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Hatwar G, Dhale A, Dharamshi JD, Pendkar R. Comparative Analysis of Standard Percutaneous Nephrolithotomy (PCNL) and Mini-Percutaneous Nephrolithotomy (Mini-PCNL) for Renal Stones Larger Than 2 cm at a Rural Hospital: A Study Protocol. Cureus 2024; 16:e61963. [PMID: 38978895 PMCID: PMC11230606 DOI: 10.7759/cureus.61963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/08/2024] [Indexed: 07/10/2024] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) is considered a standard treatment option for large-size renal stones but is associated with drawbacks such as bleeding and prolonged recovery. Mini-PCNL offers a less invasive alternative, but its efficacy compared to standard PCNL for renal stones larger than 2 cm remains under debate. This study aims to compare the efficacy and safety of standard PCNL versus mini-PCNL for renal stone sizes more than 2 cm. Methods This single-centre prospective interventional study will be conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH). The study will include patients 18 to 70 years of age undergoing unilateral PCNL for renal calculi. Patients with renal stones larger than 2 cm will be enrolled. Data on stone-free rate (SFR), operative duration, hospital stay time, surgical site infection, haemoglobin (Hb) drop, need for blood transfusion, and post-surgery fever will be collected and compared between the two procedures. Statistical analysis of data will be performed using descriptive and analytical statistics. Results The study aims to enrol a total of 32 patients. Data analysis will be done using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York). Conclusion This study will provide valuable insights into the comparative outcome in terms of efficacy and safety of standard PCNL and mini-PCNL for kidney stones larger than 2 cm.
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Affiliation(s)
- Ghanshyam Hatwar
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhijit Dhale
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay D Dharamshi
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ruturaj Pendkar
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Morales Y, Smyth E, Zubiago J, Bearnot B, Wurcel AG. "They Just Assume That We're All Going to Do the Wrong Thing With It. It's Just Not True": Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs. Open Forum Infect Dis 2022; 9:ofac364. [PMID: 36267246 PMCID: PMC9579457 DOI: 10.1093/ofid/ofac364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the absence of adequate harm reduction opportunities, people who inject drugs (PWID) are at increased risk for serious infections. Infectious diseases guidelines recommend extended periods of intravenous antibiotic treatment through peripherally inserted central catheters (PICCs), but PWID are often deemed unsuitable for this treatment. We conducted semi-structured interviews and focus groups to understand the perspectives and opinions of patients and clinicians on the use of PICCs for PWID. Methods We approached patients and clinicians (doctors, nurses, PICC nurses, social workers, and case workers) involved in patient care at Tufts Medical Center (Boston, Massachusetts) between August 2019 and April 2020 for semi-structured interviews and focus groups. Results Eleven of 14 (79%) patients agreed to participate in an in-depth interview, and 5 role-specific clinician focus groups (1 group consisting of infectious diseases, internal medicine, and addiction psychiatry doctors, 2 separate groups of floor nurses, 1 group of PICC nurses, and 1 group of social workers) were completed. Emergent themes included the overall agreement that PICCs improve healthcare, patients' feelings that their stage of recovery from addiction was not taken into consideration, and clinicians' anecdotal negative experiences driving decisions on PICCs. Conclusions When analyzed together, the experiences of PWID and clinicians shed light on ways the healthcare system can improve the quality of care for PWID hospitalized for infections. Further research is needed to develop a system of person-centered care for PWID that meets the specific needs of patients and improves the relationship between them and the healthcare system.
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Affiliation(s)
- Yoelkys Morales
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Emma Smyth
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Julia Zubiago
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Benjamin Bearnot
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Alysse G Wurcel
- Correspondence: Alysse G. Wurcel, MD, MS, Tufts Medical Center, Department of Geographic Medicine and Infectious Diseases, 800 Washington St, Boston MA 02111, USA ()
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Attwood LO, McKechnie M, Vujovic O, Higgs P, Lloyd‐Jones M, Doyle JS, Stewardson AJ. Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient-centred multidisciplinary care. Med J Aust 2022; 217:102-109. [PMID: 35754144 PMCID: PMC9539935 DOI: 10.5694/mja2.51623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 09/26/2023]
Abstract
There has been a global increase in the burden of invasive infections in people who inject drugs (PWID). It is essential that patient-centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence-based management and preventive strategies. The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient's presentation. PWID have a range of antimicrobial delivery options that can be tailored in a patient-centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long-acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials. Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting-related harms.
