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Open Forum Infect Dis. 2018 Jun 8;5(7):ofy132. doi: 10.1093/ofid/ofy132. eCollection 2018 Jul.

Infectious Diseases Physicians' Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017.

Author information

1
Cambridge Health Alliance, Cambridge, Massachusetts.
2
Harvard Medical School, Boston, Massachusetts.
3
Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
4
University of Iowa Carver College of Medicine, Iowa City, Iowa.
5
Emerging Infections Network, Iowa City, Iowa.
6
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
7
Harvard School of Public Health, Boston, Massachusetts.

Abstract

Background:

In the context of the opioid epidemic, injection drug use (IDU)-related infections are an escalating health issue for infectious diseases (ID) physicians in the United States.

Methods:

We conducted a mixed methods survey of the Infectious Diseases Society of America's Emerging Infections Network between February and April 2017 to evaluate perspectives relating to care of persons who inject drugs (PWID). Topics included the frequency of and management strategies for IDU-related infection, the availability of addiction services, and the evolving role of ID physicians in substance use disorder (SUD) management.

Results:

More than half (53%, n = 672) of 1273 network members participated. Of these, 78% (n = 526) reported treating PWID. Infections frequently encountered included skin and soft tissue (62%, n = 324), bacteremia/fungemia (54%, n = 281), and endocarditis (50%, n = 263). In the past year, 79% (n = 416) reported that most IDU-related infections required ≥2 weeks of parenteral antibiotics; strategies frequently employed for prolonged treatment included completion of the entire course in the inpatient unit (41%, n = 218) or at another supervised facility (35%, n = 182). Only 35% (n = 184) of respondents agreed/strongly agreed that their health system offered comprehensive SUD management; 46% (n = 242) felt that ID providers should actively manage SUD.

Conclusions:

The majority of physicians surveyed treated PWID and reported myriad obstacles to providing care. Public health and health care systems should consider ways to support ID physicians caring for PWID, including (1) guidelines for providing complex care, including safe provision of multiweek parenteral antibiotics; (2) improved access to SUD management; and (3) strategies to assist those interested in roles in SUD management.

KEYWORDS:

bacterial infection; health care surveys; infectious diseases specialty; injection drug use; opioid use disorder

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