scholarly journals 1562. Reduction in Healthcare Utilization and Overdose after Skin and Soft Tissue Infections for Injection Drug Users through Addiction Medicine Consultation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S780-S780
Author(s):  
Catherine G Bielick ◽  
Ryan D Knodle ◽  
Shana Burrowes ◽  
Tamar F Barlam
Keyword(s):  
Soft Tissue ◽  
Healthcare Utilization ◽  
Injection Drug ◽  
Wilcoxon Test ◽  
Soft Tissue Infections ◽  
Impact Reduction ◽  
High Utilizers ◽  
High Utilizer ◽  
High Utilization ◽  
One Year

Abstract Background Healthcare encounters for skin and soft tissue infections (SSTIs) due to injection drug use (IDU) may provide opportunities for interventions to improve outcomes. We explored factors that may impact reduction of healthcare utilization and modify other complications of substance use disorder after an IDU-related SSTI. Methods We conducted a retrospective cohort chart review for 305 patients with IDU-related SSTIs between 10/1/2015 and 6/1/2019 to examine demographic, clinical and healthcare utilization data one year before and after the SSTI encounter. Patients were categorized as a low utilizer if they had < 3 emergency department encounters and as a high utilizer if they had ≥3 encounters in the one-year period before or after the SSTI. For patients that changed utilization categories from the pre- to post-SSTI period, we analyzed demographic and clinical differences using Chi Square tests. We performed a secondary analysis using a Wilcoxon test to examine the relationship between receipt of an addiction consult and change in number of overdoses after SSTI. Results 131 patients were low utilizers at baseline and 174 were high utilizers. Patients who transitioned from low to high utilization (64 patients) were significantly less likely to have received an addiction consult, 16 (25%), than patients who transitioned from high to low utilization, 15 (48%), p=0.03. However, high utilizers were significantly more likely to remain a high utilizer (p< 0.0001) with no variable predictive of transition to low utilization including addiction consultation, homelessness, insurance type, or treatment with medications for opioid use disorder. Patients who were low utilizers at baseline were more likely to remain low utilizers if they were not homeless, p=0.01. Of the entire sample, 96.2% (p< 0.0001) of those admitted obtained an addiction consult, which significantly reduced rates of overdose in the following year (p=0.0014) for 223 patients for which we had overdose data. Conclusion Patients with IDU-related SSTIs who do not receive an addiction consult are more likely to cross from low to high utilization after the event. Preferentially targeting this population for addiction consultation can significantly improve outcomes. Disclosures All Authors: No reported disclosures

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 Directly Observed Therapy with Azithromycin for Skin and Soft Tissue Infections in Injection Drug Users

2007 ◽  
Vol 18 (4) ◽  
pp. 263-264
Author(s):  
Harout K Tossonian ◽  
Brian Conway ◽  
Jesse D Raffa ◽  
Mark Viljoen ◽  
Milan Khara ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Injection Drug Users ◽  
Drug Users ◽  
Injection Drug ◽  
Soft Tissue Infections ◽  
Directly Observed Therapy

High Resource Utilizers From The Multicenter Compact Study Of Complications In Patients With Sickle Cell Disease and Utilization Of Iron Chelation Therapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 982-982
Author(s):  
Lanetta B Jordan ◽  
Patricia Adams-Graves ◽  
Julie Kanter-Washko ◽  
Patricia A Oneal ◽  
Medha Sasane ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Research Funding ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Cell Disease ◽  
High Utilizers ◽  
Ed Visits ◽  
High Utilizer ◽  
High Utilization

