1096. Evaluation of Vancomycin Pharmacokinetics in Intravenous Drug Users

Background People who inject illicit drugs (PWID) are 16 times more likely to develop methicillin-resistant Staphylococcus aureus (MRSA) infections including severe infections like bacteremia and endocarditis. Vancomycin is recommended as the drug of choice for empiric and targeted coverage in both severe and non-severe MRSA infections. Pharmacokinetic literature has suggested up to 31% higher renal clearance in intravenous drug users (IVDU) compared to non-IVDUs. This increased clearance may theoretically lead to more frequent sub-therapeutic troughs in otherwise standard dosing schemes. There is a paucity of data examining vancomycin pharmacokinetics following typical dosing schemes in IVDU population. Methods This was a single-center, retrospective chart review that examined therapeutic drug monitoring in patients treated with vancomycin between January 1st, 2015 through July 31st, 2020. Patients were identified as either IVDU or non-IVUD groups based on ICD-9/10 codes. The primary outcome was the difference between mean first vancomycin steady state troughs. Secondary outcomes were differences in time to first therapeutic trough, mean number of days on vancomycin based on infection, rate of acute kidney injury (AKI) after vancomycin, and rate of vancomycin failure. Results A total of 158 patients were included in the analysis (77 IVDU vs. 81 non-IVDU). Mean first vancomycin steady state trough were significantly less in IVDU group compared to non-IVDU group (11.85 vs. 13.98 mcg/mL P = 0.007). Mean time to first therapeutic trough and mean number of days treated were significantly higher in IVDU versus non-IVDR samples (65.9 vs. 50.2 hours P = 0.044 and 5.4 vs. 12.3 days P = 0.017, respectively). There was no detectable difference in rates of AKI and vancomycin failure. Primary outcome graph for patients with IV drug use Primary outcome graph for patients without IV drug use Conclusion Vancomycin use in patients with IVDU resulted in significantly lower steady state troughs compared to patients who were non-IVDU. These patients also had a longer time to first therapeutic trough. Patient populations who are IVDU may require additional consideration as a special population for future development of vancomycin pharmacokinetic models. Disclosures All Authors: No reported disclosures

HBV, HCV, HIV & TB Prevalence in Injection Drug Users in Major Cities of Punjab, Pakistan- a Survey-Based Research Report

Hepatitis-B,C,HIV and TB among intravenous drug users continues to be a serious explanation for disease and death, this study was conducted to survey the prevalence of Hepatitis-B,C,HIV and TB in rehabilitation center of Punjab, Pakistan. A telephonic and visited survey of 78 rehabilitation centers in Punjab Pakistan to assess their treatment. An analysis of 21 responded that returned useable data revealed that only 7.2% patients of responded rehabilitation centers are positive for HEP-B. 33.23% patients are positive for HEP-C, 8.74% patients are positive for HIV and 0.87% patients are positive for TB. Majority of the respondent of whom doctors, psychologists believe that the patient, partner of the patient and their children should be offered for HEP-B,C,HIV and TB screening regularly.

Intravenous drug users in Iceland: Use of emergency departments, hospital admissions and mortality

INTRODUCTION: Drug abuse is a significant contributor to premature disease and mortality. Drug users are less likely to attend traditional Primary Health Care and more likely to present to Emergency Departments with their problems. Drug users often present late for treatment and find difficult ot engage and follow through treatment in standard models of health services. Materials and methods: The study is retrospective. 108 intravenous drug users were identified upon admission to one of three intpatient addiction treatment centres in Iceland in the years 2012-2013. Case notes for the two years leading to admission were examined. Results: The study group had significantyl more contacts with Emergency Departments than a matched sample from the community (p<0.001). Mean number of visits for the study group per year was 4.8 (median 3.5) and 43% had four or more visits in a year. Majority of visits were for pshychiatric symptoms with a third considered serious. The two main medical reasons were infections from injecting and accidents/violence. There was no significant difference in study parameters between those who mainly use methylphenidate vs other substances. Mortality rate for the study group compared to the general population of same age was 26.4 (CI 16.7-41.5, p<0,001).

Identification of Two Similar Novel HIV-1 Recombinant Forms (CRF01_AE/CRF07_BC) among Intravenous Drug Users in Guangxi, China

New kinds of HIV-1 circulating recombinant forms (CRFs) and unique recombinant forms (URFs) earn a great prevalence in China nowadays. In this study, we identified 2 similar URFs (2016GXNNIDU037 and 2019QZLSIDU253) both isolated from intravenous drug users (IDUs) in Guangxi, China. Phylogenetic analysis of the near full-length genome (NFLG) revealed 2 URFs both clustered with CRF01_AE but setting up a monophyletic branch, supporting a high bootstrap value. Bootscan analysis and subregional recombinant analysis found that the NFLG of 2016GXNNIDU037 and 2019QZLSIDU253 were both composed of CRF01_AE and CRF07_BC, with 3 CRF07_BC mosaic segments inserted into CRF01_AE backbones. The CRF01_AE segments of the 2 URFs clustered with a previously reported cluster 2 lineage of CRF01_AE. The 5 recombinant breakpoints of the 2 URFs were quite similar. Distinct from CRF01_AE/CRF07_BC URFs reported before, 2016GXNNIDU037 and 2019QZLSIDU253 are new evidence of a high genetic variety of HIV-1 in Guangxi, which may pose new challenges to HIV-1 prevention and molecular epidemiological surveillance in China.

Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers

Background The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE. Methods We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated. Results IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% (p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% (p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7–101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1–6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003). Conclusions IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.