Infectious Complications of Injection Drug Use

Abstract Background Sepsis is an important cause of morbidity and mortality in the pregnant patient. Injection drug use in pregnant populations has led to increased cases of bacteremia and infective endocarditis (IE) due to Staphylococcus aureus. We describe all cases of S. aureus bacteremia and IE among admitted pregnant patients at our hospital over a 6-year period. Methods This was a retrospective review of pregnant patients hospitalized with S. aureus bacteremia between April 2013 and November 2019. Maternal in-hospital mortality and fetal in-hospital mortality were the primary outcomes measured; the secondary outcome was the rate of 6-month maternal readmission. Results Twenty-seven patients were included; 15 (56%) had IE. The median (interquartile range [IQR]) age was 29 (25–33) years; 22 (82%) patients had methicillin-resistant S. aureus. Infection onset occurred at a median (IQR) of 29 (23–34) weeks’ gestation. Twenty-three (85%) mothers reported active injection drug use, and 21 (78%) were hepatitis C seropositive. Fifteen (56%) mothers required intensive care unit (ICU) care. Twenty-two (81%) patients delivered 23 babies; of the remaining 5 mothers, 3 (11%) were lost to follow-up and 2 (7%) terminated pregnancy. Sixteen (73%) babies required neonatal ICU care, and 4/25 (16%) infants/fetuses died during hospitalization. One (4%) mother died during hospitalization, and 7/26 (27%) mothers were readmitted to the hospital within 6 months for infectious complications. Conclusions Injection drug use is a modifiable risk factor for S. aureus bacteremia in pregnancy. Fetal outcomes were poor, and mothers were frequently readmitted secondary to infection. Future targeted interventions are needed to curtail injection drug use in this population.

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1020. Injection Drug Use-Associated Staphylococcus aureus Bacteremia in a Large Urban Hospital in Atlanta, Georgia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.857 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S304-S304

Author(s):

David P Serota ◽

Colleen Kelley ◽

Jesse T Jacob ◽

Susan M Ray ◽

Marcos C Schechter ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Drug Use ◽

Injection Drug Use ◽

Infectious Complications ◽

Opioid Use Disorder ◽

Injection Drug ◽

First Episode ◽

Opioid Use ◽

Urban Hospital ◽

Multiple Drugs

Abstract Background Infectious complications of injection drug use (IDU) have increased with the expanding opioid epidemic in the southeast. We assessed the incidence, clinical presentation, and treatment outcomes of IDU-associated Staphylococcus aureus (SA) bacteremia (SAB). Methods We created a retrospective cohort of all adults with community acquired (CA) SAB over 5 years presenting to Grady Memorial Hospital, a 1,000-bed urban county hospital in Atlanta, GA. Charts were reviewed by infectious diseases physicians to obtain clinical and laboratory characteristics, including substance use disorder (SUD), and determine if SAB was IDU-associated. The study period was divided into three periods (P1 = March 2012–January 2014, P2 = January 2014–December 2015, P3 = December 2015–November 2017) to evaluate changes in the incidence of IDU-SAB over time using Poisson regression. Results Among 321 patients with a first episode of CA-SAB, 24 (7%) were IDU-SAB. The number of IDU-SAB cases in each period increased (P1 = 4, P2 = 7, and P3 = 13 [P = 0.07 for trend]). The median age of IDU-SAB patients was 38 (IQR 31–57), 11 (46%) were black, and 15 (63%) had chronic hepatitis C virus infection. Heroin was the most common injected drug (92%) followed by cocaine (25%); multiple drugs were injected in 29%. All but two patients (92%) had a complication of SAB, most commonly endocarditis (50%) and septic pulmonary emboli (38%). The median hospitalization was 23 days (IQR 19.5–37.5) and 5 patients (12%) left the hospital against medical advice (AMA). Readmission for persistent or recurrent SA infection during the study period was common (42%), and three (13%) died ≤6 months from initial presentation, including two with prior discharge AMA. Half of the discharge summaries did not mention SUD as a hospital problem. Outpatient SUD treatment was recommended to eight (33%) patients and a recommendation of abstinence was the intervention for 12 (50%). Conclusion Increasing IDU-SAB was observed over 5 years in our urban Atlanta hospital, primarily due to heroin use. Most cases were associated with complications of SAB with a long length of stay and frequent readmission, but few patients received treatment or harm reduction interventions for their SUD. These data will raise awareness and direct resources to expanding evidence-based opioid use disorder treatment for patients with infectious complications of IDU. Disclosures All authors: No reported disclosures.

