Understanding and preventing injecting-related bacterial and fungal infections among people who inject drugs

Background: Injection drug use-associated bacterial and fungal infections (e.g., skin and soft tissue infections, endocarditis, osteomyelitis, septic arthritis, epidural abscess, etc.) are increasingly common. Risk factors include subcutaneous/intramuscular injecting and lack of skin cleaning, but individual-level educational interventions on safer injecting practices have shown limited effectiveness. There may be value in looking beyond individual injecting behaviours to understand risk and prevention opportunities. Aims: (1) identify social-structural factors that influence risk for injecting-related infections; (2) estimate the effect of opioid agonist treatment on all-cause mortality or infection-related rehospitalization, after hospital admissions with injecting-related infections; (3) assess how risk for injecting-related infections changes within-individuals over time, in relation to social (i.e., incarceration) and clinical (i.e., opioid agonist treatment) exposures. Methods: Qualitative systematic review with thematic synthesis; quantitative systematic review with meta-analysis; survival analysis and self-controlled case series using data from a cohort of people with opioid use disorder in New South Wales, Australia. Results: Injecting-related bacterial and fungal infections are shaped by modifiable social-structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services, and harmful health care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community. After a hospital admission, opioid agonist treatment is associated with a large reduction in mortality but a modest reduction in risk of infection-related rehospitalization. Risk of injecting-related infections changes substantially within-individuals over time; high-risk moments include release from incarceration and around initiation and discontinuation of opioid agonist treatment. Conclusions: Risk for injecting-related bacterial and fungal infections, and associated treatment outcomes, are shaped by social-structural factors beyond individuals’ control. Offering individual-level education and addiction treatment may be helpful, but is likely insufficient. Prevention and treatment strategies should engage more broadly with the social and material conditions within which people prepare and consume drugs, and access health car

Perioperative Care

Perioperative care practices worldwide are in the midst of a seeing change with the implementation of multidisciplinary processes that improve surgical outcomes through (1) better patient education, engagement, and participation; (2) enhanced pre-operative, intra-operative, and post-operative care bundles; and (3) interactive audit programs that provide feedback to the surgical team. These improved outcomes include reductions in the frequency and severity of complications and improved throughput, which ultimately reduce operative stress. Practices in theatre as well as ward are becoming more collaborative and evidence-driven.This book is best utilized by perioperative care team members engaged in quality improvement, collaborative practice, and application of innovations in surgical care

Feature Paper in Antibiotics for 2019

There has been much speculation about a possible antibiotic Armageddon; this would be the result of having untreatable post-operative infections, and similarly untreatable complications after chemotherapy. The now famous “O’Neill Report” (https://amr-review.org/) suggests that more people could die from resistant bacterial infections by 2050 than from cancer. We are still learning about all the subtle drivers of antibiotic resistance, and realizing that we need a single “whole of health” co-ordinated policy. We ingest what we sometimes feed to animals. There do not seem to be any new classes of antibiotics on our horizon. Perhaps something that has been around “forever” will come to our rescue—bacteriophages! Nevertheless, we have to do things differently, use antibiotics appropriately, for the correct indication, for the correct duration and with the correct dose, and with that, practice good antibiotic stewardship. Whilst by no means comprehensive, this book does cover some of the many topics of antibiotic stewardship. It also addresses some of the older antibiotics, some new combinations, and even some new agents. Last, and by no means least, there are two excellent articles on bacteriophages

Cost analysis of colorectal cancer chemotherapy treatment in public and privste healthcare sectors in South Africa

Low-middle income countries are experiencing greater increases in cancer incidence due to changes in lifestyle. Colorectal cancer is one cancer that reflects this increase [1, 2]. As cancer incidence increases so do the costs associated with treatment. Although chemotherapy is not the only cost contributor, it increases costs considerably. This problem is not unique to lowmiddle income countries and requires further research [3]. Therefore this research was conducted to ascertain the cost of colorectal cancer chemotherapy in South Africa for both public and private healthcare sectors and to determine if treatment is equitable between the sectors. Clinical pathways were developed and compared to clinical practice by conducting a retrospective drug utilisation review to determine any variation from the pathways. A costing model was developed to include chemotherapy, supportive medicines, administration fees and administrative fees. The cost was calculated for the developed pathways and the retrospective drug utilisation review allowed for comparison between the sectors and with expected costs. Observations indicate private sector treatments are similar to international standards due to the availability of biological agents however public sector patients have limited access to newer therapies. Comparing the two sectors indicates a higher cost of chemotherapy in the private sector and one such example is the cost difference observed for a commonly prescribed regimen CAPOX for advanced CRC. The observed cost per cycle was R 6 068,28 (public sector) vs. R 9 480,93 (private sector). This is largely due to different access as well as acquisition costs. Nevertheless these patients do have access to newer biological agents. In conclusion, South Africa’s two healthcare sectors differ in access to treatment with the public sector per capita cost for therapy being lower.GR201