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Jawa R, Ismail S, Shang M, Murray S, Murray-Krezan C, Zheng Y, Mackin S, Washington K, Alvarez P, Dillon J, McMurtrie G, Stein M, Walley A, Liebschutz JM. Drug use practices and wound care experiences in the age of xylazine adulteration. Drug Alcohol Depend 2024; 263:112390. [PMID: 39173221 DOI: 10.1016/j.drugalcdep.2024.112390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/12/2024] [Accepted: 08/03/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Exposure to xylazine has been associated with wounds distinct from typical injection-related skin and soft tissue infections. We sought to understand drug use and wound care practices, and treatment experiences of people who use drugs (PWUD) in a high-prevalence area of xylazine adulteration. METHODS In August 2023, we surveyed adult PWUD reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs. Using a representative illustration, participants indicated if they had experienced a xylazine wound in the past 90 days. We compared demographic, drug use factors, wound care, and medical treatment experiences among those with and without xylazine wounds. We also conducted additional content analysis of open-ended responses. RESULTS Of the 171 respondents, 87 % (n=148) had a xylazine wound in the past 90 days. There were no statistically significant demographic differences between those with and without xylazine wounds. Among those primarily injecting (n=155), subcutaneous injection was nearly ten times more likely among people with xylazine wounds. For those with xylazine wounds (n=148), many engaged in heterogeneous wound self-treatment practices, and when seeking medical care, 74 % experienced healthcare stigma and 58 % had inadequate pain and withdrawal management. CONCLUSION People with self-identified xylazine wounds were more likely to engage in subcutaneous injection and faced several barriers seeking medical wound treatment. Programs serving people exposed to xylazine should work to support safer injection practices, including alternatives to injecting and improving access to high-quality, effective wound care. Further study is warranted to understand the causes, promoters, and prevention of xylazine-related wounds.
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Affiliation(s)
- Raagini Jawa
- Center for Research on Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Ave, 2nd floor, Pittsburgh, PA 15213, USA.
| | - Samia Ismail
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Margaret Shang
- Center for Research on Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Ave, 2nd floor, Pittsburgh, PA 15213, USA
| | - Stephen Murray
- Clinical Addiction Research and Education Unit, General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, USA
| | - Cristina Murray-Krezan
- Center for Research on Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Ave, 2nd floor, Pittsburgh, PA 15213, USA
| | - Yihao Zheng
- Center for Research on Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Ave, 2nd floor, Pittsburgh, PA 15213, USA
| | - Sarah Mackin
- AHOPE, Boston Public Health Commission, 774 Albany St, 1st Floor, Boston, MA 02118, USA
| | - Kenny Washington
- AHOPE, Boston Public Health Commission, 774 Albany St, 1st Floor, Boston, MA 02118, USA
| | - Pedro Alvarez
- Tapestry, 1985 Main Street, Suite G, Springfield, MA 01103, USA
| | - Jaime Dillon
- Life Connection Center, 192 Appleton St, Lowell, MA 01852, USA
| | - Gary McMurtrie
- Center for Research on Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Ave, 2nd floor, Pittsburgh, PA 15213, USA
| | - Michael Stein
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Alexander Walley
- Clinical Addiction Research and Education Unit, General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, USA
| | - Jane M Liebschutz
- Center for Research on Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3609 Forbes Ave, 2nd floor, Pittsburgh, PA 15213, USA
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Grigoryan L, Paasche-Orlow MK, Alquicira O, Laytner L, Schlueter M, Street RL, Salinas J, Barning K, Mahmood H, Porter TW, Khan F, Raphael JL, Faustinella F, Trautner BW. Antibiotic Use Without a Prescription: A Multisite Survey of Patient, Health System, and Encounter Characteristics. Clin Infect Dis 2023; 77:510-517. [PMID: 37094252 DOI: 10.1093/cid/ciad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Using antibiotics without a prescription is potentially unsafe and may increase the risk of antimicrobial resistance. We evaluated the effect of patient, health system, and clinical encounter factors on intention to use antibiotics without a prescription that were (1) purchased in the United States, (2) obtained from friends or relatives, (3) purchased abroad, or (4) from any of these sources. METHODS The survey was performed January 2020-June 2021 in 6 publicly funded primary care clinics and 2 private emergency departments in Texas, United States. Participants included adult patients visiting 1 of the clinical settings. Nonprescription use was defined as use of antibiotics without a prescription; intended use was professed intention for future nonprescription antibiotic use. RESULTS Of 564 survey respondents (33% Black and 47% Hispanic or Latino), 246 (43.6%) reported prior use of antibiotics without a prescription, and 177 (31.4%) reported intent to use antibiotics without a prescription. If feeling sick, respondents endorsed that they would take antibiotics obtained from friends/relatives (22.3% of 564), purchased in the United States without a prescription (19.1%), or purchased abroad without a prescription (17.9%). Younger age, lack of health insurance, and a perceived high cost of doctor visits were predictors of intended use of nonprescription antibiotics from any of the sources. Other predictors of intended use were lack of transportation for medical appointments, language barrier to medical care, Hispanic or Latino ethnicity, and being interviewed in Spanish. CONCLUSIONS Patients without health insurance who report a financial barrier to care are likely to pursue more dangerous nonprescription antimicrobials. This is a harm of the US fragmented, expensive healthcare system that may drive increasing antimicrobial resistance and patient harm.
