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Abstract
Problem: There are very few recent studies on the etiology of ARTIs done in the US. Care seeking behavior of college-aged students has not been researched. Our primary goal is to identify bacterial and/or viral organisms that are pathogenic and ones that could be commensal. Our secondary goal is to identify symptoms and illness severity that influences students’ likelihood for seeking care or antibiotic treatment. Methods: We performed a meta-analysis to identify etiologies associated with symptomatic illness and etiologies that could be commensal. We conducted a case-control study composed of cases with symptomatic ARTIs and controls to determine identify etiology of ARTIs. A survey was administered to University of Georgia students as a cross-sectional study to identify symptoms and illness severity associated with seeking care or seeking antibiotic treatment. Results: The meta-analysis identified 17 studies that reported etiology for symptomatic ARTIs, 9 of which also included etiology in healthy individuals. We found that among symptomatic patients, the etiology of ARTIs was most often viral. The viruses included influenza, rhinovirus, human coronavirus, and enterovirus. Bacteria such as Streptococcus pneumoniae and Haemophilus influenzae were detected more often in asymptomatic persons compared to symptomatic. A total of 1,215 individuals met the inclusion criteria for our case-control study. Again, viral etiology was more often association with being symptomatic. The most common viruses in the symptomatic group included rhinovirus, influenza A and B, and SARS-CoV-2. Rhinovirus and SARS-CoV-2 were determined to be pathogenic with P-EPVs greater than 80%. Streptococcus pneumoniae, Klebsiella pneumoniae, Acinetobacter baumanii, Streptococcus pyogenes, Ureaplasma urealyticum, Staphylococcus aureus, Pneumocysitis jirovecii, and Ureaplasma parvum had the potential to be commensal as they were detected more frequently in healthy individuals compared to symptomatic patients. As such, these bacterial organisms had P-EPVs approaching or less than 0%. A total of 2,000 students completed our vignette survey. The likelihood for seeking care or antibiotic treatment significantly increased by scenario severity. Recent antibiotic use was a predictor for seeking care and/or seeking antibiotic treatment for all conditions (aOR 1.5 – 3.8, 95% CI [1.0, 5.4]). Non-white race was an independent predictor of seeking care for URTIs and LRTIs (aOR 1.8 – 2.1, 95% CI [1.2, 3.7]) and seeking antibiotic treatment for URTI and sore throat (aOR 1.6 – 2.4, 95% CI [1.2, 3.7]). Being an undergraduate in school was an independent predictor for seeking an antibiotic for all conditions (aOR 1.5 – 3.8, 95% CI [1.0, 5.4]). Symptom specific predictors for seeking care and/or antibiotic treatment for URTIs were fever (aOR 12.5, 95% CI [9.2, 16.9]), nasal discharge (aOR 2.9, 95% CI [2.5, 3.4]), and sore throat (aOR 3.5 – 6.1, 95% CI [2.8, 8.1]). Symptom specific predictors for seeking care and/or antibiotic treatment for sore throat were long symptom duration (aOR 2.0 – 3.6, 95% CI [1.5, 4.7]) and swollen glands (aOR 2.7 – 3.0, 95% CI [2.1, 3.9]). Symptom specific predictors for seeking care and/or antibiotic treatment for LRTIs were discolored sputum (aOR 10.8 – 25.6, 95% CI [8.0, 37.5]). Conclusion: Etiology of symptomatic ARTIs were determined to most often be viral. Certain bacterial organisms, when present, have the potential of being commensal as they are identified more often in healthy individuals than patients with symptoms. Students are more likely to seek care and antibiotics with more severe illness when compared to mild or moderate. Students were also more likely to seek antibiotic treatment if they had recently been prescribed an antibiotic. Other common predictors for seeking care included non-white race and younger age in school.