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Introduction: Appropriate vaccination status in the pre-solid organ transplant period is critically important., Methods: To determine if lung transplant candidates are adequately vaccinated for Streptococcus pneumoniae, a cross-sectional study was performed. Electronic records of patients referred to our institution for transplantation evaluation between July 2002 and January 2004 were reviewed., Results: Only 98 of 157 patients (62.4%; 95% confidence interval [CI], 54.8 to 70.1%) evaluated for lung transplantation reported prior receipt of S pneumoniae vaccine. COPD was the only factor significantly associated with vaccination. Patients with COPD were more likely to have received vaccination compared to patients with other diagnoses (odds ratio, 4.66; 95% CI, 2.26 to 9.60)., Conclusions: S pneumoniae vaccination rates among potential lung transplant candidates fall substantially short of current recommendations for universal immunization. Transplant programs should thoroughly review vaccination status and develop strategies to ensure that candidates receive all appropriate vaccines before transplantation.

Study Objective: To determine whether standard clinical and transthoracic echocardiographic criteria considered to be suggestive of the presence of endocarditis-associated paravalvular abscess are predictive of which patients would benefit from reliable but invasive transesophageal echocardiographic investigations for abscess., Design: Retrospective chart review., Setting: A 630-bed university hospital., Patients: Forty-eight patients with 51 episodes of definite endocarditis and 24 paravalvular abscesses., Measurements and Results: A comparison of abscess and nonabscess populations revealed that clinical parameters (patient demographics, valvular involvement, presence of a prosthesis, infection with a virulent organism, pericarditis, persistent fever, persistent bacteremia, congestive heart failure, history of intravenous drug use, embolization) and transthoracic echocardiographic parameters were insensitive predictors of the presence of abscess. The only statistically significant correlate was the presence of previously undetected atrioventricular or bundle branch block. Paravalvular abscesses were common in our population and were associated with increased mortality. Improved survival correlated with the absence of mitral valve involvement and the absence of moderate-to-severe congestive heart failure., Conclusions: Given the accuracy and safety of transesophageal echocardiography and the unreliability of clinical and transthoracic echocardiographic criteria, we recommend that transesophageal echocardiography be considered in all endocarditis patients with previously unrecognized conduction disturbances, aortic or prosthetic valve involvement, or both, or indications for valve replacement, or all of the foregoing.

Polymicrobial endocarditis is being reported with increasing frequency in drug abusers. However, the full extent of infection may be unrecognized with routine blood culture techniques because of the overgrowth of more fastidious organisms by other pathogens. This report documents an intravenous drug abuser with the first reported case of tricuspid valve endocarditis involving seven pathogens, discusses pitfalls of routine blood cultures and examines the role of the laboratory in microbiologic diagnosis.