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Affiliation(s)
- Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | | | - Osvaldo Alquicira
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lindsey Laytner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Richard L Street
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Juanita Salinas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth Barning
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hammad Mahmood
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas W Porter
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fareed Khan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jean L Raphael
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Fabrizia Faustinella
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
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3
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Colledge-Frisby S, Jones N, Larney S, Peacock A, Lewer D, Brothers TD, Hickman M, Farrell M, Degenhardt L. The impact of opioid agonist treatment on hospitalisations for injecting-related diseases among an opioid dependent population: A retrospective data linkage study. Drug Alcohol Depend 2022; 236:109494. [PMID: 35605532 DOI: 10.1016/j.drugalcdep.2022.109494] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Injecting-related bacterial and fungal infections cause substantial illness and disability among people who use illicit drugs. Opioid agonist treatment (OAT) reduces injecting frequency and the transmission of blood borne viruses. We estimated the impact of OAT on hospitalisations for non-viral infections and examine trends in incidence over time. METHODS We conducted a retrospective cohort study using linked administrative data. The cohort included 47 163 individuals starting OAT between August 2001 and December 2017 in New South Wales, Australia, with 454 951 person-years of follow-up. The primary outcome was hospitalisation for an injecting-related disease. The primary exposure was OAT status (out of OAT, first four weeks of OAT, and OAT retention [i.e., more than four weeks in treatment]). Covariates included demographic characteristics, year of hospitalisation, and recent clinical treatment. RESULTS 9122 participants (19.3%) had at least one hospitalisation for any injecting-related disease. Compared to time out of treatment, retention on OAT was associated with a reduced rate of injecting-related diseases (adjusted rate ratio[ARR]=0.92; 95%CI 0.87-0.97). The first four weeks of treatment was associated with an increased rate (ARR 1.53, 95%CI 1.38-1.70), which we believe is explained by referral pathways between hospital and community OAT services. The age-adjusted incidence rates of hospitalisations for any injecting-related disease increased from 34.8 (95% CI =30.2-40.0) per 1000 person-years in 2001 to 54.9 (95%CI=51.3-58.8) in 2017. INTERPRETATION Stable OAT is associated with reduced hospitalisations for injecting-related bacterial infections; however, OAT appears insufficient to prevent these harms as the rate of these infections is increasing in Australia.
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Affiliation(s)
- Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Burnet Institute, Melbourne, Australia.
