scholarly journals Septic Arthritis and the Opioid Epidemic: 1465 Cases of Culture-Positive Native Joint Septic Arthritis From 1990–2018

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
John J Ross ◽  
Kevin L Ard ◽  
Narath Carlile
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Facet Joints ◽  
Cell Counts ◽  
Culture Positive ◽  
Fluid Cell

Abstract Background The clinical spectrum of septic arthritis in the era of the opioid crisis is ill-defined. Methods This is a retrospective chart review of 1465 cases of culture-positive native joint septic arthritis at Boston teaching hospitals between 1990 and 2018. Results Between 1990–2008 and 2009–2018, the proportion of septic arthritis cases involving people who inject drugs (PWID) rose from 10.3% to 20% (P < .0000005). Overall, methicillin-sensitive Staphylococcus aureus (MSSA) caused 41.5% of cases, and methicillin-resistant Staphylococcus aureus (MRSA) caused 17.9%. Gram-negative rods caused only 6.2% of cases. Predictors of MRSA septic arthritis included injection drug use (P < .001), bacteremia (P < .001), health care exposure (P < .001), and advancing age (P = .01). Infections with MSSA were more common in PWID (56.3% vs 38.8%; P < .00001), as were infections with MRSA (24% vs 16.8%; P = .01) and Serratia sp. (4% vs 0.4%; P = .002). Septic arthritis in the setting of injection drug use was significantly more likely to involve the sacroiliac, acromioclavicular, and facet joints; 36.8% of patients had initial synovial fluid cell counts of <50 000 cells/mm3. Conclusions Injection drug use has become the most common risk factor for septic arthritis in our patient population. Septic arthritis in PWID is more often caused by MRSA, MSSA, and Serratia sp., and is more prone to involve the sacroiliac, acromioclavicular, sternoclavicular, and facet joints. Synovial fluid cell counts of <50 000 cells/mm3 are common in culture-positive septic arthritis.

scholarly journals Risk Factors, Screening and Treatment Challenges in Staphylococcus aureus Native Septic Arthritis

2020 ◽  
Author(s):  
Valerie C Gobao ◽  
Mostafa Alfishawy ◽  
Clair Smith ◽  
Karin E Byers ◽  
Mohamed Yassin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Drug Use ◽  
Septic Arthritis ◽  
Injection Drug Use ◽  
Predictive Value ◽  
Injection Drug ◽  
Opioid Epidemic ◽  
Demographic Shift ◽  
Predictive Values

Abstract Background Staphylococcus aureus is the most common cause of native septic arthritis. Few studies have characterized this disease during the U.S. opioid epidemic. The role of MRSA nasal screening in this disease has not been elucidated. We sought to identify risk factors and outcomes for S. aureus native septic arthritis and to evaluate MRSA screening in this disease. Methods A retrospective cohort study of native septic arthritis patients (2012-2016) was performed. Demographics, risk factors, and outcomes were compared between Staphylococcus aureus and other native septic arthritis infections. Sensitivity, specificity, and predictive values of MRSA screening were assessed. Results 215 cases of native septic arthritis were included. S. aureus was cultured in 64% (138/215). MRSA was cultured in 23% (50/215). S. aureus was associated with injection drug use (OR: 4.33, CI: 1.74 to 10.81, p=0.002) and switching antibiotics (OR: 3.92, CI: 1.01 to 21.38, p=0.032). For every ten-year increase in age, odds of S. aureus decreased (OR: 0.72, CI: 0.60 to 0.87, p=0.001). For one unit increases in CCMI, odds of S. aureus decreased (OR: 0.82 CI: 0.73 to 0.91, p=0.0004). MRSA screening during admission demonstrated sensitivity of 0.59, specificity of 0.96, positive predictive value of 0.85, and negative predictive value of 0.84 for MRSA native septic arthritis. Conclusions The opioid epidemic may be contributing to a demographic shift in native septic arthritis to younger, healthier individuals. S. aureus native septic arthritis has unique risks, including injection drug use. MRSA screening may be useful to rule in MRSA native septic arthritis.

scholarly journals Maternal Bacteremia Caused by Staphylococcus Aureus With a Focus on Infective Endocarditis

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Morgan K Morelli ◽  
Michael P Veve ◽  
Mahmoud A Shorman
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Hospital Mortality ◽  
Injection Drug Use ◽  
Pregnant Patient ◽  
Infectious Complications ◽  
Injection Drug ◽  
Secondary Outcome ◽  
Targeted Interventions

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.

scholarly journals Staphylococcus aureus injection drug use-associated bloodstream infections are propagated by community outbreaks of diverse lineages

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Laura R. Marks ◽  
Juan J. Calix ◽  
John A. Wildenthal ◽  
Meghan A. Wallace ◽  
Sanjam S. Sawhney ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Injection Drug Use ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Clonal Expansion ◽  
The United States ◽  
Injection Drug ◽  
Comparative Genomic ◽  
Molecular Features

