Tetanus: A Rare Complication of Black Tar Heroin Use

Pichlinski, Elisa; Hoff, Emily; Epperson, Lindsey Claire; Morley, E. C.; Cao, Dazhe; Thoppil, Joby; Field, Steven; Mehta, Prayag; Good, Daniel W.; Nijhawan, Ank E.

doi:10.1093/ofid/ofab613

Cited by 5 publications

(1 citation statement)

References 12 publications

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“…This has important implications for empiric antimicrobial therapy in this setting, which would need to treat organisms beyond common gram-positives and may require surgical incision and drainage. In addition, healthcare providers in areas where black tar heroin is used need to remain vigilant about the possibility of lifethreatening Clostridial infections, including botulism, tetanus, and others (32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

Infectious Disease Complications Associated with Opioid Use Disorder at a Southern County Hospital: A Retrospective Chart Review

Balakrishnan,

Campalans,

Marambage

et al. 2024

Preprint

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Background: Injection drug-use (IDU) is related to significant morbidity and mortality. Recent studies of IDU-associated infections have primarily focused on regions outside of the southern US; however, this area presents greater barriers to healthcare funding and lower availability of harm reduction services such as syringe exchange programs.Methods: A retrospective electronic health record review was conducted for patients admitted to an urban county hospital from February 2018-February 2020. Inclusion criteria: (a) opioid use disorder (OUD) within the last 12 months and (b) addiction psychiatry consultation. Baseline characteristics were compared between those with and without IDU-associated infections. IDU-associated infections, cultured microbes, and medication for opioid use disorder (MOUD) uptake were described.Results: Of 283 charts reviewed, 248 individuals met inclusion criteria. 65% were male, 48% non-Hispanic white, and 34% Hispanic. 72% reported opiate IDU in the past 30 days. 52% had IDU-associated infections, including skin and soft-tissue infections (SSTI) (49%), bacteremia (17%), osteomyelitis, (7%), and endocarditis (5%). Comorbid stimulant use disorder was frequently reported (70%). Overall, methicillin-resistant Staphylococcus aureus was the most common organism identified (24%). 40% of IDU-associated infections were monomicrobial, 23% were polymicrobial (including anaerobes, gram-negatives, and yeast species). Those with IDU-associated infections had lower rates of MOUD on admission (8% vs. 32%), but had higher new MOUD uptake (81% vs. 51%).Conclusions: SSTIs, which were often polymicrobial, comprised most IDU-associated infections among inpatients with OUD hospitalized in an urban Texas hospital. Individuals with IDU-associated infections had increased MOUD uptake. These findings have implications for empiric antibiotic management of IDU-associated infections and support inpatient initiation of substance use treatment.

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Section: Discussionmentioning

confidence: 99%