scholarly journals 1558. Injection Drug Use-Related Skin and Soft Tissue Infections Serve as Sentinel Events for Healthcare Utilization in a Vulnerable Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S779-S779
Author(s):  
Ryan D Knodle ◽  
Catherine Bielick ◽  
Shana Burrowes ◽  
Tamar F Barlam
Keyword(s):  
Soft Tissue ◽  
Drug Use ◽  
Healthcare Utilization ◽  
Injection Drug Use ◽  
Vulnerable Population ◽  
Injection Drug ◽  
Categorical Variables ◽  
Rank Test ◽  
Soft Tissue Infections ◽  
Sentinel Events

Abstract Background Persons with injection drug use (IDU) can have frequent skin and soft tissue infections (SSTIs) and high healthcare utilization. We sought to examine whether IDU-related SSTIs are associated with an acceleration in disease course and increased healthcare utilization (a ‘sentinel event’) and may present an important opportunity for intervention. Methods We performed a retrospective chart review of patients with an emergency department (ED) visit or hospital admission due to an IDU-related SSTI between 10/1/2015 and 6/1/2019 to obtain information on demographics, microbiologic data, addiction service consultation, and treatment with medications for opioid use disorder (MOUD). We compared the number of healthcare encounters in the 12 months before and after the SSTI using the Wilcoxon signed rank test for data with non-normal distribution. We examined differences in the distribution of variables between patients who were admitted and those discharged from the ED using Chi Square and Fisher exact tests for categorical variables and t-tests and Wilcoxon tests for continuous variables. Results In all, 305 patients met inclusion criteria for an IDU-related SSTI. The patients were 66.5% male, had a median age of 41 years (range 23-70), 84% were experiencing homelessness and 87% had Medicaid. Most patients (55.7%) were admitted to the hospital and the remainder were discharged from the ED. There was a statistically significant change in healthcare utilization in the year prior to the SSTI compared to the year after (median change +16.7%, p < 0.0001). Compared to those who were admitted, it was rare for patients discharged from the ED to have microbiologic data sent (13% vs 87%, p < 0.0001), an addiction consult completed (4% vs 96%, p < 0.0001), or to be discharged on MOUD (8.0% vs 92%, p < 0.0001). Despite these differences, there were no significant predictors of high vs low utilization among all-comers based on demographic and clinical data. Conclusion IDU-related SSTIs serve as sentinel events with increased healthcare utilization after the episode. Addiction consultation and initiation of MOUD had no impact on the trajectory of healthcare utilization. Further work must be done to identify how best to improve outcomes for this vulnerable population. Disclosures All Authors: No reported disclosures

scholarly journals Population-Based Surveillance of Invasive Group A Streptococcal Disease in British Columbia: 1996-1998

2001 ◽  
Vol 12 (4) ◽  
pp. 232-236 ◽  
Author(s):  
Gordean L Bjornson ◽  
David W Scheifele ◽  
Alison Bell ◽  
Arlene King
Keyword(s):  
British Columbia ◽  
Chronic Illness ◽  
Soft Tissue ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Soft Tissue Infections ◽  
Skin Damage ◽  
Invasive Group ◽  
Group A

OBJECTIVE:To identify and describe all cases of invasive group A streptococcal (GAS) infection occurring in British Columbia during a two-year period.DESIGN:Active, laboratory-based surveillance with supplemental case description.SETTING:Forty community and regional hospitals and the provincial laboratory participated, encompassing all health regions.POPULATION STUDIED:Entire provincial population from April 1, 1996 to March 31, 1998.MAIN RESULTS:Over the 24-month surveillance period, 182 eligible cases were identified, yielding a mean annual incidence rate of 2.3/100,000. Patients ranged in age from two to 91 years, with a mean of 39.1 years. Soft tissue infections accounted for 89 of 130 cases (68.5%) with a defined clinical syndrome, 20 of which were necrotizing fasciitis. Injection drug use was described in 55 patients, who, as a group, were younger, more likely to have soft tissue infections and less likely to die of infection than nondrug users. Other risk factors for infection included HIV infection (19 patients); skin damage (26 patients, damage independent of injection drug use); chronic illness (27 patients); and immunosuppresion (three patients). Death from GAS infection occurred in 15 of 131 (11.5%) cases with known outcome, yielding an annual case fatality rate of 1.9/million population. Among necrotizing faciitis cases, the mortality rate was 30%.CONCLUSIONS:Invasive GAS infections are rare in British Columbia and tend to involve persons with chronic illness or prior skin trauma, especially injection drug abuse, which accounted for nearly half of the cases.

