2% versus 12.8%) [45]. The pneumococcal bacteremia and meningitis mortality rates we observed also agreed with previous findings,

which range from 10% to greater than 40% [46–50]. Overall, one-third of the patients in our study with serious infections had a history of pneumococcal vaccination, which is much lower than the previously reported vaccination rate of 85% for patients at VA facilities nationally in 2003 [51]. As we conducted our study in older adults and observed significant increases in risk factors for S. pneumonia, it is likely #Erismodegib clinical trial randurls[1|1|,|CHEM1|]# that a number of these non-vaccinated patients had indications for vaccination. This is extremely concerning as non-vaccinated patients with indications for vaccination are more likely to become infected with pneumococcus than those without indications, and non-vaccinated patients are also twice as likely to die if they develop invasive pneumococcal disease [52, 53]. The sickest patients in our study were more likely to receive pneumococcal vaccination. Therefore, the vaccinated patients likely had more healthcare exposures resulting in greater opportunities to receive a pneumococcal vaccination than the non-vaccinated NSC23766 cost patients. Increased pneumococcal vaccination awareness may be needed

for patients who are at risk of pneumococcal disease and have indications for vaccination but have fewer

healthcare exposures. The administration of vaccination in non-traditional settings, such as pharmacies and shopping malls, may improve vaccine coverage in these patients [4]. There are several limitations Tangeritin to this study. Our estimation of burden of non-invasive pneumococcal disease may be an underestimate, particularly in the outpatient population, as the value of cultures is limited in the diagnosis of many non-invasive pneumococcal infections. For acute otitis media, the standard of diagnosis is with otoscopic examination not bacterial cultures. For pneumonia, sputum samples are optional in most patients as utility is limited by the inability of many patients to produce adequate sputum samples and by poor specificity due to pneumococcal colonization of the upper airways [38]. For the inpatient population, we attempted to increase the specificity of respiratory cultures by requiring a diagnosis code for pneumonia. We did not include S. pneumoniae antigen detection tests to define pneumococcal disease. Pneumococcal urinary antigen tests may be adequate to diagnose pneumococcal pneumonia; however, sputum cultures are often still indicated at the point of care for sensitivity testing to confirm the appropriate antimicrobial treatment [38].