Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia.
Data and Analytics, The Alfred Hospital, Melbourne, Australia.
Drug Alcohol Rev. 2022 Nov;41(7):1543-1553. doi: 10.1111/dar.13525. Epub 2022 Aug 22.
People who inject drugs are at risk of hospitalisation with injection-related infections (IRI). We audited the clinical features, microbiology and management of IRI at a tertiary service in Melbourne to describe the burden and identify quality improvement opportunities.
We performed retrospective review of IRI admissions from January 2017 to April 2019. We extracted admissions where ICD-10 codes or triage text suggested injecting drug use, and the diagnosis suggested IRI. We reviewed these for eligibility and extracted data using a standardised form. We performed mixed-effects logistic regression to determine predictors of unplanned discharge.
From 574 extracted candidate admissions, 226 were eligible, representing 178 patients. Median age was 41 years (interquartile range 36-47), 66% (117/178) male and 49% (111/226) had unstable housing. Over 50% (96/178) had a psychiatric diagnosis and 35% (62/178) were on opioid agonist therapy (OAT) on admission. Skin and soft tissue infection was the most common IRI (119/205, 58%), followed by bacteraemia (36/205, 18%) and endocarditis (26/205, 13%). Management included addictions review (143/226, 63%), blood-borne virus screening (115/226, 51%), surgery (77/226, 34%) and OAT commencement (68/226, 30%). Aggression events (54/226, 15%) and unplanned discharge (69/226, 30%) complicated some admissions. Opioid use without OAT was associated with almost 3-fold increased odds of unplanned discharge compared to no opioid use (odds ratio 2.90, 95% confidence interval 1.23, 6.85, p = 0.015).
Comorbidities associated with IRI may be amenable to opportunistic intervention during hospitalisation. Further research is needed to develop optimal models of care for this vulnerable patient group.
注射毒品的人有因注射相关感染（IRI）住院的风险。我们在墨尔本的一家三级服务机构对 IRI 的临床特征、微生物学和管理进行了审核，以描述其负担并确定质量改进机会。
我们对 2017 年 1 月至 2019 年 4 月期间的 IRI 入院病例进行了回顾性审查。我们提取了 ICD-10 代码或分诊文本提示使用注射毒品且诊断提示 IRI 的入院病例。我们对这些病例进行了资格审查，并使用标准表格提取了数据。我们进行了混合效应逻辑回归分析，以确定计划外出院的预测因素。
从 574 份候选入院病例中，有 226 份符合条件，代表了 178 名患者。中位年龄为 41 岁（四分位距 36-47 岁），66%（117/178）为男性，49%（111/226）住房不稳定。超过 50%（96/178）有精神科诊断，35%（62/178）入院时正在接受阿片类激动剂治疗（OAT）。皮肤和软组织感染是最常见的 IRI（119/205，58%），其次是菌血症（36/205，18%）和心内膜炎（26/205，13%）。治疗包括成瘾评估（143/226，63%）、血源性病毒筛查（115/226，51%）、手术（77/226，34%）和 OAT 起始（68/226，30%）。一些入院患者出现了攻击事件（54/226，15%）和计划外出院（69/226，30%）。与无阿片类药物使用相比，阿片类药物使用但无 OAT 与近 3 倍的计划外出院风险相关（比值比 2.90，95%置信区间 1.23-6.85，p=0.015）。
与 IRI 相关的合并症可能适合在住院期间进行机会性干预。需要进一步研究，以制定针对这一脆弱患者群体的最佳护理模式。