Abstract Background The ongoing injection drug use (IDU) crisis in the United States has been complicated by an emerging epidemic of Staphylococcus aureus IDU-associated bloodstream infections (IDU-BSI). Methods We performed a case-control study comparing S. aureus IDU-BSI and non-IDU BSI cases identified in a large US Midwestern academic medical center between Jan 1, 2016 and Dec 21, 2019. We obtained the whole-genome sequences of 154 S. aureus IDU-BSI and 91 S. aureus non-IDU BSI cases, which were matched with clinical data. We performed phylogenetic and comparative genomic analyses to investigate clonal expansion of lineages and molecular features characteristic of IDU-BSI isolates. Results Here we show that patients with IDU-BSI experience longer durations of bacteremia and have lower medical therapy completion rates. In phylogenetic analyses, 45/154 and 1/91 contemporaneous IDU-BSI and non-IDU BSI staphylococcal isolates, respectively, group into multiple, unique clonal clusters, revealing that pathogen community transmission distinctively spurs IDU-BSI. Lastly, multiple S. aureus lineages deficient in canonical virulence genes are overrepresented among IDU-BSI, which may contribute to the distinguishable clinical presentation of IDU-BSI cases. Conclusions We identify clonal expansion of multiple S. aureus lineages among IDU-BSI isolates, but not non-IDU BSI isolates, in a community with limited access to needle exchange facilities. In the setting of expanding numbers of staphylococcal IDU-BSI cases consideration should be given to treating IDU-associated invasive staphylococcal infections as a communicable disease.

Clinical and demographic predictors of antiretroviral efficacy in HIV–HBV co-infected patients

2021 ◽  
pp. e20200011
Author(s):  
Urvi Rana ◽  
Matt Driedger ◽  
Paul Sereda ◽  
Shenyi Pan ◽  
Erin Ding ◽  
...  
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Proportional Hazards ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Virological Suppression ◽  
Injection Drug ◽  
Cell Counts ◽  
Cox Proportional Hazards Models ◽  
Living With Hiv

Background: The clinical and demographic characteristics that predict antiretroviral efficacy among patients co-infected with HIV and hepatitis B virus (HBV) remain poorly defined. We evaluated HIV virological suppression and rebound in a cohort of HIV–HBV co-infected patients initiated on antiretroviral therapy. Methods: A retrospective cohort analysis was performed with Canadian Observation Cohort Collaboration data. Cox proportional hazards models were used to determine the factors associated with time to virological suppression and time to virological rebound. Results: HBV status was available for 2,419 participants. A total of 8% were HBV co-infected, of whom 95% achieved virological suppression. After virological suppression, 29% of HIV–HBV co-infected participants experienced HIV virological rebound. HBV co-infection itself did not predict virological suppression or rebound risk. The rate of virological suppression was lower among patients with a history of injection drug use or baseline CD4 cell counts of <199 cells per cubic millimetre. Low baseline HIV RNA and men-who-have-sex-with-men status were significantly associated with a higher rate of virological suppression. Injection drug use and non-White race predicted viral rebound. Conclusions: HBV co-infected HIV patients achieve similar antiretroviral outcomes as those living with HIV mono-infection. Equitable treatment outcomes may be approached by targeting resources to key subpopulations living with HIV–HBV co-infection.

scholarly journals Disparity in Quality of Infectious Disease vs Addiction Care Among Patients With Injection Drug Use–Associated Staphylococcus aureus Bacteremia

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
David Phillip Serota ◽  
Emily D Niehaus ◽  
Marcos C Schechter ◽  
Jesse T Jacob ◽  
Jeb Jones ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Evidence Based ◽  
High Quality ◽  
Staphylococcus Aureus Bacteremia ◽  
Addiction Care

Abstract Evidence-based interventions for Staphylococcus aureus bacteremia (SAB) are well known, but it is unclear how they are implemented among patients with injection drug use–associated (IDU) SAB. Of 46 patients with IDU-SAB identified, all received high-quality SAB management; however, few received appropriate recognition or treatment of their underlying substance use disorder.

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

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.

scholarly journals Injection drug use infective endocarditis: clinical features and therapeutic challanges

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Scheggi ◽  
N Ceschia ◽  
F Vanni ◽  
I Merilli ◽  
E Sottili ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Injection Drug ◽  
Considerable Proportion ◽  
Prognostic Impact

