Recurrent refractory Clostridium difficile infection has been a cause of significant morbidity. There have been years of anecdotal case reports of successful fecal transplant. This study  published in the January 31st 2013 issue of New England Journal of Medicine describes resolution of symtoms in 13 of 16 patients treated with single duodenal infusion of feces. Feces was collected on the day of infusion from prescreened volunteers, processed and administered within 6 hours of collection via nasoduodenal tube. The feces was diluted with 500 ml of sterile water, stirred, strained before administration. All patients in the study first received oral vancomycin followed by bowel prep with 4 liters of macrogol solution on the last day of antibiotic treatment.
This past week we reviewed some hospital data and found ongoing confusion with regards to classifying surgical wounds. I put together a quick cheat sheet to help with wound classification.
Under classifying the wound will produce a lower severity of illness making the provider and the institution appear worse for the same outcomes
Remember as more data is being collected for hospital report cards it is imperative to have accurate wound classification. The knee jerk reaction of many providers is to under classify the surgical wound. Outcomes are being compared to these data points. Under classifying the wound will produce a lower severity of illness making the provider and the institution appear worse for the same outcomes.
So lets all get the credit we deserve by making sure we classify wounds correctly.
Invasive pneumococcal disease is the most common vaccine preventable disease worldwide
A few key point on Pneumovax (23-valent):
There is no contraindication to give pneumovax at hospital admission.
Invasive pneumococcal disease is the most common vaccine preventable disease worldwide. 40,000 deaths are attributable to invasive pneumococcal disease in the US annually.
Current 23-valent polysaccharide vaccine covers 95% of the most common causes of invasive pneumococcal disease.
Vaccination reduces rates of death from invasive pneumococcal disease. At least half of these deaths are preventable with vaccination.
Pneumovax reduces duration of hospitalization for CAP. 1
Pneumovax reduces rates of death from myocardial infarction and strokes as shown in a recent prospective trial 2
The goal of pneumovax is to reduce death from invasive pneumococcal disease NOT to reduce the number of pneumonia cases.
The current national average for patients 65 years of age and over is 65% coverage. This is too low.
To address the issue of why only one dose after the age of 65 please see the attached algorithm that I put together. I hope that it better explains who needs to be vaccinated and how often. The recommendations are that EVERYONE get one dose of pneumovax after the age of 65. Anyone with additional risk factors will get the greater interval of vaccination per the higher risk group.
Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587. http://www.ncbi.nlm.nih.gov/pubmed/20887208.
Dominguez, Angela, Lluis Salleras, David S Fedson, Conchita Izquierdo, Laura Ruiz, Pilar Ciruela, Asuncion Fenoll, and Julio Casal. 2005. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 40, no. 9 (May): 1250-7. doi:10.1086/429236. http://www.ncbi.nlm.nih.gov/pubmed/15825026.
Vila-Córcoles, Angel, Olga Ochoa-Gondar, Imma Hospital, Xabier Ansa, Angels Vilanova, Teresa Rodríguez, and Carl Llor. 2006. Protective effects of the 23-valent pneumococcal polysaccharide vaccine in the elderly population: the EVAN-65 study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 43, no. 7 (October): 860-8. doi:10.1086/507340. http://www.ncbi.nlm.nih.gov/pubmed/16941367.
Johnstone, Jennie, Thomas J Marrie, Dean T Eurich, and Sumit R Majumdar. 2007. Effect of pneumococcal vaccination in hospitalized… [Arch Intern Med. 2007] – PubMed result. Archives of internal medicine 167, no. 18 (October): 1938-43. doi:10.1001/archinte.167.18.1938. http://www.ncbi.nlm.nih.gov/pubmed/17923592.
Jackson, Lisa a, and Edward N Janoff. 2008. Pneumococcal vaccination of elderly adults: new paradigms for protection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 47, no. 10 (November): 1328-38. doi:10.1086/592691. http://www.ncbi.nlm.nih.gov/pubmed/18844484.