| | - Nicola Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Sarah Larney
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychology, University of Tasmania, Hobart, Australia
| | - Dan Lewer
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Thomas D Brothers
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Self and professional treatment of skin and soft tissue infections among women who inject drugs: Implications for wound care provision to prevent endocarditis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35813351 PMCID: PMC9262139 DOI: 10.1016/j.dadr.2022.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Skin and soft tissue infections (SSTI) are common among people who inject drugs and can result in severe health consequences, including infective endocarditis. Numerous barriers to accessing care often prevent people who inject drugs from seeking healthcare including past negative healthcare experiences, transportation, and shame around drug use. These barriers can lead some people who inject drugs to self-care instead of seeking formal treatment. Methods: We explored the prevalence of SSTIs and associated treatment behaviors among women who inject drugs and sell sex (N = 114). Women reported their drug use and SSTI histories. Those who experienced an SSTI reported if they self-treated their SSTIs and/or sought formal treatment. Results: Half (50.0%) experienced at least one SSTI in the past 6 months. SSTIs were more common among those who injected painkillers (24.6% vs 8.8%, p = 0.02) and who had ever been treated for endocarditis (28.1% vs 10.5%, p = 0.02). SSTIs were less common among those who injected multiple times per day (17.9% vs 38.6%, p = 0.01) and always injected with a sterile syringe (19.3% vs 42.1%, p = 0.01). Among those who experienced an SSTI, most (85.7%) reported self-treating, and half (52.6%) sought formal care. The emergency room was the most common source of care (73.3%). Conclusions: When experiencing SSTIs, women often opted to self-treat rather than seek formal healthcare. A lack of formal care can lead to infections progressing to serious conditions, like endocarditis. Self-treatment with non-prescribed antibiotics may further result in antibiotic-resistant infections. Low threshold, stigma free, community-based wound care programs are warranted.
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Bashar MA, Miot J, Shoul E, van Zyl RL. Impact of an antibiotic stewardship programme in a surgical setting. S Afr J Infect Dis 2021; 36:307. [PMID: 34917678 PMCID: PMC8661296 DOI: 10.4102/sajid.v36i1.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background Antibiotics are miracles of science and critical for many surgical procedures. However, the emergence of multidrug resistant pathogens resulting from inappropriate antibiotic use is a threat to modern medicine. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting. Methods Baseline antibiotic utilisation was determined with a retrospective cross-sectional study in two surgical wards in a tertiary academic hospital in South Africa where medical records of 264 patients who received antibiotics were reviewed. In the second stage of the study, records of 212 patients who received antibiotics were reviewed during a weekly antibiotic stewardship intervention round. The volume of antibiotics consumed was determined using defined daily doses (DDDs)/1000 patients' days, and the appropriateness of the antibiotic prescription for treatment was also determined using a quality-of-use algorithm. Results There was a reduction in the volume of antibiotic consumption from a total 739.30 DDDs/1000 to 564.93 DDDs/1000 patient days, with reduction in inappropriate antibiotic use from 35% to 26% from baseline to antibiotic stewardship programme stages, respectively. There was an overall increase in culture targeted therapy in both wards in the antibiotic stewardship programme stage. Conclusion The implementation of an antibiotic stewardship programme led to a reduction in antibiotic consumption and improvement in appropriate use of antibiotics.
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Affiliation(s)
- Muhammad A Bashar
- Pharmacology Division, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pharmacology and Therapeutics, College of Health Sciences, Federal University Birnin Kebbi, Birnin Kebb, Nigeria
| | - Jacqui Miot
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evan Shoul
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robyn L van Zyl
- Pharmacology Division, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Fay K, Onukwube J, Chochua S, Schaffner W, Cieslak P, Lynfield R, Muse A, Smelser C, Harrison LH, Farley M, Petit S, Alden N, Apostal M, Vagnone PS, Nanduri S, Beall B, Van Beneden CA. Patterns of antibiotic nonsusceptibility among invasive group A Streptococcus infections-United States, 2006-2017. Clin Infect Dis 2021; 73:1957-1964. [PMID: 34170310 DOI: 10.1093/cid/ciab575] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Treatment of severe group A streptococcal infections requires timely and appropriate antibiotic therapy. We describe the epidemiology of antimicrobial-resistant invasive group A streptococcal (iGAS) infections in the U.S. METHODS We analyzed population-based iGAS surveillance data at 10 U.S. sites from 2006-2017. Cases were defined as infection with GAS isolated from normally sterile sites or wounds in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. Antimicrobial susceptibility was determined using broth microdilution or whole genome sequencing. We compared characteristics among patients infected with erythromycin nonsusceptible (EryNS) and clindamycin nonsusceptible (CliNS) strains to those with susceptible infections. We analyzed proportions of EryNS and CliNS among isolates by site, year, risk factors and emm type. RESULTS Overall, 17,179 iGAS cases were reported; 14.5% were EryNS. Among isolates tested for both inducible and constitutive CliNS (2011-2017), 14.6% were CliNS. Most (99.8%) CliNS isolates were EryNS. Resistance was highest in 2017 (EryNS: 22.8%; CliNS: 22.0%). All isolates were susceptible to beta-lactams. EryNS and CliNS infections were most frequent among persons aged 18-34 years and in persons residing in long-term care facilities, experiencing homelessness, incarcerated, or who injected drugs. Patterns varied by site. Patients with nonsusceptible infections were significantly less likely to die. Emm types with >30% EryNS or CliNS included: 77, 58, 11, 83, 92. CONCLUSION Increasing prevalence of EryNS and CliNS iGAS infections in the U.S. is predominantly due to expansion of several emm types. Clinicians should consider local resistance patterns when treating iGAS infections.
