limited spread of MDR disease took place. Those results were evident despite the fact that Los Angeles County reported the second highest number of TB cases among all metropolitan areas between 1993 and 1997, along with one-third of all California cases. The researchers attempted to determine the extent of MDR-TB transmission by using restriction fragment length polymorphism testing and by cross-matching contact information to the Tuberculosis Registry. During the study period, 102 MDR-TB cases were identified. Only four molecular clusters of two MDR-TB cases each and a closely related pair were identified among the 102 cases. The authors believe that aggressive contact investigation, very careful surveillance, and good management of cases contributed to limiting the spread of MDR-TB in Los Angles County. They identified 946 contacts of the MDR-TB cases, with tuberculin skin test conversion documented in 58 (6 percent). This conversion percentage was considerably lower than previously reported among contacts of inner city pulmonary TB cases. Despite social factors similar to New York City, the proportion of MDR-TB cases remained low in Los Angeles County (0.7 to 2.3 percent), compared with New York City’s 19 percent in April 1991. (In that year, New York City reported 62 percent of the nation’s MDR-TB cases). The authors believe that better climate was a factor, much lower population density than the New York City area, and the establishment of a centralized consultation and tracking service to follow MDR-TB cases though treatment completion and up to two years afterwards. The study appears in the second issue for March of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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Journal
American Journal of Respiratory and Critical Care Medicine