scholarly journals Outcomes According to Discharge Location for Persons Who Inject Drugs Receiving Outpatient Parenteral Antimicrobial Therapy

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Helen T D’Couto ◽  
Gregory K Robbins ◽  
Kevin L Ard ◽  
Sarah E Wakeman ◽  
Justin Alves ◽  
...  
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Injection Drug ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Study Population ◽  
Antibiotic Courses

Abstract Background Opioid use disorder poses a significant public health risk. Persons who inject drugs (PWID) suffer from high mortality and morbidity secondary to serious infectious diseases, often requiring prolonged courses of outpatient parenteral antibiotics. The goal of this study was to determine the outcomes of PWID discharged to home or to a skilled nursing or rehabilitation facility (SNF/rehab) with parenteral antibiotic treatment under an outpatient parenteral antimicrobial therapy (OPAT) program. Methods This is a retrospective observational study. The study population was identified via hospital and OPAT databases using substance use disorder diagnoses and confirmed through chart review. The study population included hospitalized PWID with injection drug use in the preceding 2 years who were discharged between 2010 and 2015 to complete at least 2 weeks of parenteral antibiotics and monitored by the OPAT program. Retrospective chart review was used to describe patient characteristics and outcomes. Results Fifty-two patients met inclusion criteria, 21 of whom were discharged to home and 31 were discharged to a SNF/rehab. Of the patients discharged to home, 17 (81%) completed their planned antibiotic courses without complication. Twenty (64%) patients discharged to a SNF/rehab completed the antibiotic courses without complication. Six (11%) patients had line infections, 6 (11%) had injection drug use relapse, and 12 (23%) required readmission. Conclusions Persons who inject drugs discharged home were not more likely to have complications than those discharged to a SNF/rehab. Home OPAT may be a safe discharge option in carefully selected patients.

scholarly journals Low Knowledge of HIV PrEP Within a Midwestern U.S. Cohort of Persons Who Inject Drugs

2021 ◽  
Author(s):  
Sena Sayood ◽  
Laura R Marks ◽  
Rupa Patel ◽  
Nathanial S Nolan ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Sexual Intercourse ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Opioid Use ◽  
Persons Who Inject Drugs

Abstract We interviewed persons who inject drugs (PWID) to understand perceptions of PrEP to prevent HIV infection. Knowledge of PrEP was poor. Patients felt PrEP was for sexual intercourse rather than injection drug use, and PWID managed on medications for opioid use disorder (MOUD) felt they had no need for PrEP.

Outcomes of Outpatient Parenteral Antimicrobial Therapy in Patients With Injection Drug Use

2018 ◽  
Vol 59 (5) ◽  
pp. 490-495 ◽  
Author(s):  
Mohsen Vazirian ◽  
Jason M. Jerry ◽  
Nabin K. Shrestha ◽  
Steven M. Gordon
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Antimicrobial Therapy ◽  
Injection Drug ◽  
Outpatient Parenteral Antimicrobial Therapy

scholarly journals A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

2021 ◽  
Vol 6 ◽  
Author(s):  
Cara Jane Bergo ◽  
Jennifer R. Epstein ◽  
Stacey Hoferka ◽  
Marynia Aniela Kolak ◽  
Mai T. Pho
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Drug Use ◽  
Injection Drug Use ◽  
Negative Binomial ◽  
Cook County ◽  
Injection Drug ◽  
County Level ◽  
Opioid Use ◽  
Zip Code

The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons <40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

scholarly journals Brucella Endocarditis in Persons Who Inject Drugs

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
John M Cafardi ◽  
Douglas Haas ◽  
Thomas Lamarre ◽  
Judith Feinberg
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug Users ◽  
Drug Users ◽  
Cardiac Involvement ◽  
Injection Drug ◽  
Persons Who Inject Drugs ◽  
Brucella Infection