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Affiliation(s)
| | | | - Olga Vujovic
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Peter Higgs
- Burnet InstituteMelbourneVIC
- La Trobe UniversityMelbourneVIC
| | | | - Joseph S Doyle
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
- Burnet InstituteMelbourneVIC
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Clinical Utility and Cost Effectiveness of Long-Acting Lipoglycopeptides Used in Deep-Seated Infections among Patients with Social and Economic Barriers to Care. PHARMACY (BASEL, SWITZERLAND) 2021; 10:pharmacy10010001. [PMID: 35076601 PMCID: PMC8788434 DOI: 10.3390/pharmacy10010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
The use of long-acting lipoglycopeptides (LaLGPs) in serious, deep-seated infections is of increasing interest. The purpose of this study is to evaluate the economic and clinical utility of LaLGPs in patients requiring protracted antibiotic courses who are not ideal candidates for oral transition or outpatient parenteral antibiotic therapy (OPAT). This is a retrospective, observational, matched cohort study of adult patients who received a LaLGP. Patients were matched 1:1 to those who received standard of care (SOC). Cost effectiveness was evaluated as total healthcare-related costs between groups. Clinical failure was a composite endpoint of mortality, recurrence, or need for extended antibiotics beyond planned course within 90 days of initial infection. There was no difference in clinical failure between the two cohorts (22% vs. 30%; p = 0.491). Six patients in the SOC cohort left against medical advice (AMA) prior to completing therapy. Among those who did not leave AMA, receipt of LaLGPs resulted in a decreased hospital length of stay by an average of 13.6 days. The average total healthcare-related cost of care was USD 295,589 in the LaLGP cohort compared to USD 326,089 in the SOC cohort (p = 0.282). Receipt of LaLGPs may be a beneficial treatment option for patients with deep-seated infections and socioeconomic factors who are not candidates for oral transition or OPAT.
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Mawn JG, Rao SS, Chaudhry YP, Gottlich C, Lobaton GO, Sabharwal S, Sterling RS, Humbyrd CJ. Septic Arthritis Among Users of Injection Drugs: Clinical Course and Microbial Characteristics. Orthopedics 2021; 44:e747-e752. [PMID: 34618644 DOI: 10.3928/01477447-20211001-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Injection drug use (IDU) is a risk factor for septic arthritis (SA) of native joints. Amid the opioid crisis, IDU rates have increased. This study assessed differences in pre-operative characteristics, microbial characteristics, and postoperative outcomes of 177 cases of SA treated operatively from 2015 to 2019 at 3 US hospitals, by self-reported IDU status. Forty cases (23%) involved patients who reported IDU. Patient characteristics, comorbidities, microbial characteristics, duration of hospital stay, discharge destination, follow-up rates, and rates of persistent/secondary infection were compared by self-reported IDU status. Compared with non-IDU-associated SA (non-IDU-SA), IDU-associated SA (IDU-SA) was associated with female sex (P=.001), younger age (P<.001), lower body mass index (P<.001), tobacco use (P<.001), and psychiatric diagnosis (P=.04) and was more likely to involve methicillin-resistant Staphylococcus aureus (P<.001). The IDU-SA was associated with discharge to a skilled nursing facility or against medical advice (P<.001) and with loss to follow-up (P=.01). The 2 groups did not differ in terms of American Society of Anesthesiologists classification, joint involved, Gram stain positivity, presence of bacteremia, peripherally inserted central catheter placement, return to hospital within 3 months, or persistent/secondary positive results on culture within 3 months. Patients with IDU-SA were younger, were more likely to be female, had lower body mass index, and had fewer medical comorbidities but were more likely to use tobacco and to have a psychiatric diagnosis compared with patients with non-IDU-SA. Methicillin-resistant S aureus was more common in the IDU-SA group, as was discharge to a skilled nursing facility or against medical advice. Patients with IDU-SA were less likely to return for follow-up than patients with non-IDU-SA. [Orthopedics. 2021;44(6):e747-e752.].
