Wounds and Skin and Soft Tissue Infections in People Who Inject Drugs and the Utility of Syringe Service Programs in Their Management PMC

Many participants also described the progression from cellulitis (which cannot be drained) to an abscess, which requires drainage in some capacity. An abscess is an infection that is under your skin, that is full of pus, and needs to be cut open and drained. Best practice recommendations for SSP for primary and secondary prevention of wounds and SSTIs in PWID. Relationship between combined SSPs and early wound intervention with health outcomes of PWID. AH, PMG, CC, and BE analyzed and interpreted the data from the semi-structured interviews. AH and BE analyzed and interpreted the patient data extracted from the electronic health record.

The datasets generated during and/or analyzed during the current study are not publicly available due to them containing information that could compromise research participant privacy/consent but are available from the corresponding author on reasonable request. If you have any concerns with your skin or its treatment, see a dermatologist for advice. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice.

Reporting of adverse events of treatment interventions in multiple myeloma: an overview of systematic reviews

The majority (36 of 59) of deep venous thromboses in IVDU was septic, constituting 10.5% of hospitalizations. These results emphasize the importance of screening for signs and symptoms of deep venous thrombosis in IVDU. † Antibiotic prescribed for the longest period intravenously during one hospitalization. Major psychiatric disease, defined as major depression, schizophrenia, or personality disorders, was noted if mentioned in the final medical report as assed by a board certified psychiatrist.

Despite underlying knowledge of the potential risk and general avoidance in sharing drug injection paraphernalia, participants mostly reported a perception of minimal individual risk and a generalized lack of understanding regarding safe injection practices for prevention of SBI. Intravenous drug users can be challenging patients to manage on medical wards, with aggressive behaviour, illicit drug use while in hospital and early self-discharge commonly encountered. Data is still scarce about success rates for treatment of infectious disease in IVDU in a hospital setting, including the extent of non-compliant patient behavior and its impact on the efficacy of treatment and patient outcomes. Therefore, the goal of the present study was to analyze the appropriateness of treatment protocols, compliance with treatment by patients, and the outcomes of therapy in IVDU who were hospitalized with infectious diseases and were seen by a specialist in infectious diseases. The hypothesis was that the appropriateness of treatment protocols in IVDU was higher than suspected by most physicians and that the outcome of treatment depends on the appropriateness of treatment and the compliance of the patients.

Standards of treatment

It is recognized that β-glucan tests can often be falsely positive in this patient population, due to patients receiving IVIG treatment. If aspergillosis is suspected, we recommend serum galactomannan testing (level IIC). Cultures, imaging, and diagnostic tests can help identify the fungal infection, if suspected (level III). If imaging is concerning for a patient with sinusitis, it is recommended to consult an ear, nose, and throat specialist to perform a biopsy, confirming fungal infections (level III). Broad-spectrum antibiotics are recommended for patients with concomitant neutropenia (level III).

Underlying tissue damage both locally and at distant sites would allow for adherence and propagation of bacteria. Increased medical management of uncomplicated SSTI among PWID would likely decrease rates of treatment failure and risk of progression to SBI. For participants with prior SBI hospitalization, adaptation of safer injection practices as a result of education and past experience were reported to occur yet did not lead to prevention of future SBI in this population. This may be related to limited knowledge and omission by healthcare providers surrounding the multiple potential amplifiers of bacterial infection risk during the injection process. Many respondents in this survey reported receiving medical care outside of a hospital or healthcare facility.

What are the clinical features of skin infections in people who inject drugs?

Routine care for patients who continue to inject should include advice on hand hygiene and not injecting into skin that has not been cleaned or to use any equipment contaminated by reuse, saliva, soil, or water (4,5). Risk factors for bacterial and fungal infections found in other recent assessments include skin breakdown and limited access to clean running water and showers (7). Where legal, syringe service programs can provide referrals to treatment for substance use disorder, clean equipment, and education about safer injection iv drug use practices. Other services, such as prompt wound care, laundry, and showers could also help prevent serious bacterial and fungal infections (8). Medication-assisted treatment addresses the underlying opioid use disorder through decreased cravings and prevents infections by reducing injection drug use. Initiating medication-assisted treatment when persons who inject opioids are found to have a bacterial or fungal infection might also improve retention of these patients in treatment for both the infection and substance abuse (10).