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Affiliation(s)
- Katherine Fay
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | | - Sopio Chochua
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | | - Paul Cieslak
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Alison Muse
- New York State Department of Health, Emerging Infections Program, Rochester, New York, USA
| | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica Farley
- Emerging Infections Program, Emory University, Atlanta, Georgia, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford Connecticut, USA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | | | | | - Bernard Beall
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
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Wilding S, Kettu V, Thompson W, Howard P, Jeuken LJC, Pownall M, Conner M, Sandoe JAT. Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics. JAC Antimicrob Resist 2021; 3:dlab083. [PMID: 34223142 PMCID: PMC8251327 DOI: 10.1093/jacamr/dlab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health crisis but reducing antibiotic use can help. Some antibiotic use is driven by patient demand. OBJECTIVES To develop an intervention to discourage antibiotic-seeking behaviour in adults. METHODS Literature reviewed to identify behaviours for acquiring antibiotics among adults in the community. Behaviour change wheel approach was used to select the target behaviour and behaviour change techniques. An intervention in the form of a short animated film was developed and its potential impact evaluated in a randomized, controlled, online questionnaire study. RESULTS Asking a general medical/dental practitioner for antibiotics was identified as the target behaviour. A short stop-motion animated film was chosen to deliver several behaviour-change techniques. Education and persuasion were delivered around information about the normal microbial flora, its importance for health, the negative effect of antibiotics, and about AMR. 417 UK-based individuals completed the questionnaire; median age 34.5 years, 71% female, 91% white ethnicity. 3.8% of participants viewing the test film intended to ask for antibiotics compared with 7.9% viewing the control film. Test film viewers had significantly higher knowledge scores. At 6 week follow up, knowledge scores remained significantly different, while most attitude and intention scores were not different. CONCLUSIONS Some patients continue to ask for antibiotics. The film increased knowledge and reduced intentions to ask for antibiotics. At 6 weeks, knowledge gains remained but intentions not to ask for antibiotics had waned. Evaluation in the clinical environment, probably at the point of care, is needed to see if antibiotic prescribing can be impacted.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of
Leeds, Leeds, UK
| | | | - Wendy Thompson
- Division of Dentistry, University of
Manchester, Manchester, UK
| | - Philip Howard
- School of Healthcare, University of
Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
| | - Lars J C Jeuken
- School of Biomedical Sciences, University of
Leeds, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of
Leeds, Leeds, UK
| | - Jonathan A T Sandoe
- Leeds Teaching Hospitals NHS Trust,
Leeds, UK
- Leeds Institute of Medical Research, School of
Medicine, University of Leeds, Leeds, UK
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Serota DP, Chueng TA, Schechter MC. Applying the Infectious Diseases Literature to People who Inject Drugs. Infect Dis Clin North Am 2021; 34:539-558. [PMID: 32782101 DOI: 10.1016/j.idc.2020.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People who inject drugs (PWID) presenting with injection drug use-associated infections are an understudied population excluded from most prospective infectious disease (ID) clinical trials. Careful application of the existing ID literature to PWID must consider their unique medical, psychological, and social challenges. Identification and treatment of the underlying substance use disorder are key underpinnings to any successful ID intervention.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA.
