Dalai Arunima Soma, Leung Wayne, Johnson Heather, Bai Anthony D
Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Division of Infectious Diseases, Department of Medicine, Western University, London, Ontario, Canada.
Open Forum Infect Dis. 2024 Oct 10;11(11):ofae613. doi: 10.1093/ofid/ofae613. eCollection 2024 Nov.
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.
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.
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.
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.
注射吸毒者（PWID）面临严重注射相关感染（SIRI）的风险，这种感染难以管理。我们进行了一项范围综述，以梳理门诊环境中管理患有SIRI的PWID的现有证据。
我们在MEDLINE、Embase、Cochrane Central和CINAHL数据库中进行了文献检索，检索时间从各数据库建库至2023年12月6日。纳入的研究需聚焦于患有SIRI且需要≥2周抗生素治疗的PWID，且部分管理在医院外进行。对研究进行归纳分类并描述。
该综述纳入了68篇文章，主题如下。如果被认为安全有效，PWID通常更喜欢门诊管理。大多数研究支持门诊管理，发现其与住院治疗一样有效和安全，且成本更低。成功过渡到门诊管理需要多学科出院计划，并仔细考虑患者的具体因素。新出现的证据支持门诊胃肠外抗生素治疗、长效脂糖肽和口服抗生素治疗的有效性和安全性，每种治疗都有其独特的优缺点。各种专门的门诊机构，如专业护理机构和住院治疗中心，可用于管理这些感染。最后，所有患者可能都能从辅助成瘾护理中受益。
新出现的证据表明，门诊管理对SIRI有效且安全，这是大多数PWID所青睐的。门诊管理的关键组成部分包括多学科出院计划、适当的抗生素治疗方式、合适的护理机构和辅助成瘾护理。这些要素应根据患者的需求和情况进行精心调整。
