423. Pilot assessment of Intravenous Antibiotic Therapy in a Live-in Street-based Clinic, for Infections in Intravenous Drug Users (IVDU's).
Session: Poster Session: Clinical Studies, Public Health/Epidemiology
Friday, October 13, 2006: 12:00 AM
Room: Hall E
In a retrospective review from 2002 to 2004 of 181 IVDU admissions for IV antibiotics to Vancouver General and St. Paul’s hospitals in Vancouver, 89 (49%) had incomplete treatment courses. In an attempt to improve care, the VCH piloted a 12-bed street-based live-in clinic in Vancouver’s downtown core area for IV therapy of infections in IVDU’s, 24 of whom have been enrolled to date. We compared their treatment course to 63 non-IVDU’s enrolled in the VCH home IV antibiotic program (NIVDU). Compliance, infection type, course duration, complications of PICC lines, were recorded. Median days of inpatient treatment inpatients were 17, and 13, and as outpatients 19 and 28, for IVDU and NIVDU respectively. Infections in IVDU vs NIVDU included: endocarditis 5/24 (21%) vs 14/63 (22%); osteomyelitis 13/24 (54%) vs 43/63 (68%); septic arthritis 6/24 (25%) vs 6/63 (17%). The causative organism in 16 of 24 (67%) IVDU’s was Staphylococcus aureus, with 75% of these being MRSA. In 42 NIVDU’s who had positive cultures, 14/42 (33%) were S. aureus (8 MSSA, 6 MRSA), and 19/42 (45%) were streptococci. In the IVDU group, antibiotics used were vancomycin in 12/24 (50%), β-lactam in 11/24 (46%). In the NIVDU group, 24/63 (38%) received vancomycin, and 39/63 (62%) received a β-lactam. PICC line problems occurred in 11/24 (46%) IVDU’s and in 15/63 (24%) (with 1 line infection) NIVDU’s. Replacement was required in 3/24(13%) and 9/63 (14%) respectively. Completed treatment was achieved in 21/24 IVDU’s (86%) (2 left AMA), and 50/63 NIVDU’s (79%) (2 left AMA). Readmissions for infection were 3/24 IVDU’s (13%), 1 with a relapse (osteomyelitis), and 4/63 NIVDU’s (6%) (all relapses of osteomyelitis). In conclusion, IV antibiotic therapy at a street-based live-in clinic for IVDU’s is feasible, and results in good compliance and outcomes, with acceptable rates of PICC complications.
Amanda Hill, MB, BCh1, Amy Wai, PharmD2, David Marsh, MD3, H. Stiver, MD1, Todd Sakakibara, MD3 and   H.G. Stiver, Bayer, Company / Companies,Membership on Advisory Committees or Review Panels; Abbott, Company / Companies,Membership on Advisory Committees or Review Panels; Wyeth Canada, Company / Companies,Membership on Advisory Committees or Review Panels; Merck Frosst Canada, Company / Companies,Membership on Advisory Committees or Review Panels; honoraria, What was received,Membership on Advisory Committees or Review Panels; A. Wai, None; T. Sakakibara, None; A.J. Hill, None; D. Marsh, Schering Canada, Company / Companies,Membership on Advisory Committees or Review Panels; honorarium, What was received,Membership on Advisory Committees or Review Panels., (1)University of British Columbia, Vancouver, BC, Canada, (2)Vancouver General Hospital, Vancouver, BC, Canada, (3)Vancouver Coastal Health Authority, Vancouver, BC, Canada