Abstract We report 2 cases of infective endocarditis in injection drug users due to Brucella infection. Although cardiac involvement is a frequent sequela of brucellosis and endocarditis is often seen with injection drug use, Brucella endocarditis in persons who inject drugs without zoonotic exposure has not been reported to date.

scholarly journals Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use–Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak—Cincinnati/Northern Kentucky, 2017–2018

2020 ◽  
Author(s):  
Nathan W Furukawa ◽  
Erin F Blau ◽  
Zach Reau ◽  
David Carlson ◽  
Zachary D Raney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Hiv Testing ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Diagnosis ◽  
Persons Who Inject Drugs ◽  
Missed Opportunities ◽  
Immunodeficiency Virus

Abstract Background Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. Methods PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017–September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. Results Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70–4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10–2.82). Conclusions PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.

scholarly journals Clostridium botulinum Type B Isolated From a Wound Botulism Case Due to Injection Drug Use Resembles Other Local Strains Originating From Hawaii

2021 ◽  
Vol 12 ◽  
Author(s):  
Jessica L. Halpin ◽  
Victoria Foltz ◽  
Janet K. Dykes ◽  
Kevin Chatham-Stephens ◽  
Carolina Lúquez
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Clostridium Botulinum ◽  
The United States ◽  
Sequence Type ◽  
Injection Drug ◽  
Toxin Gene ◽  
Type B ◽  
Persons Who Inject Drugs ◽  
Wound Botulism

Clostridium botulinum produces botulinum neurotoxin (BoNT), which can lead to death if untreated. In the United States, over 90% of wound botulism cases are associated with injection drug use of black tar heroin. We sought to determine the phylogenetic relatedness of C. botulinum isolated from an injection drug use wound botulism case and isolates from endogenous infant botulism cases in Hawaii. Nineteen C. botulinum type B isolates from Hawaii and one type B isolate from California were analyzed by whole-genome sequencing. The botulinum toxin gene (bont) subtype was determined using CLC Genomics Workbench, and the seven-gene multi-locus sequence type (MLST) was identified by querying PubMLST. Mashtree and pairwise average nucleotide identity were used to find nearest neighbors, and Lyve-SET approximated a phylogeny. Eighteen of the isolates harbored the bont/B5 gene: of those, 17 were classified as sequence type ST36 and one was classified as ST104. A single isolate from Hawaii harbored bont/B1 and was determined to belong to ST110, and the isolate from California harbored bont/B1 and belonged to ST30. A tree constructed with Lyve-SET showed a high degree of homology among all the Hawaiian C. botulinum isolates that harbor the bont/B5 gene. Our results indicate that the bont/B-expressing isolates recovered from Hawaii are closely related to each other, suggesting local contamination of the drug paraphernalia or the wound itself with spores rather than contamination of the drug at manufacture or during transport. These findings may assist in identifying interventions to decrease wound botulism among persons who inject drugs.

scholarly journals New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

2019 ◽  
Vol 15 (10) ◽  
pp. 606-612
Author(s):  
David P Serota ◽  
Theresa Vettese
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Trial Data ◽  
Injection Drug ◽  
Soft Tissue Infections ◽  
Opioid Use ◽  
Surgical Interventions ◽  
Care Plans ◽  
Severe Infections

Hospitalists are increasingly responsible for the management of infectious consequences of opioid use disorder (OUD), including increasing rates of hospitalization for injection drug use (IDU)-associated infective endocarditis, osteomyelitis, and soft tissue infections. Management of IDU-associated infections poses unique challenges: symptoms of the underlying addiction can interfere with care plans, patients often have difficult psychosocial circumstances in addition to their addiction, and they are often stigmatized by the healthcare system. Although there are few randomized trial data to support one particular approach to management, the literature suggests that successful treatment of IDU-associated infections requires appropriate antimicrobial and surgical interventions in addition to acknowledgment and treatment of the underlying OUD. In this narrative review, the best available evidence is used to answer several of the most commonly encountered questions in the management of IDU-associated infections. These data are used to develop a framework for hospitalists to approach the care of patients with IDU-associated infections.

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