Cotton shots, when not shared, are perceived by participants as a safe last resort source for drugs, unaware that warm, moist environments facilitate bacterial growth. Themes were identified on the basis of topic and recurrent patterns highlighted throughout analysis of multiple participants’ accounts. Theoretical interpretations resulted from comparative analysis of the most commonly voiced themes and attempted to connect key themes across individual accounts.
- Storage of cottons/filters and cookers already exposed to wet material could provide an environment for bacteria to remain viable and proliferate.
- As such, availability of food for those who are hungry, a place to rest for those who are tired, a nurse to attend to sickness and abscesses, clean clothing, and showers for those who cannot have access to them would go a long way in facilitating the hygienic conditions SBI prevention requires.
- WashU Medicine is committed to changing the world by helping improve the human condition through research, education and care, leading to the treatment and cures of the most complex diseases affecting the world.
- Our study corroborates results from earlier studies [1,2,34] that show that skin and soft tissue infections are the most frequently occurring infections in IVDU (Table (Table2).2).
- Before the blood culture results are prepared, empiric therapy such as vancomycin or daptomycin should be given for methicillin-resistant S.
Soft Tissue, Bone, and Joint Infections in People Who Inject Drugs
- Nearly 30 years of research shows that comprehensive syringe services programs (SSPs) are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.
- Additionally, as difficulties with filling prescriptions, due to either cost, travel, or other issues, has been previously cited as a key barrier to medication adherence, significant efforts were made to reduce this burden on patients [25, 26].
- The resulting delay in diagnosis and possibly reduced number of available therapeutic options may produce a less favorable outcome to treatment as well as more frequent and potentially life-threatening complications.
- Sharing needles, syringes, or other equipment (works) to inject drugs puts people at high risk for getting or transmitting HIV and other infections.
Although the articles in this supplement were submitted prior to the coronavirus disease 2019 (COVID-19) pandemic, people who inject drugs (PWID) have in no way been spared. The social distancing measures that helped slow the spread of severe acute respiratory syndrome coronavirus 2 may increase feelings of anxiety and loneliness among PWID while making it more difficult to obtain prevention, treatment, and social services. Although the full impact of the pandemic on PWID has not been defined, PWID are likely at risk for infection and severe disease, due to high rates of comorbid health conditions, homelessness, and other suboptimal social conditions [5–11]. While IV antibiotics are still considered the standard of care for invasive infections, the study’s findings suggest that people who do not want to stay in the hospital for weeks should be given the option of taking oral antibiotics at home, even if they most likely became infected by injecting drugs.
CARDIOVASCULAR COMPLICATIONS
Epidermidis and coagulase-negative staphylococci (CNS), which are gram-positive organisms. Gram-negative organisms like Escherichia coli, Enterobacter species, and Klebsiella species are commonly seen in hemodialysis patients [37]. Patient demographics, substance use history, infection type, care characteristics, and outcomes were reviewed in the electronic medical record.
Harm Reduction Knowledge
Harm reduction messaging consistently acknowledges the importance of access to clean injection equipment in the prevention of blood-borne viral pathogens such as HIV and hepatitis C, however guidance on the prevention of bacterial infection is limited [51, 52]. Interventions could include earlier medical evaluation for skin and soft tissue infection and training to improve sterile, and less risky, injection practices. Lastly, beyond injection supplies and prevention knowledge, the embodiment of harsh socio-ecological factors leading to SBIs (and other infections), calls for a forward acknowledgement and welcoming of PWID’s bodies in harm reduction services.
Skin and Soft Tissue Infections
Participation in any program of heroin or methadone substitution administered by a public organization was considered participation in an opioid maintenance program. Hepatitis doesn’t cause sepsis, but the virus can cause damage to your liver, which puts you at higher risk for infections. Sixty respondents (80.0%) reported they had never referred a patient to an SSP and 14 (18.7%) reported that they had.
- Sharing of other drug injection equipment, including cottons/filters, cookers, and drug diluting water and/or containers, was more commonly reported among participants and perceived as less risky.
- Perceived likelihood of risk, severity, and susceptibility of SBI among PWID varies widely, and these beliefs can lead to risky injection practices in the context of withdrawal symptoms, drug injection network, and lived experiences.
- Early diagnosis and appropriate medical care and treatment of infections can help to alleviate symptoms and improve outcomes.
- Nearly all persons with such infections injected opioids; most were not offered medication-assisted treatment to reduce injection drug use.
Demographic data and laboratory results for the 344 hospitalizations of 216 patients are summarized in Table Table1.1. Although the majority of IVDU (93.7%) were enrolled in an opioid maintenance program, 98.4% also used illicit drugs in addition to their maintenance doses. The patients in this study population suffered from diverse co-morbidities and malnutrition as indicated by the rather low body mass index. Psychiatric co-morbidities in IVDU are reported in up to 30% of IVDU and are recognized as risk factors for needle-sharing, more frequent sex for money or gifts and being raped [13], all of which can lead to infection. Patients with psychiatric diseases are known to have a limited capacity to consent to proposed interventions and are consequently more likely to refuse treatment [14].
SS contributed to manuscript drafting and revision and was responsible for intellectual data gathering and literature review. FL performed the patient’s echocardiography and collected data.FL also highly contributed to the drafting and revising of the manuscript for important intellectual content and reviewed the literature. This iv drug use study was approved and granted a waiver of consent by the Washington University Institutional Review Board before any research activities were performed. Is the site PI for a study funded by Gilead Sciences (funds paid to institution). The authors thank all of the participants who provided feedback about the Six Moments model.
Participants without a prior history of hospitalization from injection-related bacterial infections reported anecdotal experiences of SBI from fellow injection drug users. The percentage of microbiologically documented infections was 100% for bacterial endocarditis and septic thrombosis, 96% for bone and joint infections, 85.7% for primary sepsis without focus, 77.7% for skin and soft tissue infections, and 72% for pneumonia. The percentage of microbiologically documented infections for all other types of infections together was 62.3%. Medical treatment of IE is initiated based on the causative microorganisms isolated in blood cultures. Before the blood culture results are prepared, empiric therapy such as vancomycin or daptomycin should be given for methicillin-resistant S. The patient was then continued on a carbapenem-aminoglycoside regimen until the end of his hospitalization.
In our study, therapy for septic thrombosis was defined as adequate if a minimum duration of four weeks of treatment was planned and the antibiotic was given intravenously for the first 2 weeks [20] according to the guidelines for treating right heart endocarditis [24,25]. The diagnostic challenges of IPE often lead to patients needing to be noticed and treated. Therefore, a comprehensive cardiopulmonary investigation should be pursued for any patient with recurrent fever, sepsis, and pulmonary symptoms, even if the patient has no common risk factors. The decision between early and late surgery and pulmonary valve repair or replacement in complicated IPE remains a significant challenge, as there are no definitive guidelines for providing a clear answer. Furthermore, the rarity of IPE as a clinical entity and the uncommon microbial pathogens causing it suggest further research in the future, particularly in patients with an unclear history of precipitating factors. Future reports should aim to include longitudinal follow-up data to assess the long-term efficacy of surgical interventions in pediatric IPE patients, especially those with complex conditions like Down syndrome.