Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis

<p>Abstract</p> <p>Background</p> <p>Infectious disease is often the reason for intravenous drug users being seen in a clinical setting. The objective of this study was to evaluate the appropriateness of treatment and outcomes for this patient population in a hospital setting.</p> <p>Methods</p> <p>Retrospective study of all intravenous drug users hospitalized for treatment of infectious diseases and seen by infectious diseases specialists 1/2001–12/2006 at a university hospital. Treatment was administered according to guidelines when possible or to alternative treatment program in case of patients for whom adherence to standard protocols was not possible. Outcomes were defined with respect to appropriateness of treatment, hospital readmission, relapse and mortality rates. For statistical analysis adjustment for multiple hospitalizations of individual patients was made by using a generalized estimating equation.</p> <p>Results</p> <p>The total number of hospitalizations for infectious diseases was 344 among 216 intravenous drug users. Skin and soft tissue infections (n = 129, 37.5% of hospitalizations), pneumonia (n = 75, 21.8%) and endocarditis (n = 54, 15.7%) were most prevalent. Multiple infections were present in 25%. Treatment was according to standard guidelines for 78.5%, according to an alternative recommended program for 11.3%, and not according to guidelines or by the infectious diseases specialist advice for 10.2% of hospitalizations. Psychiatric disorders had a significant negative impact on compliance (compliance problems in 19.8% of hospitalizations) in multiple logistic regression analysis (OR = 2.4, CI 1.1–5.1, p = 0.03). The overall readmission rate and relapse rate within 30 days was 13.7% and 3.8%, respectively. Both non-compliant patient behavior (OR = 3.7, CI 1.3–10.8, p = 0.02) and non-adherence to treatment guidelines (OR = 3.3, CI 1.1–9.7, p = 0.03) were associated with a significant increase in the relapse rate in univariate analysis. In 590 person-years of follow-up, 24.6% of the patients died: 6.4% died during hospitalization (1.2% infection-related) and 13.6% of patients died after discharge.</p> <p>Conclusion</p> <p>Appropriate antibiotic therapy according to standard guidelines in hospitalized intravenous drug users is generally practicable and successful. In a minority alternative treatments may be indicated, although associated with a higher risk of relapse.</p

Patients presenting to the emergency department with non-specific complaints : the Basel Non-specific Complaints (BANC) study

Patient management in emergency departments (EDs) is often based on management protocols developed for specific complaints like dyspnea, chest pain, or syncope. To the best of our knowledge, to date no protocols exist for patients with nonspecific complaints (NSCs) such as "weakness,""dizziness," or "feeling unwell." The objectives of this study were to provide a framework for research and a description of patients with NSCs presenting to EDs

Limitations of infrared ear temperature measurement in clinical practice

Detection of elevated body temperature is critical in the early diagnosis of sepsis. Due to its convenience, infrared ear temperature measurement (IETM) has become the standard of care. Unfortunately, the limitations of this method are largely unexplored.; To evaluate potential limitations of IETM, including the presence of cerumen on otoscopy, depth of penetration, side of measurement, and the impact of acclimatisation to room temperature.; In this prospective cohort study, 333 patients presenting to the medical emergency department underwent serial IETM before and after otoscopy and cleaning of the external auditory canal. The primary endpoint was defined as mean change in infrared ear temperature (IET) before and after removal of cerumen. We also tested for the effect of penetration depth, side of measurement and impact of acclimatisation.; Otoscopy revealed cerumen in 98 patients (29%). Cerumen had a weak but statistically significant impact on IETM. The removal of cerumen obturans resulted in a rise in IET of 0.20 °C (95% CI 0.10-0.28 °C, P = 0.03). The effects of penetration depth (P = 0.39), side of measurement (P = 0.78) and impact of acclimatisation (P = 0.82) were not significant.; Cerumen has a statistically significant, albeit not clinically meaningful, influence on IETM. Thus routine ear inspection prior to the use of IETM is not warranted. IETM provides highly reproducible assessments of IET irrespective of penetration depth, side of measurement and acclimatisation

Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis-1

Alist. Rx = Prescribed treatment. * seen by an ID during a period of 5 years. Not included in study: -Patients who did not require antibiotic. -Former IVDU who had stopped using narcotics at least two years prior to their admittance to the hospital and were not participating in an opioid maintenance program p = 0.03 (Rx according to guidelines vs. others)<p><b>Copyright information:</b></p><p>Taken from "Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis"</p><p>http://www.biomedcentral.com/1471-2334/8/42</p><p>BMC Infectious Diseases 2008;8():42-42.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2323004.</p><p></p

Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis-0

Alist. Rx = Prescribed treatment. * seen by an ID during a period of 5 years. Not included in study: -Patients who did not require antibiotic. -Former IVDU who had stopped using narcotics at least two years prior to their admittance to the hospital and were not participating in an opioid maintenance program p = 0.03 (Rx according to guidelines vs. others)<p><b>Copyright information:</b></p><p>Taken from "Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis"</p><p>http://www.biomedcentral.com/1471-2334/8/42</p><p>BMC Infectious Diseases 2008;8():42-42.</p><p>Published online 3 Apr 2008</p><p>PMCID:PMC2323004.</p><p></p