Arunima Soma Dalai, Wayne Leung, Heather Johnson, Anthony D Bai
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引用次数: 0
Abstract
Background: People who inject drugs (PWID) are at risk of severe injection-related infection (SIRI), which is challenging to manage. We conducted a scoping review to map the existing evidence on management of PWID with SIRI in an outpatient setting.
Methods: We conducted a literature search in MEDLINE, Embase, Cochrane Central, and CINAHL from their inception until 6 December 2023. Studies were included if they focused on PWID with SIRI requiring ≥2 weeks of antibiotic therapy, with a proportion of management occurring outside hospitals. Studies were categorized inductively and described.
Results: The review included 68 articles with the following themes. PWID generally prefer outpatient management if deemed safe and effective. Most studies support outpatient management, finding it to be as effective and safe as inpatient care, as well as less costly. Successful transition to outpatient management requires multidisciplinary discharge planning with careful consideration of patient-specific factors. Emerging evidence supports the effectiveness and safety of outpatient parenteral antibiotic therapy, long-acting lipoglycopeptides, and oral antibiotic therapy, each having unique advantages and disadvantages. Various specialized outpatient settings, such as skilled nursing facilities and residential treatment centers, are available for management of these infections. Finally, all patients are likely to benefit from adjunctive addiction care.
Conclusions: Emerging evidence indicates that outpatient management is effective and safe for SIRI, which is preferred by most PWID. Key components of outpatient management include multidisciplinary discharge planning, appropriate antibiotic modality, suitable care settings, and adjunctive addiction care. These elements should be carefully tailored to patient needs and circumstances.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.