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Infectious Complications of Injection Drug Use

Emergency Management of Infectious Diseases ◽

10.1017/cbo9780511547454.056 ◽

2009 ◽

pp. 363-372

Author(s):

Ralph Wang ◽

Bradley W. Frazee

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Infectious Complications ◽

Injection Drug

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The Dynamics of Infectious Diseases Associated with Injection Drug Use in Lawrence and Lowell, Massachusetts

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab128 ◽

2021 ◽

Author(s):

Gregg S Gonsalves ◽

A David Paltiel ◽

Thomas Thornhill ◽

Suzan Iloglu ◽

Alfred DeMaria ◽

...

Keyword(s):

Drug Use ◽

Infectious Diseases ◽

Injection Drug Use ◽

Warning System ◽

Infectious Complications ◽

Injection Drug ◽

Health Departments ◽

Incision And Drainage ◽

Public Health Departments ◽

Distributed Lag

Abstract There are a wide variety of infectious complications of injection drug use. Understanding the trajectory of these complications might inform the development of an early warning system for HIV outbreaks that occur regularly among people who inject drugs (PWID). A distributed lag Poisson regression model in the Bayesian setting was used to examine temporal patterns in the incidence of injection-associated infectious diseases and their association with HIV cases in Lawrence and Lowell, Massachusetts between 2005-2018. Current-month HIV counts are associated with fatal overdoses approximately 8 months prior, cases of infective endocarditis 10 months prior, cases of skin and soft tissue infections and incision and drainage procedures associated with these infections, 12 months prior. Collecting data on these other complications associated with injection drug use by public health departments may be important to consider as these complications may serve as input to a sentinel system to trigger early intervention and avert potential outbreaks of HIV.

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767. Can Integration of Addiction Treatment Facilitate Safe Discharge on OPAT for Patients with Infectious Complications of Injection Drug Use?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.835 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S341-S342

Author(s):

Daniel A Solomon ◽

Christin Price ◽

Jennifer A A Johnson ◽

Mary W Montgomery ◽

Bianca Martin ◽

...

Keyword(s):

Infectious Disease ◽

Drug Use ◽

Injection Drug Use ◽

Addiction Treatment ◽

Infectious Complications ◽

Injection Drug ◽

Opioid Use ◽

Eligibility Criteria ◽

Joint Infections ◽

The Impact

Abstract Background While there is a growing body of evidence that suggests outpatient parental antibiotic treatment (OPAT) for people who inject drugs (PWID) may be safe, research on integrating OPAT with addiction treatment for PWID has been limited. Methods Adults hospitalized for infectious complications of injection drug use (IDU) requiring prolonged IV antibiotics were included in this study. The suitability for OPAT was determined by the infectious disease and addiction consultation services. Eligibility criteria included safe housing, attendance at infectious disease (ID) clinic visits, and engagement with addiction treatment. Demographic and clinical outcomes were summarized, and compared with patients without any IDU history enrolled in OPAT during the same time at the same institution. Results Eighteen OPAT episodes among 17 individuals were included, with 9 (50.0%) males. Mean age was 38.4 (SD 9.5). Types of infection included endocarditis (38.9%), epidural abscess (38.9%), and bone/joint infections (33.3%). Opioid use disorders (OUD) were most common (94.4%), followed by cocaine (33.3%) and benzodiazepines (16.7%). All individuals completed the recommended course of IV antibiotics. All OUD patients received buprenorphine (52.9%) or methadone (47.1%). Two (11.1%) relapsed to drug use during OPAT, but no instances of line tampering, thrombosis, line infection or line dislodgement were identified. No deaths or overdoses were reported. Collectively, 504 inpatient days were avoided. Compared with 390 individuals without any history of IDU, those with IDU history were significantly younger (38.4 vs. 59.0, P < 0.0001), had fewer episodes of endocarditis (38.9% vs. 43.6%) and bone/joint infections (33.3% vs. 41.8%), but more epidural abscesses (38.9% vs. 3.1%). There were no statistical differences in rates of readmission (22.2% vs. 11.3%), line complications (0% vs. 3.5%), mortality (0% vs. 1.0%), ID clinic visit attendance (100.0% vs. 82.0%), or number of days on OPAT (28.0 vs. 30.1). Conclusion Results add further evidence of OPAT’s safety among PWID and that integration of addiction treatment may be feasible. OPAT outcomes were similar to those without any IDU history. More research is needed to study the impact of integrating addiction treatment with OPAT for PWID. Disclosures All authors: No reported disclosures.

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