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA; Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA. https://twitter.com/teresachueng
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. https://twitter.com/limbsandlungs
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9
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Barani A, Tabatabaee Bafroee AS, Jabalameli L. Abundance of extended-spectrum β-lactamase genes among intestinal Escherichia coli strains from drug users. Arch Microbiol 2021; 203:3245-3255. [PMID: 33837441 DOI: 10.1007/s00203-021-02316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
Drug users may represent a hidden reservoir of antibiotic resistance genes among their intestinal flora due to the poor hygiene and inappropriate use of antibiotics. Therefore, this study was focused to examine the prevalence of extended-spectrum β-lactamase (ESBL) genes among intestinal Escherichia coli isolated from drug users in Ahvaz, Iran. Among clients of toxicology laboratory who were confirmed their addiction to each of Morphine, Amphetamine or Methamphetamine, 109 drug users were examined voluntarily for infection with hepatitis B or C using commercial enzyme linked immunosorbent assays (ELISA) method. Their stool specimens were obtained to isolate intestinal E. coli. The disc diffusion and combination disk methods were conducted to demonstrate antibiotic resistance pattern and phenotypically ESBL producers. ESBL-encoding genes (bla-TEM, bla-CTX-M, and bla-SHV) were also examined by PCR. Based on results, hepatitis C infection was more prevalent than hepatitis B among drug users. Of 109 isolates, a total of 57 (52.29%) ESBL positive E. coli were obtained from drug users and bla-TEM gene (60.55%) was found to be the most prevalent type, followed by bla-CTX-M (40.36%) and bla-SHV (39.44%). All isolates represented different resistance levels to tested antibiotics and 54.43% of the ESBL‑producing isolates showed multidrug resistance (MDR) and the most frequent MDR pattern was simultaneous resistance to the seven (27.90%) of antimicrobials particularly erythromycin, penicillin, amoxycilin, cefteriaxon, cefotaxim, tetracycline and trimethoprim-Sulfamethoxazole. Fecal carriage of ESBL-production and MDR commensal isolates such as E. coli among drug users underlines the risk of transferring resistance genes between nonpathogenic and pathogenic bacteria.
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Affiliation(s)
- Alireza Barani
- Department of Biology, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | | | - Leila Jabalameli
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
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10
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Grigoryan L, Germanos G, Zoorob R, Juneja S, Raphael JL, Paasche-Orlow MK, Trautner BW. Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review. Ann Intern Med 2019; 171:257-263. [PMID: 31330541 DOI: 10.7326/m19-0505] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance. PURPOSE To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it. DATA SOURCES Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019. STUDY SELECTION Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use. DATA EXTRACTION Two reviewers independently screened citations and full texts and performed data abstraction. DATA SYNTHESIS Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems. LIMITATION Scarce evidence and heterogeneous methods and outcomes. CONCLUSION Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
| | - George Germanos
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Roger Zoorob
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Shivanki Juneja
- University of Pennsylvania, Philadelphia, Pennsylvania (S.J.)
| | - Jean L Raphael
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
| | | | - Barbara W Trautner
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
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11
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Lekshmi M, Ammini P, Kumar S, Varela MF. The Food Production Environment and the Development of Antimicrobial Resistance in Human Pathogens of Animal Origin. Microorganisms 2017; 5:E11. [PMID: 28335438 PMCID: PMC5374388 DOI: 10.3390/microorganisms5010011] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 02/08/2023] Open
Abstract
Food-borne pathogens are a serious human health concern worldwide, and the emergence of antibiotic-resistant food pathogens has further confounded this problem. Once-highly-efficacious antibiotics are gradually becoming ineffective against many important pathogens, resulting in severe treatment crises. Among several reasons for the development and spread of antimicrobial resistance, their overuse in animal food production systems for purposes other than treatment of infections is prominent. Many pathogens of animals are zoonotic, and therefore any development of resistance in pathogens associated with food animals can spread to humans through the food chain. Human infections by antibiotic-resistant pathogens such as Campylobacter spp., Salmonella spp., Escherichia coli and Staphylococcus aureus are increasing. Considering the human health risk due to emerging antibiotic resistance in food animal-associated bacteria, many countries have banned the use of antibiotic growth promoters and the application in animals of antibiotics critically important in human medicine. Concerted global efforts are necessary to minimize the use of antimicrobials in food animals in order to control the development of antibiotic resistance in these systems and their spread to humans via food and water.
