Skin Infections In People Who Inject Drugs
Common themes of staying hydrated, eating well, using a warm compress, adequate sleep, and applying salve to the affected area were all discussed as techniques for home health care of early stage SSTIs. Notably, antibiotics and/or pursuing medical attention were not referenced during this stage of SSTI development, though they are likely clinically indicated. The clinical presentation of a SSTI includes erythema, warmth, edema, and pain over the affected site, systemic features of infection may follow as well [24]. Many also described the chronology of symptoms, noting a vaguely-defined “point of no return,” prior to which an abscess will resolve spontaneously, and after which an abscess requires treatment to prevent life- or limb-threatening complications. Septic pulmonary emboli can seed from injection-site infections and tricuspid valve endocarditis and usually present with high fever and symptoms suggestive of pulmonary emboli.11 Lung abscesses result typically from aspiration, frequently due to K pneumoniae13 or septic emboli. Although chest X-ray is sufficient to demonstrate the pulmonary infection in most cases, CT can be useful to confirm cavitation and the distribution of infection and to exclude pulmonary embolus.
- Patients with illnesses that result in profound and prolonged immune suppression should receive long-term suppressive therapy with itraconazole after the initial treatment course is complete.
- Skin and soft tissue infections are the most common cause for hospital admission of injection drug users.
- The optimal duration for treating bubonic plague is unknown, but 10–14 days is probably adequate.
- This knowledge and many of these behaviors appear empowering to participants, and may be beneficial.
- The panel’s recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections.
Soft Tissue and Skin Infections in IVDA: Treatment, Complications and Use of Imaging
Infections following surgical operations on the axilla also have a significant recovery of gram-negative organisms, and those in the perineum have a higher incidence of gram-negative organisms and anaerobes [100, 103, 104]; antibiotic selections should provide coverage for these organisms (Table 3). Figure 2 presents a schematic algorithm to approach patients with suspected SSIs and includes specific antibiotic recommendations [105]. Infections developing after surgical procedures involving nonsterile areas such as colonic, vaginal, biliary, or respiratory mucosa may be caused by a combination of aerobic and anaerobic bacteria [18, 87, 88, 101]. These infections can rapidly progress and involve deeper structures than just the skin, such as fascia, fat, or muscle (Tables 3 and 4). Injection drug use can result in harmful infectious and noninfectious effects to almost every organ system (Table 2).
Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA
- Topical steroid treatment (lotions or creams put right on the skin) and managing HIV/AIDS with antiretroviral drugs are used to treat the condition.
- Blood cultures are frequently positive (40%–50%) when cutaneous lesions appear.
- AEs that resulted in treatment discontinuation were higher in the vancomycin plus aztreonam group compared with the delafloxacin group (4.3% vs 0.9%) [8].
- Their presence usually reflects either a disseminated infection, or, in the case of HSV, the autoinoculation of virus from mucosal sites to adjacent or distant cutaneous sites.
Cutaneous mold infections are unusual, but there could be local infections at sites of IV catheter insertion or at nail bed and cuticle junctions on fingers and toes, or secondary to hematogenous dissemination [221]. Aspergillus, Rhizopus, and Mucor species cause painful erythematous skin nodules that become necrotic and can resemble ecthyma gangrenosum because of their tendency for angioinvasion [222]. Aspergillus species infections occur in 10%–14% of patients with profound and prolonged neutropenia, and mortality remains high [223].
- Patients with bubonic plague may develop secondary pneumonic plague and should be placed in respiratory isolation until after 48 hours of effective drug therapy.
- Studies in animal models demonstrate little efficacy of HBO when used alone, whereas antibiotics alone, especially those that inhibit bacterial protein synthesis, have marked benefit [139].
- Using an approach that is both theory-guided and informed by our recent empirical findings, we therefore sought to understand how PWIDs understand and care for their SSTIs, using a secondary analysis of qualitative data collected as part of this larger mixed-methods study, which was previously published [25, 26].
- In addition, differences in the incidence of gastrointestinal AEs have been observed between tedizolid and linezolid [50–52], possibly due to the effects of these agents on intestinal flora [50].
Study design, population, and setting
Group A streptococci, Streptococcus pneumoniae, and gram-negative enteric bacteria are other possible etiologic agents [127]. Serum creatine kinase concentrations are typically normal in patients with a single area of pyomyositis related to hematogenous seeding of muscle [124]. The microbiology and antibiotic selection were compared among injection drug users and non-injection drug users using Chi-square testing iv drug use or the Fisher exact test, as appropriate, with an alpha level of 0.05. In the nextparagraph, we review the previous studies which link HIV infection and PWID, and therelated approaches to reduce the frequency of injection behavior. Lefamulin is currently in late stage development as an IV and oral treatment for ABSSSIs [60]. Lefamulin inhibits protein synthesis by binding to the 50S ribosomal subunit [61].
What should I avoid while using this medicine?
Necrotizing fasciitis is an aggressive subcutaneous infection that tracks along the superficial fascia, which comprises all the tissue between the skin and underlying muscles [106, 107]. The term “fasciitis” sometimes leads to the mistaken impression that the muscular fascia or aponeurosis is involved, but in fact it is the superficial fascia that is most commonly involved. These infections cause rapidly spreading areas of erythema, swelling, tenderness, and warmth, sometimes accompanied by lymphangitis and inflammation of the regional lymph nodes. The skin surface may resemble an orange peel (peau d’orange) due to superficial cutaneous edema surrounding hair follicles and causing skin dimpling because the follicles remain tethered to the underlying dermis.
The infection usually occurs in the same area as the previous episode. Edema, especially lymphedema and other local risk factors such as venous insufficiency, prior trauma (including surgery) to the area, and tinea pedis or other toe web abnormalities [65–71], increase the frequency of recurrences. Other predisposing conditions include obesity, tobacco use, a history of cancer, and homelessness [66, 67, 71].
What are the potential complications of skin infections in people who inject drugs?
It will swell up like this [makes doughnut shape with hand] with a little lump and a ring around it. I want to check on the inside of the ring and make sure there’s no hard parts on the inside. All I know is that I put it in and blood came out and I pushed it back in and I must have missed putting it back in and it goes underneath the skin and it makes a lump. Most likely you missed though, I’ve never really seen anyone get an abscess that hits because you miss and just like the stuff accumulated under the skin. Diagnosis is usually made clinically, although laboratory tests and imaging can be useful to confirm the diagnosis and clarify specific aetiologies.
Commonly reported reasons for delaying treatment include stigma and discrimination from health care providers [1]. Our previous research has shown that PWIH often delay care and resort to treating SSTIs outside of the formal healthcare system, and that fear of inadequate pain control and withdrawal played a significant role in their decisions to delay or avoid seeking care [9, 26]. In this study population, 38% report delaying care for SSTI by 2 weeks or more, 57% left the hospital against medical advice, 54% had lanced their own abscesses, and 32% reported taking non-prescribed antibiotics [26]. The reticence to pursue formal health care forces PWIH to turn to themselves and trusted community members for care. Historically, PWIH have incised their own abscesses, sought out non-prescribed antibiotics, and participated in various forms of homeopathic care [9, 20]. This is particularly salient in the context of a population of PWIH who experience a high burden of disease with poor access to formal healthcare channels [6].