Severe infections

Description

• Common Types of Severe Infections
  • Complicated Skin & Soft Tissue Infections (SSTI): Includes deep abscesses, extended cellulitis, myositis, and necrotizing fasciitis.
  • Infective Endocarditis (IE): Infection of the heart lining and valves, frequently affecting the tricuspid valve in PWID.
  • Bacteremia: Presence of bacteria in the bloodstream, which can spread to other organs.
  • Osteomyelitis/Septic Arthritis: Bone or joint infections.
  • Other: Spinal infection (vertebral osteomyelitis, epidural abscess) and deep seated organ abscesses. 
    National Institutes of Health (NIH) | (.gov) +4
  Clinical Presentation and Causes
  • Symptoms: Fever, severe pain, swelling, redness, warmth at the injection site, or systemic symptoms like chills, nausea, and confusion.
  • Causes: Repeated injections at a single site, using non-sterile equipment (needles, cookers, filters), using contaminated water, and failing to perform skin hygiene.
  • Risk Factors: High-frequency injection, specifically cocaine and opioid (“speedball”) use, homelessness, and pre-existing tissue damage. 
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  Common Injection-Based Treatment (In-Hospital)
  Severe infections often require admission for prolonged intravenous (IV) antibiotics. 
  • Antibiotics: Commonly used antibiotics include Ceftriaxone (for various bacterial infections), Daptomycin (for blood/skin infections), and Vancomycin (for methicillin-resistant Staphylococcus aureus or MRSA).
  • Long-acting options: Dalbavancin is increasingly used due to its long half-life, allowing for weekly dosing, which is useful for patients with difficult access to healthcare.
  • Surgical Intervention: Incision and drainage for abscesses, or surgical debridement for severe necrotizing infections. 
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  Management Challenges
  • Patient-Directed Discharge (PDD): High rates of leaving against medical advice (14-30%), often due to withdrawal symptoms or feeling unsafe.
  • Need for Multi-disciplinary Care: Effective treatment requires combining infectious disease management with addiction medicine, such as providing Medication for Opioid Use Disorder (MOUD) to prevent withdrawal and facilitate treatment completion.
  • Recurrence: High rates of readmission for re-infection (up to 35% in some cohorts).