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Gruss ZP, Baumeister T, Smith J. The Use of Long-Acting Lipoglycopeptides for the Treatment of Serious, Off-label Infections: a Review of the Literature. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Appa A, Marquez C, Jain V. Home-Based Outpatient Parenteral Antibiotic Therapy at an Urban Safety Net Hospital: Comparing Outcomes in Persons With and Without Noninjection Drug Use. Open Forum Infect Dis 2020; 7:ofaa162. [PMID: 32494584 PMCID: PMC7252283 DOI: 10.1093/ofid/ofaa162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022] Open
Abstract
As stimulant use and infections among persons using drugs rise nationally, evidence remains limited on how best to deliver outpatient parenteral antimicrobial therapy (OPAT) to persons using noninjection drugs. In an urban safety net population including persons using noninjection drugs, home-based OPAT completion rates were similarly high as those of non-drug-using individuals.
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Affiliation(s)
- Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Vivek Jain
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
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Chapman ALN, Patel S, Horner C, Green H, Guleri A, Hedderwick S, Snape S, Statham J, Wilson E, Gilchrist M, Seaton RA. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC Antimicrob Resist 2019; 1:dlz026. [PMID: 34222901 PMCID: PMC8209972 DOI: 10.1093/jacamr/dlz026] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.
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Affiliation(s)
| | - Sanjay Patel
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Susan Snape
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Julie Statham
- South Warwickshire NHS Foundation Trust, Warwick, UK
| | | | | | - R Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Outcomes of patients with a history of injecting drug use and receipt of outpatient antimicrobial therapy. Eur J Clin Microbiol Infect Dis 2019; 38:575-580. [PMID: 30680563 DOI: 10.1007/s10096-018-03461-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
People who inject drugs (PWID) are susceptible to endovascular and deep-seated infections which require prolonged antibiotic therapy. There are concerns regarding this cohort's suitability for outpatient parenteral antimicrobial therapy (OPAT), but relatively little published data. Our aim is to publish our outcomes in this setting, to inform other clinicians' decisions regarding PWID in OPAT. We reviewed case records of all PWID in our OPAT service from July 2015 to December 2017. Successful completion of OPAT care was defined as completing the duration of parenteral therapy as planned at the outset, with expected clinical improvement. Data was collected on complications including hospital re-admission, new blood stream infections, patient non-compliance including ongoing non-prescribed intravenous drug use, and staff safety compromise. Twenty-eight of 38 (76.2%) episodes of OPAT care for PWID were completed successfully, with 724 bed days of care provided. The cohort was labour intensive to manage with high rates of re-admission, non-attendance and line-associated infections. There were no adverse events for staff safety, and no patient deaths on the programme. OPAT can be a viable option for PWID provided there is careful patient selection, good patient engagement and sufficient resources allocated for patient management.
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Suzuki J, Johnson J, Montgomery M, Hayden M, Price C. Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature. Open Forum Infect Dis 2018; 5:ofy194. [PMID: 30211247 PMCID: PMC6127783 DOI: 10.1093/ofid/ofy194] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/06/2018] [Indexed: 11/14/2022] Open
Abstract
Hospitalizations for people who inject drugs (PWID) with infectious complications requiring prolonged antibiotic therapy are increasing in the context of the opioid epidemic. Although outpatient parenteral antimicrobial therapy (OPAT) is routinely offered to patients without a history of injection drug use (IDU), PWID are often excluded from consideration of OPAT. To better assess the evidence base for the safety and effectiveness of OPAT for PWID, we conducted a review of the published literature. Results suggest that OPAT may be safe and effective for PWID, with rates of OPAT completion, mortality, and catheter-related complications comparable to rates among patients without a history of IDU. Rates of hospital readmissions may be higher among PWID, but instances of misuse of the venous catheter were rarely reported. More research is needed to study the safety and effectiveness of OPAT among PWID, as well as studying the combination of OPAT and addiction treatment.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jennifer Johnson
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mary Montgomery
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Christin Price
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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