buprenorphine and Staphylococcal-Infections

Syringe services programs (SSPs) are able to offer wrap-around services for people who inject drugs (PWID) and improve health outcomes.. A 47-year-old man screened positive for a skin and soft tissue infection (SSTI) at an SSP and was referred to a weekly on-site student-run wound care clinic. He was evaluated by first- and third-year medical students, and volunteer attending physicians determined that the infection was too severe to be managed on site. Students escorted the patient to the emergency department, where he was diagnosed with a methicillin-resistant Staphylococcus aureus arm abscess as well as acute HIV infection.. Student-run wound care clinics at SSPs, in conjunction with ongoing harm reduction measures, screenings, and treatment services, provide a safety-net of care for PWID and help mitigate the harms of injection drug use.

Topics: Abscess; Anti-Bacterial Agents; Buprenorphine; Doxycycline; Harm Reduction; HIV Infections; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Needle-Exchange Programs; Opioid-Related Disorders; Soft Tissue Infections; Staphylococcal Infections; Substance Abuse, Intravenous; Vancomycin

i.v. buprenorphine hydrochloride (Subutex) misuse has been creating a number of medical complications, and cutaneous manifestations such as soft tissue infection are one of the commonest consequences. Between January 2004 and December 2006, amongst 130 i.v. buprenorphine abusers who presented to the National University Hospital, Singapore, cutaneous complications were identified in 45 patients (prevalence, 31%) with cellulitis and skin abscess being the commonest complications. Tissue and blood culture were positive in 19 (42%) patients and Methicillin-sensitive Staphylococcus aureus was the commonest microbiological isolate (20%). Univariate linear regression revealed significant relationships between body temperature (P = 0.03), heart rate (P = 0.02), respiratory rate (P < 0.001), total peripheral white cell count (P = 0.011), absolute neutrophil count (P < 0.001) and serum C-reactive protein (CRP) level (P < 0.001) on admission and through the duration of hospitalization. In multivariate analysis, respiratory rate on admission remained significantly associated with longer duration of hospitalization (P = 0.01). i.v. cloxacillin, i.v. crystallized penicillin and oral cloxacillin were the most commonly prescribed antibiotics while 11 (24%) patients required surgical treatment. The mean duration of hospitalization was 8 +/- 11 days and repeated cutaneous complications occurred in eight (18%) patients. In conclusion, cutaneous complications are common among i.v. buprenorphine users. Respiratory rates on admission predict duration of hospital stay. A high index of suspicion coupled with a correct choice of antibiotics based on local bacteriological surveillance is necessary in an attempt to reduce cutaneous complications and length of hospitalization.

Topics: Abscess; Adult; Buprenorphine; Cellulitis; Female; Humans; Injections, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Narcotic Antagonists; Opioid-Related Disorders; Singapore; Skin Diseases; Skin Diseases, Bacterial; Staphylococcal Infections

We report a 25-year-old Malay man with Subutex-related endocarditis, complicated by protein-losing enteropathy from severe tricuspid regurgitation and congestive heart failure. The intestinal protein loss was reversed with surgical valvular intervention. This case highlights the importance of recognising the rare association between protein-losing enteropathy and congestive heart failure in the setting of endocarditis.

Topics: Adult; Biopsy; Buprenorphine; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Endocarditis, Bacterial; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Jejunum; Male; Mitral Valve Insufficiency; Narcotics; Postoperative Complications; Prosthesis Failure; Protein-Losing Enteropathies; Reoperation; Sepsis; Staphylococcal Infections; Substance Abuse, Intravenous; Surgical Wound Dehiscence; Tricuspid Valve Insufficiency