Abstract Introduction Injection drug use (IDU) is a known risk factor for infective endocarditis (IE) and is associated with frequent recurrences, but its prognostic impact is still debated. Moreover, the potential futility of surgery in this population is an unsolved matter. Purpose We aimed to determine the clinical characteristics, the therapeutic strategy, and the prognostic impact of injection drug use IE (IDUIE). Method We retrospectively included in the analysis 454 consecutive episodes of definite active IE admitted in a single surgical centre from January 2012 to December 2020; 14 out of them where a subsequent infective episode of the same patient. Results IDUIE cases were 63 (13.8%), without significant proportional differences over time. IDUIE patients were significantly younger (43.95±10.12 vs 67.84±13.33, p 0.00) and presented fewer comorbidities (p&lt;0.001). They were admitted with a first episode of IE only in 60.3% of cases vs 92.8% of non-IDU (p&lt;0.001). Embolism was present at admission in a higher percentage (60.3 vs 38.4%, p&lt;0.001). IDUIE was more frequently associated with spondylodiscitis (15.9 vs 7.4%, p=0.026). The infection was less frequently left-sided than in non-IDU patients (57.1 vs 97.2%, p&lt;0.001) and was more often polimicrobic (12.7 vs 4.9%, p=0.015). Most patients were positive for Staphylococcus aureus (54.0 vs 12.8%, p&lt;0.001), while Streptococci were significantly less frequent in patients with IDUIE (11 vs 25%, p=0.015). The proportion of patients undergoing surgery was similar among the two groups (85.5 vs 78.8%, NS). IDUIE patients treated medically for absence of surgical indication had a better survival than patients undergoing surgery for complicated IE (p&lt;0.001). IDUIE was associated with a higher proportion of relapse during follow-up (28.3 vs 3.3%, p&lt;0.001). It was not associated with higher mortality (Figure 1) but was an independent predictor of mortality in multivariable analysis including age (HR per unit 1.048, 95% CI 1.038–1.063, p=0.00) and drug abuse (HR 3.2, 95% CI 1.8–5.6, p=0.00; Figure 2). Among IDUIE patients, we did not find predictors of futility of surgery, not even multiple relapses. Conclusions IDUIE represents a considerable proportion of overall cases of IE, mainly affecting young people. Staphylococcus aureus is the most common microbiologic agent. IDUIE is not associated with higher mortality but drug abuse is an independent predictor of mortality. Considering that patient with uncomplicated IE treated medically have a better prognosis, we should reserve surgery to patients with a strict indication for it. On the other hand, since there are no predictors of futility of surgery, all patients with a complicated IE should undergo surgery without delay. The main determinant of prognosis in these patients is not IE but drug abuse itself. For this reason, increased focus on addiction treatment following hospital discharge is mandatory to improve long term prognosis. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Stenotrophomonas maltophilia Infections in Geriatric Patients

2020 ◽  
pp. 1-4
Author(s):  
Don Walter Kannangara ◽  
Don Walter Kannangara ◽  
Dhyanesh Pandya ◽  
Roopa Anmolsingh
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Otitis Externa ◽  
Stenotrophomonas Maltophilia ◽  
Organ Transplant ◽  
Injection Drug ◽  
Wound Infections ◽  
Burn Wound ◽  
Urinary Infections ◽  
Culture Positive

We present Stenotrophomonas maltophilia infections in 317 hospitalized patients in a large health network over a 3-year period. The majority of patients were elderly. Most infections were polymicrobial: respiratory 95.2%, wound 91%, urinary 80.8% and blood 64.3%. Younger patients were small in number and were more common in those with otitis externa, infections from injection drug use and those with line infections. Most deaths were in patients with terminal conditions and polymicrobial infections and mortality could not be directly attributed to Stenotrophomonas maltophilia. None of the sputum, bronchial, urinary or wound culture positive patients had positive blood cultures. Only blood (14/317) or ear (7/317) culture positive patients had significant numbers of younger individuals with only 3 out of 14 over age 50 in blood culture positive patients and 1/7 in those with otitis externa. Those with bacteremia included patients with injection drug use, chronic pain syndromes and vascular catheter infections. 94% of urinary infections, 91.7% wound infections and 85.8% respiratory isolates were in those above age 50. Overwhelming majority of urinary infections were in males with drainage devices present in 75%. Recurrent infections were uncommon. Respiratory specimens were frequently associated with tracheostomies and endotracheal tubes. Most wound infections were in chronic lower extremity ulcers. Prior carbapenem use was not significant in this study. Isolates from all sites were over 98% susceptible to Trimethoprim/sulphamethoxazole. Limitations: The study group only had 1 organ transplant and 2 cystic fibrosis patients and no burn wound infections.

scholarly journals Right-Sided Endocarditis due toStaphylococcus lugdunensis: First Reported Case

1998 ◽  
Vol 9 (4) ◽  
pp. 240-242 ◽  
Author(s):  
CL Cooper ◽  
SH Choudhri ◽  
RJ Hoeschen
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Etiological Agent ◽  
Staphylococcus Lugdunensis ◽  
Documented Case

Staphylococcus lugdunensisis a coagulase-negative organism first identified in 1988. It is often incorrectly identified asStaphylococcus aureus,and has been isolated as the etiological agent in over 20 cases of left-sided endocarditis. This report describes the first documented case of right-sided endocarditis caused byS lugdunensis. This experience suggests thatS lugdunensiscan infect native valves in the absence of any predisposing risk factors such as injection drug use.

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