scholarly journals Hospital Utilization for Injection Drug Use-Related Soft Tissue Infections in Urban versus Rural Counties in California

2006 ◽  
Vol 83 (2) ◽  
pp. 176-181 ◽  
Author(s):  
Keith G. Heinzerling ◽  
David A. Etzioni ◽  
Brian Hurley ◽  
Paul Holtom ◽  
Ricky N. Bluthenthal ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hospital Utilization ◽  
Soft Tissue Infections ◽  
Rural Counties ◽  
Urban Versus

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.

scholarly journals Injection Drug Use and Healthcare Utilization in Patients Newly Diagnosed With HIV

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Cecilia Fix ◽  
Christopher Re ◽  
Brian Roberts ◽  
Matthew Salzman ◽  
Kaitlan Baston ◽  
...  
Keyword(s):  
Drug Use ◽  
Healthcare Utilization ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Newly Diagnosed

scholarly journals National Public Health Burden Estimates of Endocarditis and Skin and Soft-Tissue Infections Related to Injection Drug Use: A Review

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S429-S436
Author(s):  
Isaac See ◽  
Runa H Gokhale ◽  
Andrew Geller ◽  
Maribeth Lovegrove ◽  
Asher Schranz ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Soft Tissue ◽  
Drug Use ◽  
Injection Drug Use ◽  
The United States ◽  
Data Sources ◽  
Soft Tissue Infections ◽  
Public Health Burden ◽  
Health Burden

Abstract Background Despite concerns about the burden of the bacterial and fungal infection syndromes related to injection drug use (IDU), robust estimates of the public health burden of these conditions are lacking. The current article reviews and compares data sources and national burden estimates for infective endocarditis (IE) and skin and soft-tissue infections related to IDU in the United States. Methods A literature review was conducted for estimates of skin and soft-tissue infection and endocarditis disease burden with related IDU or substance use disorder terms since 2011. A range of the burden is presented, based on different methods of obtaining national projections from available data sources or published data. Results Estimates using available data suggest the number of hospital admissions for IE related to IDU ranged from 2900 admissions in 2013 to more than 20 000 in 2017. The only source of data available to estimate the annual number of hospitalizations and emergency department visits for skin and soft-tissue infections related to IDU yielded a crude estimate of 98 000 such visits. Including people who are not hospitalized, a crude calculation suggests that 155 000–540 000 skin infections related to IDU occur annually. Discussion These estimates carry significant limitations. However, regardless of the source or method, the burden of disease appears substantial, with estimates of thousands of episodes of IE among persons with IDU and at least 100 000 persons who inject drugs (PWID) with skin and soft-tissue infections annually in the United States. Given the importance of these types of infections, more robust and reliable estimates are needed to better quantitate the occurrence and understand the impact of interventions.

Infection in the Intravenous Drug User

2016 ◽  
Author(s):  
Caren Euster
Keyword(s):  
Drug Use ◽  
Injection Site ◽  
Injection Drug Use ◽  
Intravenous Drug User ◽  
Injection Drug ◽  
Soft Tissue Infections ◽  
Multiple Systems ◽  
Modifying Factors ◽  
History Of ◽  
Systemic Infections

Injection drug abuse has spread worldwide and is increasing among young adults and adolescents. This chapter focuses on the management of acute infectious consequences of injection drug use (IDU), including skin and soft tissue infections, endocarditis, and systemic infections. The approach to infection is determined based upon etiology: local (injection site) infections, infections distant to the injection site, systemic infections, complications of primary infections, modifying factors, and infections associated with the patient with IDU’s lifestyle. Infections in patients with a history of injection drug use can affect multiple systems. The most commonly affected systems include the skin (eg, abscess), heart (eg, endocarditis), lung (eg, pneumonia), kidney, and brain (eg, septic emboli secondary to endocarditis).

Sign in / Sign up

Export Citation Format

Share Document