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.

Outpatient Medical Care of Injection Drug Use Related HIV

1992 ◽  
Vol 3 (2) ◽  
pp. 96-100 ◽  
Author(s):  
R P Brettle ◽  
S M Gore ◽  
A McNeil
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Positive ◽  
Initial Increase ◽  
Medical Clinic ◽  
Loss To Follow Up ◽  
Disease Unit

By the end of March 1990 470 HIV positive patients, 77% injection drug use (IDU) related, had attended the outpatient department of the Regional Infectious Disease Unit with a cumulative loss to follow-up of only 20%. Coincident with the prescribing of oral methadone and a specific all-day IDU-related HIV medical clinic the total number of appointments increased from 28/month in May 1986 to 300/month in May 1989 ( P< 0.001) and the number of defaulted appointments decreased from a maximum of 60% (17/28) to 16% (48/294, P<0.001) in these months. There was a significant initial increase in the number of defaulted appointments for the infectious disease (ID) clinics from 11% (77/726) to 16% (124/797, P<0.01) which returned to previous levels once a specific IDU-related HIV clinic was established. There was also a significant decline in the number of new patients referred which was greater for the urinary tract infection clinics (108 to 56 per 6 months, P<0.0001) than for the ID clinics (119 to 88 per 6 months, P<0.05).

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 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 &lt; .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 &lt; .001), bacteremia (P &lt; .001), health care exposure (P &lt; .001), and advancing age (P = .01). Infections with MSSA were more common in PWID (56.3% vs 38.8%; P &lt; .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 &lt;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 &lt;50 000 cells/mm3 are common in culture-positive septic arthritis.

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.

scholarly journals Impact of an Evidence-Based Bundle Intervention in the Quality-of-Care Management and Outcome of Staphylococcus aureus Bacteremia

2013 ◽  
Vol 57 (9) ◽  
pp. 1225-1233 ◽  
Author(s):  
L. E. Lopez-Cortes ◽  
M. D. del Toro ◽  
J. Galvez-Acebal ◽  
E. Bereciartua-Bastarrica ◽  
M. C. Farinas ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Quality Of Care ◽  
Care Management ◽  
Evidence Based ◽  
Staphylococcus Aureus Bacteremia

scholarly journals Injection and non-injection drug use and infectious disease in Baltimore City: Differences by race

2014 ◽  
Vol 39 (9) ◽  
pp. 1325-1328 ◽  
Author(s):  
Larry Keen ◽  
Maria Khan ◽  
Lisa Clifford ◽  
Paul T. Harrell ◽  
William W. Latimer
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Baltimore City

scholarly journals 257. Staphylococcus aureus Bacteremia: Does Intravenous Drug Use Impact Quality of Care and Clinical Outcomes?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S127-S128
Author(s):  
Kristen McClellan ◽  
Cami Hilsendager ◽  
Strnad Luke
Keyword(s):  
Staphylococcus Aureus ◽  
Quality Of Care ◽  
Drug Use ◽  
Clinical Outcomes ◽  
Intravenous Drug ◽  
Standards Of Care ◽  
Intravenous Drug Use ◽  
Staphylococcus Aureus Bacteremia ◽  
Device Infection

Abstract Background Individuals with intravenous drug use (IDU) have higher risk for Staphylococcus aureus bacteremia (SAB) and increased management complexity. The goal of this study was to compare differences in SAB characteristics, adherence to standard of care metrics, and clinical outcomes in those with and without IDU. Methods A retrospective chart review was conducted on cases of SAB between January 1, 2016 and December 31, 2017 at a 500-bed teaching hospital. Inclusion criteria was age &gt; 18 years and ≥ one blood culture positive for S. aureus. Patients were excluded if they transferred hospitals, had care withdrawn or died within 48 hours of diagnosis or had a ventricular assist device infection. Records were reviewed for substance use, SAB characteristics, standards of care, and outcomes. Data were analyzed using SPSS software. The study was approved by the Institutional Review Board. Results In 248 patients with SAB, 28.2% had documented IDU. Median age was 37 (IDU) and 57 (non-IDU). In the IDU group, 75.7% had the formal diagnosis of opioid use disorder and 78.9% of stimulant use disorder. IDU was associated with hepatitis C and houselessness while non-IDU was associated with diabetes, hemodialysis, and cancer. Those with IDU had higher rates of MRSA, endocarditis, and spinal infections, but did not have higher rates of polymicrobial infections or venous thrombosis. There was no difference in appropriate repeat blood cultures, antibiotic management, and ID consultation. Length of stay and against medical advice (AMA) discharges were higher in those with IDU. There was no difference in 90-day recurrence or readmission, but 90-day mortality was higher in the non-IDU group. Conclusion There was no difference in adherence to SAB quality of care metrics between groups with and without IDU. Despite the IDU group being younger with fewer comorbidities, 90-day readmissions were not different between groups. This bears further analysis but may represent the influence of therapy completion, AMA discharges, and unmeasured social determinants of health. Disclosures All Authors: No reported disclosures

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