Soft Tissue, Bone, and Joint Infections in People Who Inject Drugs PMC November 8, 2022

It exhibits activity against frequently identified gram-positive skin pathogens, including MRSA, MSSA, Streptococcus pyogenes, Streptococcus agalactiae, and vancomycin-resistant Enterococcus faecium [62]. The treatment of acyclovir-resistant HSV isolates requires a prolonged course of intravenous foscarnet, but continuous infusion of high-doses of acyclovir has been reported to be successful in HSCT patients [242]. Surgery should be avoided in patients with HSV infections, unless a documented bacterial or fungal abscess is identified. Purulent bite wounds and abscess are more likely to be polymicrobial (mixed aerobes and anaerobes), whereas nonpurulent wounds commonly yield staphylococci and streptococci [156, 157]. Pasteurella species are commonly isolated from both nonpurulent wounds with or without lymphangitis and from abscesses.

Bone and Joint Infections

• Untreated SSTIs pose significant risks, including endocarditis, septicemia, and necrotizing fasciitis, which increases morbidity and healthcare costs for this population [3, 10].
• These peer educator/advocates must be provided with the tools and knowledge to do so confidently and effectively.
• Therefore, treatment with amoxicillin-clavulanate, ampicillin-sulbactam, or ertapenem is recommended; if there is history of hypersensitivity to β-lactams, a fluoroquinolone, such as ciprofloxacin or levofloxacin plus metronidazole, or moxifloxacin as a single agent is recommended.
• Novel long-acting and oral antibiotic formulations have shown promising results particularly when barriers to compliance are identified.

A categorical view is used by clinicians to meetthe needs of reporting for health care planners; on the other hand, a dimensional approachconceptualizes a quantitative disorder that is more useful for the purpose of research8. In 2013, DSM-V was published and revealed the criteria change of substance-relateddisorders. DSM-V removed the criterion of recurrent substance use resulting in legalproblems and added the criterion of craving to use substance, and kept all other criteriafrom DSM-IV. Furthermore, the criteria of DSM-V substance use disorder can be used tospecify current severity, with mild, moderate, and severe6. Therefore, this panel supports continued research into the rapid diagnosis of causes of cellulitis specifically, but SSTIs in general. This is of particular importance as the FDA has required inclusion of patients with cellulitis into clinical trials.

• Single or multiple painless skin lesions involving the face and scalp develop in 5%–10% of clinically infected patients, and in some patients, these lesions may precede documented cryptococcal meningitis by several weeks.
• Aureus, including MRSA, and more likely to involve streptococci or anaerobes compared with non-injection drug users.
• Clinically, furuncles are inflammatory nodules with overlying pustules through which hair emerges.
• Discrepancies were discussed and resolved, and all panel members are in agreement with the final recommendations.
• These patients are at increased risk for infection caused by a select group of bacteria, fungi, viruses, protozoa, and helminths, and some of these pathogens have the capacity to cause SSTIs.
• Support for these guidelines was provided by the Infectious Diseases Society of America.

If you use drugs or drink alcohol, take the following steps to protect your health.

Glanders, characterized by ulcerating nodular lesions of the skin and mucous membrane, is caused by the aerobic gram-negative rod Burkholderia mallei. Glanders is mainly a disease mainly of solipeds (eg, horses and mules). Although other organs may be involved, pustular skin lesions and lymphadenopathy with suppurative nodes can be a prominent feature. The organism is susceptible to ceftazidime, gentamicin, imipenem, doxycycline, and ciprofloxacin [174]. A recent laboratory-acquired case was successfully treated with imipenem and doxycycline for 2 weeks, followed by azithromycin and doxycycline for an additional 6 months [175]. The patient was hospitalized, treated with intravenous vancomycin, and the needle was surgically extracted using ultrasound guidance.

Recommendations (Abridged)

Nonbullous impetigo can occur from infections with β-hemolytic streptococci or S. Impetigo begins as erythematous papules that rapidly evolve into vesicles and pustules that rupture, with the dried discharge forming honey-colored crusts on iv drug use an erythematous base. To evaluate evidence, the panel followed a process consistent with other IDSA guidelines. GRADE is a newly created system for grading the quality of evidence and strength of recommendations for healthcare [2, 11].