Abstract Introduction While treating patients (pts) with sickle cell disease (SCD) can be costly, costs are not evenly distributed across pts; rather, a minority of pts accounts for a majority of costs. Identifying those pts who consume a disproportionately large share of healthcare resources can assist payers and providers in directing appropriate and targeted interventions to deliver better pt care with lower costs. The objective of this study was to understand characteristics of pts who have increased utilization of inpatient (IP) and emergency department (ED) resources in a population of SCD pts ≥16 years old. Method Medical records of 254 SCD pts ≥16 years old were retrospectively reviewed between 8/2011 and 7/2012 at three US tertiary care centers. The high utilization threshold was derived from the literature and defined as pts with ≥ 5 days of IP+ED care (assuming 1 day/ED visit) for SCD-related complications per year (high utilizer group). Pts were also classified into cohorts based on cumulative blood transfusion units and use iron chelation therapy (ICT): <15 units, no ICT (Cohort 1 [C1]), ≥15 units, no ICT (Cohort 2 [C2]), and ≥15 units, with ICT (Cohort 3 [C3]). SCD complication rates were expressed as the number of SCD complications per pt per year (PPPY); rate ratios (RRs) were used for cohort comparisons. A logistic regression was used to identify risk factors associated with high utilization of IP+ED care. Results Of the 254 pts (C1: 69, C2: 91, C3: 94), 30% (n =76) were classified as high utilizers (C1: 14 [18.4%], C2: 37 [48.7%], C3: 25 [32.9%]). Patients in the high utilizer group were younger (median [range] (21 years old [16-65], vs. 23 years old [16-59]) and had shorter follow-up (4.2 years [0.6-23.9], vs. 5.4 years [0.5-33.3]) compared to the rest of the sample. Those in the high utilizer group accounted for 68% of all SCD-related complications and over 88% of all IP+ED days for treatment of these complications. Similar to the rest of the sample, pain (81%) and infection (7%) were the two key complications seen in this high utilizer group. The rate of IP +ED days was significantly higher among the high utilizer group with 16.63 [16.28-16.99] IP+ED days PPPY compared to 0.89 [0.84-0.94] PPPY for other pts. Similarly, the high utilizer group had 4.58 [95% CI: 4.39-4.76] IP+ED visits PPPY, compared to 0.34 [0.31-0.37] visits PPPY for other pts (Table). Among regularly transfused pts (C2+C3) in the high utilizer group, those who received ICT had lower rates of IP+ED visits (C2 vs. C3 rate ratio [RR] [95% CI]: 1.31[1.20-1.44]), IP+ED days (C2 vs. C3 RR: 1.30 [1.24-1.36]), and readmission to IP+ED settings within 30 days (1.70 [1.49-1.93]) compared with those who did not (Table). History of infections (odds ratio: 7.45, p<0.0001) was associated with an increased risk of high utilization of IP+ED care. Conclusion Results from this study show that a relatively small fraction of SCD pts account for the majority of IP+ED visits. Moreover, among regularly transfused pts identified as high utilizers, those who received ICT had lower rates of IP+ED utilization than those who did not. Pts receiving ICT may also receive closer monitoring, which may help with early identification and intervention to delay or prevent the development of complications and improve outcomes. Closer management of pts with SCD, especially those at risk of becoming high utilizers, is critical to lowering IP+ED utilization and reducing the overall costs of care. Disclosures: Jordan: Novartis Pharmaceuticals Corporation: Consultancy. Adams-Graves:Analysis Group, Inc.: Research Funding. Kanter-Washko:Analysis Group, Inc.: Research Funding. Oneal:Novartis Pharmaceuticals Corporation: Honoraria; Analysis Group, Inc.: Research Funding. Sasane:Novartis Pharmaceuticals: Employment. Vekeman:Novartis Pharmaceuticals: Research Funding. Bieri:Novartis Pharmaceuticals Corporation: Research Funding. Marcellari:Novartis Pharmaceuticals Corporation: Employment. Magestro:Novartis Pharmaceuticals: Employment. Adams:Novartis Pharmaceuticals Corporation: Research Funding. Duh:Novartis Pharmaceuticals: Research Funding.

scholarly journals Treatment of sepsis secondary to blast injuries

2021 ◽  
pp. 31-40
Keyword(s):  
Intensive Care ◽  
Soft Tissue ◽  
Care Service ◽  
Young Patients ◽  
Infectious Agent ◽  
Blast Injuries ◽  
Soft Tissue Infections ◽  
Mortality And Morbidity ◽  
One Year

Blast injuries are an important cause of morbidity and mortality due to ongoing conflicts, especially among young patients. Due to the adversities of warfare, the first interventions for these patients are performed in unsuitable environments. Patients generally do not receive further treatment in their own country, but in other countries as wounded war refugees. Local and systemic infections in patients with associated polytrauma, soft tissue damage, and blast effects cause mortality and morbidity. All of the patients were injured during the Libyan civil war and the first intervention was performed in hospitals in their own country or in Tunisia. The patients were transferred to our clinic by ambulance plane. All patients presented bone-soft tissue infection and sepsis. Bone-soft tissue and blood cultures were obtained from the patients. The first interventions for the patients were performed multidisciplinarily in orthopedics, general surgery, infection, and intensive care clinics. The patients were followed in our clinic for one year including inten-sive care, service, and outpatient monitoring. Sixteen patients with a mean age of 28.8 years were included in the study. All patients were wounded by explosives or missiles. The patients were admitted to our clinic at a mean of approximately 24.4 days after these events. The patients were followed in the intensive care unit for an average of 7.9 days. The mean follow-up was 4 months. After the service follow-up, each patient continued outpatient follow-up for a total of 12 months. Antibiotics were given according to the causative infectious agent during the intensive care and service follow-up. Three patients had lung infections. Colistin-induced renal failure or hepatotoxicity developed due to resistant infections in 4 patients. After colistin was ceased, this situation resolved. Two of the 16 patients died. The sepsis and bone-soft tissue infections were controlled in all other patients. Four patients had femoral nonu-nion and one patient had short femoral healing. While 2 patients were able to walk without support and 11 patients could walk using support and one patient who was Quadriplegic was unable to walk. The treatment of bone-soft tissue infections accompanied by sepsis should be multidisciplinary. This should be kept in mind for patients with systemic injuries due to explosion effects. The infectious agents in these patients are often drug-resistant and there may be complications secondary to the antibiotics used during treatment.

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