Author Archives: admin

New Drug Approvals Fall in 2010 as Safety Concerns Slow U.S. FDA Decisions – Bloomberg

Having a good pipeline of new drugs in essential to keep medical progress going forward. This is especially true for infectious diseases as bacteria continually evolve the ability to resist current drugs. Unfortunately new antibiotic development is on the back burner for many drug companies, as it is seen as being to expensive to develop.

New Drug Approvals Fall in 2010 as Safety Concerns Slow U.S. FDA Decisions – Bloomberg.

Fruit and vegetable intake and overall cancer risk

This is a published 8 year study that followed over 477 thousand individuals looking for incidence of cancer. The results were interestingly that the intake of fresh fruit and vegetables make little if no difference in the rates of cancer. Interesting but not surprising findings. Remember statistically the best ways to maintain health is:

  1. Watch your weight, keep the BMI within normal range
  2. Dont smoke
  3. Get regular exercise
  4. Get treatment for hypertension and diabetes
  5. Keep up to date on vaccinations
  6. Avoid accidents

Fruit and vegetable intake and overall cancer risk… [J Natl Cancer Inst. 2010] – PubMed result.

Body-Mass Index and Mortality among 1.46 Million White Adults — NEJM

Very interesting article in the recent New England Journal of Medicine about BMI and mortality. Nothing earth shattering in terms of news but does produce more evidence that BMI accounts for a significant part of “health”. A great portion of health is just maintaining optimal BMI, not smoking and getting some exercise.

Body-Mass Index and Mortality among 1.46 Million White Adults — NEJM.

An excellent review on the future developments of influenza vaccines

This review was published in the Nov 18th, 2010 issue of the New England Journal of Medicine. It does a great job detailing the vaccine production and some of the pitfalls in developing newer universal vaccines; influenza vaccines that do not require annual shots. It is a must read.

Influenza vaccination reduces MI and stroke in elderly- a published study

Just another reason to have the elderly vaccinated every year with Influenza vaccine along with appropriate 23-valent pneumococcal vaccine (when is pneumovax given?).

This prospective study in Hong Kong observed readmission rates among 36,000 elderly patients. The study found statistically significant decrease in the number of deaths, pneumonia, strokes and myocardial infarctions among the studied population.

One may ask “What does a vaccine have to do with prevention of stroke or MI?”. The reasons are that this population is at risk for these stressful infections. The burden of these conditions (sepsis) can further stress a compromised elderly patient and can “push” them into a stroke or and MI. These vaccine may not even completely prevent the illnesses themselves but by reducing the stress of the illness can go a long way in reducing morbidity and mortality from other conditions such as MI and strokes.

Also of note that very few if any “side effects” that are often cited in the lay media were seen. If there were more side effects it should have been seen in the higher hospitalization rate. In fact the vaccinated group had lower death and hospitalization rates.

For more information read the reference:

1. 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.

Surgical wound classification

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.

Classification of surgical wounds

Classification of surgical wounds

Who gets the pneumovax?

A lot of confusion about who gets vaccinated with the 23-valent pneumococcal vaccine. I put together this article to help clarify some of the common questions.

Invasive pneumococcal disease is the most common vaccine preventable disease worldwide

Remember:

  • 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. (see reference)
  • Pneumovax reduces rates of death from myocardial infarction and strokes as shown in a recent prospective trial (see reference)
  • 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.
Chart showing who gets 23-valent pneumovax

Chart showing who gets 23-valent pneumovax

  1. Fisman, David N, Elias Abrutyn, Kimberly A Spaude, Alex Kim, Cheryl Kirchner, and Jennifer Daley. 2006. Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 42, no. 8 (April): 1093-101. doi:10.1086/501354. http://www.ncbi.nlm.nih.gov/pubmed/16575726.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.

Drug Safety and Availability > FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections

Drug Safety and Availability > FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections.

A must read notice published by the FDA. It appears that there is a trend towards statistical inferiority of tigecycline when compared to standard therapy with regards to ventilator associated pneumonia. It is also notable that it did not show better outcomes in any category when compared to standard therapy.

This by no means indicates that tigecycline is an inferior drug but merely that it is about as good as other standard therapy on the market. Yes; it is a broader coverage drug similar to imipenem. But contrary to popular belief among my fellow colleagues, broader coverage drug not always equate with better drug or even a better outcome.

Keeping the coverage appropriate to the condition being treated using a drug that achieves appropriate serum levels at the site of the infection under the conditions currently present (pH, low O2 concentrations, neutropenia) will achieve optimal results.