Evaluation and Treatment of Clostridial Gas Gangrene and Myonecrosis

They include direct extension of subcutaneous abscess into vital areas or structures, necrotizing fasciitis and myositis, bacteremia, and sepsis. An outbreak of a highly lethal SSTI that recently occurred in Scotland, Ireland, and England seems to have resulted from infection with Clostridia spp, including C. A rare but well-documented SSTI in injection drug users is pyomyositis, an abscess-forming infection of skeletal muscle. Although not life-threatening, chronic cutaneous venous ulcers of the lower extremities are common and debilitating, requiring long-term multidisciplinary care for successful healing. Persons who inject drugs are at high risk for skin and soft tissue infections.

Usual Adult Dose for Nasal Carriage of Staphylococcus aureus (12 years and older):

Despite clinical responses and appropriate treatment in one study from France, 38.6% of patients relapsed [177]. SSIs rarely occur during the first 48 hours after surgery, and fever during that period usually arises from noninfectious or unknown causes. After 48 hours, SSI is a more common source of fever, and careful inspection of the wound is indicated; by 4 days after surgery, a fever is equally likely to be caused by an SSI or by another infection or other unknown sources [80]. Later infections are less likely, but surveillance standards mandate 30 days of follow-up for operations without placement of prosthetic material and for 1 year for operations where a prosthesis was inserted.

Practice Guidelines

Staphylococcus aureus and Pseudomonas species are sometimes present, usually in mixed culture. Staphylococcus aureus is known to cause this infection as the sole pathogen. A systematic review by Mathers et al. finds PWID have increased in several countries overthe last decade and are reported with a high prevalence of HIV34. The high HIV incidence among PWID in many developing countries can be controlledby key harm reduction and treatment interventions such as needle and syringe programs,medication-assisted therapy (MAT), HIV counseling and testing, and antiretroviral therapy35.

• Participants described multiple self-care techniques practiced at various stages of an evolving infection, and most were consistent between participants.
• Isolation of Aspergillus from blood cultures is rare, but dissemination is commonly detected at autopsy [224].
• Given the frequency of hematogenous spread, a set of blood cultures should always be sent before initiating empiric antibiotics in an attempt to isolate the causative organism.
• Pyogenic myositis, necrotizing fasciitis, osteomyelitis, septic arthritis, abscesses, and bacterial endocarditis could develop.

Another rare cause of early fever and systemic signs following operation is staphylococcal wound toxic shock syndrome [89, 90]. Fever, hypotension, abnormal hepatic and renal blood studies, and diarrhea are early findings. Appropriate treatment is to open the incision, perform culture, and begin antistaphylococcal treatment. A panel of 10 multidisciplinary experts in the management of SSTIs in children and adults was convened in 2009. Efforts were made to include representatives from diverse geographic areas, pediatric and adult practitioners, and a wide breadth of specialties.

• Tissue/fluid cultures should be obtained to aid in antibiotic de-escalation.
• Our findings also highlight that given cutaneous abscesses in hospitalized patients are frequently polymicrobial and involve pathogens other than MRSA, particularly among injection drug users, future IDSA treatment guidelines should specifically address the appropriate spectrum of antimicrobial therapy in these cases.
• However, systemic antibiotics should be given to patients with severely impaired host defenses or signs or symptoms of systemic infection (Figure 1, Table 2).
• Participants discussed incision and drainage techniques when treating SSTIs that reach the point of forming an abscess.
• Bone and skeletal infections are more common in PWID, primarily from hematogenous spread of bacteria from other sites, such as infected heart valves or skin and soft tissues.

However, there may be historical, cultural or anecdotal evidence linking their use to the treatment of Skin or Soft Tissue Infection. Microbiology and antibiotics started in the emergency department in cases of cutaneous abscess. Drug interactions between HIV medicines and recreational drugs can increase the risk of dangerous side effects. For example, overdoses due to interactions between some HIV medicines and drugs, such as ecstasy (MDMA) or GHB, have been reported. Drugs and alcohol can damage the liver and cause liver disease.One of the main functions of the liver is to remove harmful substances (toxins) from the blood.