• For patients on opioid maintenance therapy, the dose and timing of the last dose should be confirmed with the dispensing centre at the first opportunity.
• PWID admitted to hospital with SBI should be treated in a multidisciplinary manner with particular focus on avoidance of withdrawal symptoms to limit failure to complete treatment and potential high-risk behaviors while hospitalized.
• Any questions or concerns expressed by the participants were addressed at the end of the session, and needle exchange staff were consistently available for any additional education or services requested.
• Our laboratories are working according to Clinical and Laboratory Standards Institute (CLSI) guidelines.
• VR provided oversight and mentorship in study design, data analysis, and manuscript preparation.

Early recognition of at-risk patients and the disease is critical for optimal management [69]. The panel recommend monthly IVIG treatment for the duration of immunoparesis, and in the absence of life-threatening infectious manifestations, until Ig levels are ≥400 mg/dl (level IIC). It is important to note that serum levels alone are not adequate to inform on an individual’s capacity to mount an antibody response against various pathogens, and it is more important to monitor the frequency of infections (level IIC).

History of HIV, HCV, and other sexually transmitted infections (STI)

The team obtained and reviewed records for hospital admissions and ED visits during April 1–June 30, 2017, from a convenience sample of five hospitals in western New York. In blood, or GAS from a normally sterile site or 2) diagnostic codes related to substance use and a bacterial or fungal pathogen or infection† were included. Injection drug use was defined as patient self-report of injection drug use; health care worker, relative, or friend report that the person injected drugs; or observation of injection equipment in the patient’s room or belongings or skin lesions indicative of injection drug use (track marks). Demographic information, infection sites, bacterial and fungal pathogens, history of human immunodeficiency virus (HIV), hepatitis B and C, and clinical outcomes were abstracted from medical records for all patients with injection drug use.

• Skin and soft tissue infections (SSTI) along with bone and joint infections represent a significant source of morbidity and mortality among people who inject drugs (PWID).
• In this assessment, infections related to injection drug use most often occurred at the site of injection and were predominantly caused by common skin and mouth flora that are introduced during injection.
• MM patients are at risk of developing neutropenia, which can result in increased risk of serious infections and febrile neutropenia [42, 43].
• Despite appreciating the potential severity of this illness, the reticence to pursue formal care due to previous firsthand or secondhand negative health care experiences is ubiquitous and concerning.
• The reported SSTI self-care strategies demonstrate resilience and ingenuity, but also raise serious concerns about inappropriate antibiotic consumption and complications of invasive surgical procedures performed without proper training, technique, or materials.

The reticence to pursue formal health care forces PWIH to turn to themselves and trusted community members for care. Historically, PWIH have incised their own abscesses, sought out non-prescribed antibiotics, and participated in various forms of homeopathic care [9, 20]. This is particularly salient in the context of a population of PWIH who experience a high burden of disease with poor access to formal healthcare channels [6].

Peer educators should be empowered to facilitate workshops, provide material resources, and educate their communities on these topics. Receiving this education from a trusted peer can propagate this knowledge, engender trust, and provide linkage to harm reduction agencies and the health system, as has been demonstrated with other disease processes in communities experiencing barriers to care [21]. The prompt identification of severe or worsening infection that requires prompt medical care should be emphasized in these teachings. These peer educator/advocates must be provided with the tools and knowledge to do so confidently and effectively. These recommendations should also be provided with the caveat that it is always best to seek medical attention if one is able to do so, and these techniques alone will not cure all SSTIs.

• D.P.S. devised the outline and wrote the article with input from all listed authors.
• It can develop quickly (called acute endocarditis) or more slowly (called infective endocarditis).
• Harm reduction knowledge and psychosocial vulnerabilities influence drug use and high-risk drug injection practices.
• A chi-squared test was performed using SAS (version 9.4; SAS Institute) to compare the proportion of patients seen only in the ED to the proportion of hospitalized patients who were offered medication-assisted treatment.
• Many also described the chronology of symptoms, noting a vaguely-defined “point of no return,” prior to which an abscess will resolve spontaneously, and after which an abscess requires treatment to prevent life- or limb-threatening complications.

Following the literature review, updated trial data have been added where relevant and reviewed by the panel. The clinical presentation of a SSTI includes erythema, warmth, edema, and pain over the affected site, systemic features of infection may follow as well [24]. Many also described the chronology of symptoms, noting a vaguely-defined “point of no return,” prior to which an abscess will resolve spontaneously, and after which an abscess requires treatment to prevent life- or limb-threatening complications. Most participants expressed intravenous injection as the preferred route of administration.