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Streptococcal Infection

Description

Group A beta-hemolytic Streptococcus (GABHS) has caused outbreaks in recruit training environments, where it leads to significant morbidity and, on occasion, has been linked to deaths. Streptococcal surveillance has long been a part of military recruit public health activities. All Navy and Marine Corps training sites are required to track and record positive throat cultures and rapid tests on weekly basis. The Navy and Marine Corps have used bicillin prophylaxis as an effective control measure against GABHS outbreaks at recruit training sites. Though streptococcal control program policies vary by site, a minimum prophylaxis protocol is required and mass prophylax is indicated when local GABHS rates exceed a specific threshold. Before July 2007, prophylaxis upon initial entry was required between October and March, and when the local rate exceeded 10 cases per 1000 recruits. In July 2007, the Navy instituted a policy of mass prophylaxis upon initial entry throughout the year. Evaluation of GABHS cases before and after implementation of the new policy, including overall rates, identification of outbreaks, and inpatient results will help enhance the Navy’s ability to evaluate threshold levels, provide  systematic/standardized monitoring across the three recruit sites, and inform prophylaxis and monitoring strategies.

 

Objective

To compare trends of GABHS among recruits before and after changes in prophylaxis implementation using electronic laboratory and medical encounter records.

Submitted by hparton on
Description

Group A Streptococcal (GAS) pharyngitis, the most common bacterial cause of acute pharyngitis, causes more than half a billion cases annually worldwide. Treatment with antibiotics provides symptomatic benefit and reduces complications, missed work days and transmission. Physical examination alone is an unreliable way to distinguish GAS from other causes of pharyngitis, so the 4-point Centor score, based on history and physical, is used to classify GAS risk. Still, patients with pharyngitis are often misclassified, leading to inappropriate antibiotic treatment of those with viral disease and to under-treatment of those with bone fide GAS. One key problem, even when clinical guidelines are followed, is that diagnostic accuracy for GAS pharyngitis is affected by earlier probability of disease, which in turn is related to exposure. Point-of-care clinicians rarely have access to valuable biosurveillance-derived contextualizing information when making clinical management decisions.

 

Objective

The objective of this study was to measure the value of integrating real-time contemporaneous local disease incidence (biosurveillance) data with a clinical score, to more accurately identify patients with GAS pharyngitis.

Submitted by hparton on
Description

Different studies have shown that Streptococcal infections in adults are more common among older age, blacks, and underlying chronic medical conditions like diabetes, cardiovascular and kidney diseases. In specific, other studies have demonstrated that streptococcal pyogenes can cause severe illnesses and dramatic hospital outbreaks. Furthermore, community-acquired pneumonia studies had also suggested that cardiovascular disease, severe renal disease, chronic lung disease and diabetes were associated with increased odds of hospitalization.

Objective:

To study the factors associated with streptococcal infection that led to hospitalization in Houston, Texas for years 2015-2016

Submitted by elamb on
Description

GAS pharyngitis affects hundreds of millions of individuals globally each year, and over 12 million seek care in the United States annually for sore throat. Clinicians cannot differentiate GAS from other causes of acute pharyngitis based on the oropharynx exam, so consensus guidelines recommend use of clinical scores to classify GAS risk and guide management of adults with acute pharyngitis. When the clinical score is low, consensus guidelines agree patients should neither be tested nor treated for GAS. A prediction model that could identify very-low risk patients prior to an ambulatory visit could reduce low-yield, unnecessary visits for a most common outpatient condition. We recently showed that real-time biosurveillance can further identify patients at low-risk of GAS. With increasing emphasis on patient-centric health care and the well-documented barriers impeding clinicians’ incorporation of prediction models into medical practice, this presents an opportunity to create a patient-centric model for GAS pharyngitis based on history and recent local epidemiology. We refer to this model as the “home score,” because it is designed for use prior to a physical exam.

Objective

1. To derive and validate an accurate clinical prediction model (“home score”) to estimate a patient’s risk of group A streptococcal (GAS) pharyngitis before a health care visit based only on history and real-time local biosurveillance, and to compare its accuracy to traditional clinical prediction models composed of history and physical exam features. 2. To examine the impact of a home score on patient and public health outcomes.

Submitted by rmathes on