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Affiliation(s)
- Manjusha Lekshmi
- QC Laboratory, Harvest and Post Harvest Technology Department, ICAR-Central Institute of Fisheries Education (CIFE), Seven Bungalows, Versova, Andheri (W), Mumbai 400061, India.
| | - Parvathi Ammini
- CSIR-National Institute of Oceanography (NIO), Regional Centre, Dr. Salim Ali Road, Kochi 682018, India.
| | - Sanath Kumar
- QC Laboratory, Harvest and Post Harvest Technology Department, ICAR-Central Institute of Fisheries Education (CIFE), Seven Bungalows, Versova, Andheri (W), Mumbai 400061, India.
| | - Manuel F Varela
- Department of Biology, Eastern New Mexico University, Portales, NM 88130, USA.
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Fink DS, Lindsay SP, Slymen DJ, Kral AH, Bluthenthal RN. Abscess and self-treatment among injection drug users at four California syringe exchanges and their surrounding communities. Subst Use Misuse 2013; 48:523-31. [PMID: 23581506 PMCID: PMC4334130 DOI: 10.3109/10826084.2013.787094] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study aimed to identify the prevalence and determinants of soft tissue infections and self-treatment among injection drug users (IDUs) in California. The study interviewed 864 IDUs in California using computer-assisted personal interview (CAPI) from 2003 to 2005. Multiple logistic regression analyses were performed to examine adjusted associations for recent abscess and abscess self-treatment. In these analyses, Latinos had higher odds than African Americans to self-treat, while IDUs reporting a usual place of health care had lower odds of self-treatment. Findings suggest an expansion of wound care facilities to mitigate the self-treatment of abscesses, with special consideration to Latinos.
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Affiliation(s)
- David S Fink
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
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13
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Ho J, Archuleta S, Tice A, Fisher D. International Approaches to Treating Intravenous Drug Users in Outpatient Parenteral Antibiotic Services. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e31824f8acb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Ward L, Patel NM, Hanlon A, Eldakar-Hein S, Sherlinski K, Ward SH. Prescription medication borrowing among adult patients at an urban medical center. J Urban Health 2011; 88:997-1014. [PMID: 21647797 PMCID: PMC3232422 DOI: 10.1007/s11524-011-9589-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prescription medication borrowing can result in adverse health outcomes. We aimed to study the patterns of borrowing prescription medications in an adult urban population seeking healthcare in the outpatient, emergency, and inpatient units of an urban medical center. Participants indicated whether they (1) had a primary care doctor, medical insurance, a prior history of substance abuse, psychiatric disorders, or chronic pain; and (2) had borrowed a prescription medication. If so, they noted the medication obtained, source, frequency of use, and reasons why they had not obtained a prescription from a licensed medical provider. Of the 641 participants, most were African American (75%), urban residents (75%), high school educated or less (71%), and lacked full-time employment (68%). Many had health insurance (90%) and had recently seen their primary medical provider (75%). Eighteen percent reported ever borrowing a prescription medication. On multivariate analysis, history of chronic pain was marginally associated with increased medication borrowing (odds ratio [OR] = 1.58) while having Medicare insurance (OR = 0.436) or a primary care medical provider routinely ask about medication usage (OR = 0.589) were significantly associated with decreased medication borrowing. The most commonly obtained medications were for pain (74%), usually in the form of opioids, and were obtained from a family member (49%) or friend (38%). Thirty-five percent of those who borrowed medications did so more than once a year, with lack of convenient access to medical care the most frequently cited reason for use (67%). Only a third of those who borrowed medications had informed their primary medical providers of the behavior. In conclusion, borrowing prescription medications is a common behavior in the population studied. Further research is warranted into interventions to reduce such use, especially the impact of methods to improve the convenience of contacting licensed medical providers.
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Affiliation(s)
- Lawrence Ward
- Department of Internal Medicine, Temple University School of Medicine, Philadelphia, PA USA
| | - Nima M. Patel
- Temple University School of Pharmacy, Philadelphia, PA USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing, Philadelphia, PA USA
| | - Shaden Eldakar-Hein
- Department of Internal Medicine, Temple University School of Medicine, Philadelphia, PA USA
| | | | - Stephanie H. Ward
- Department of Internal Medicine, Temple University School of Medicine, Philadelphia, PA USA
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