1922. The Challenges of Caring for People Who Inject Drugs – an Opportunity for an Infectious Diseases Service
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • PWID_IDSA2018.pdf (509.8 kB)
  • Background:

    The Royal London Hospital is a tertiary public hospital in the eastern region of London, UK - an ethnically diverse area with high levels of poverty and homelessness. Since its inception in 2015 the Infectious Diseases (ID) service has cared for 229 inpatients – 10% were people who inject drugs (PWID). Such patients have complex problems including homelessness, domestic violence and psychiatric illness which impact their inpatient stay and discharge from the hospital.

    Methods:

    To retrospectively evaluate the management and treatment of PWID managed by the ID team from April 2015 to June 2017 and identify strategies to improve care.

    Patients were identified via electronic records. PWID not under the direct care of the ID team were excluded. Reason for admission, microbiological diagnosis, antibiotic choice, blood borne virus status, central venous access and other specialist input were noted.

    Results:

    Twenty-two PWID were identified; 13 (59%) were male, median age was 39.5 years (IQR 32.5-46).

    Table 1. Infectious diagnoses of PWID

    Complicated MSSA bacteremia

    12

    Complicated MRSA bacteremia

    2

    Complicated other bacteremia

    2

    Non bacteremic presentations

    6

    Pulmonary TB

    3

    Groin abscess

    2

    Vertebral osteomyelitis

    1

    Eighteen patients (82%) received antibiotics via a central line. There was one case of line-associated infection (Candida glabrata). Three patients (14%) left hospital against advice, eight attended follow up after discharge. There were no deaths. The mean length of stay was 39 days. Thirteen patients were identified as homeless and eight of these (62%) were discharged to a home.

    Conclusion:

    The majority of PWID managed by the ID team had complicated bacteremia requiring long courses of intravenous antibiotics. Despite concern regarding central access, line associated infection was rare. Significant proportions also had blood borne virus infection (86%) and over 50% had psychiatric illness and/or are homeless. Together these factors represent major obstacles to providing the considered “gold standard” care. These findings highlight the currently unmet need for an integrated multidisciplinary approach to the care of PWID.

    Anna C. Riddell, MA (Oxon), MRCP, DTM&H, Emma McGuire, MRCP, DTM&H and Maximillian S. Habibi, PhD, MRCP, FRCPath, Department of Infection, Barts Health NHS Trust, London, United Kingdom

    Disclosures:

    A. C. Riddell, None

    E. McGuire, None

    M. S. Habibi, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.