BMC Infectious Diseases最新文献

Background: Injection drug-use (IDU) is related to significant morbidity and mortality. Recent studies of IDU-associated infections have primarily focused on regions outside of the southern US. However, this area presents greater barriers to healthcare funding and lower availability of harm reduction services such as syringe service programs. In this study, we sought to describe infectious disease burden, uptake of medication for opioid use disorder (MOUD), and healthcare utilization in patients with opioid use disorder (OUD) who received inpatient addiction psychiatry consultation at a large safety-net hospital in the southern US.

Methods: A retrospective electronic health record review was conducted for patients admitted to an urban county hospital from February 2018-February 2020.

Inclusion criteria: (a) OUD within the last 12 months and (b) addiction psychiatry consultation. Baseline characteristics were compared between those with and without IDU-associated infections. IDU-associated infections, cultured microbes, and MOUD uptake were described.

Results: Of 283 charts reviewed, 248 individuals met inclusion criteria. Overall, 65% were male, 48% non-Hispanic white, and 34% Hispanic. In total, 72% reported opioid IDU in the past 30 days and 52% had IDU-associated infections, including skin and soft-tissue infections (SSTI) (49%), bacteremia (17%), osteomyelitis, (7%), and endocarditis (5%). Comorbid stimulant use disorder was frequently reported (70%). Methicillin-resistant Staphylococcus aureus was the most common organism identified (24%). Though 40% of IDU-associated infections were monomicrobial, 23% were polymicrobial (including anaerobes, gram-negatives, and yeast species). Those with IDU-associated infections had lower rates of MOUD on admission (8% vs. 32%) but had higher new MOUD uptake (81% vs. 51%).

Conclusions: SSTIs, which were often polymicrobial, comprised most IDU-associated infections among inpatients with OUD hospitalized in an urban Texas hospital. Individuals with IDU-associated infections had increased MOUD uptake. These findings have implications for empiric antibiotic management of IDU-associated infections and support inpatient initiation of substance use treatment.

Background: A surge in Group A streptococcus (GAS) infections has been described in the post-COVID-19 pandemic period. We reviewed cases with periorbital GAS infections at our institution during a 14-month period, including cases with necrotizing soft tissue infection (NSTI).

Methods: A single center retrospective case series was performed at the University Hospital of Copenhagen, Rigshospitalet, during January 2023 to February 2024 including all adult patients referred from secondary centers with a suspicion of periorbital NSTI. All cases were treated for periorbital skin and soft tissue infections with culture-confirmed group A streptococci in an eye swab, a tissue sample or blood cultures.

Results: Eleven cases with a median age of 72 (range 55-84) years with periorbital GAS infection were included. Four patients had diabetes, and one patient had eyelid surgery prior to the infection. Pre-admission symptoms included pain, swelling in the periorbital area, fever and/or a sore throat. Patients presented with fever, nausea, and/or confusion and clinical exams were noticeable for erythema and edema of the periorbital area with the eyelids fully closed on the affected side. Two cases had septic shock. Based on CT scans, six cases were diagnosed with pre-septal cellulitis and five cases were suspected of post-septal NSTI, which was confirmed by surgical debridement. The GAS isolates from tissue samples or blood cultures in these five cases were of type MLST 28 / emm 1.0 (M1 clone). Treatment included meropenem and clindamycin (n = 11), intravenous immunoglobulin (n = 4), surgical debridement (n = 5) and hyperbaric oxygen therapy (n = 3). One patient died in the intensive care unit. Two patients have permanently reduced visual acuity.

Conclusion: We report an accumulation of cases with pre- or post-septal orbital GAS infections in which the majority had no evidence of immunosuppression or a triggering event such as trauma or surgery. All cases of invasive GAS infections were caused by the M1 clone.