O: Public Health
Oral Abstract Submission
Ana C. Bardossy, MD
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Decatur, GA
Disclosure: Nothing to disclose
Runa H. Gokhale, MD, MPH
Medical Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Kathleen Hartnett, PhD, MPH
Epidemiologist
Centers for Disease Control and Prevention
Decatur, GA
Disclosure: Nothing to disclose
Kelly M. Hatfield, MSPH
Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: Nothing to disclose
Kelly A. Jackson, MPH
MRSA Surveillance Coordinator
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Christina B. Felsen, MPH
Program Manager
University of Rochester
Rochester, NY
Disclosure: Nothing to disclose
Robert McDonald, MD, MPH
EISO
Centers for Disease Control and Prevention, New York State Department of Health
Atlanta, GA
Disclosure: Nothing to disclose
Ian Kracalik, PhD, MPH
Epidemiologist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Todd Lucas, MD, MPH
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Olivia L. McGovern, PhD, MS
EIS Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Chris Van Beneden, MD, MPH
Medical Epidemiologist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Sabrina R. Williams, MPH
Epidemiologist
ORISE; US Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Michael Mendoza, MD, MPH, MS
Commissioner
Monroe County Health Department
Rochester, NY
Disclosure: Nothing to disclose
Michele K. Bohm, MPH
Health Scientist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
John Brooks, MD
Senior Medical Advisor
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Alice K. Asher, PhD
Research Coordinator
The University of California, San Francisco
San Francisco, CA
Disclosure: Nothing to disclose
Shelley S. Magill, MD, PhD
Medical Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: Nothing to disclose
Anthony Fiore, MD, MPH
Branch Chief
DIv of Healthcare Quality Promotion
Atlanta, GA
Disclosure: Nothing to disclose
Debra Blog, MD, MPH
Director
New York State Department of Health
Albany, NY
Disclosure: Nothing to disclose
Elizabeth Dufort, MD
Medical Director, Division of Epidemiology
NYSDOH
Albany, NY
Disclosure: Nothing to disclose
Isaac See, MD
Medical Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Ghinwa Dumyati, MD
Professor
New York Rochester Emerging Infections Program at the University of Rochester Medical Center
Rochester, NY
Disclosure: Nothing to disclose
Background : The age-adjusted rate of drug overdose deaths in the United States tripled from 1999-2016. Public health surveillance data indicate that an increasing proportion of infections due to bacterial and fungal pathogens are associated with injection drug use (IDU). We describe healthcare encounters (HCEs) of PWID as potential opportunities to prevent infections related to IDU by identifying risks and treating SUD including with medication-assisted treatment (MAT) for opioid use disorder.
Methods : At six hospitals in western New York, we abstracted medical records from hospital admissions and emergency department (ED) visits for PWID (i.e., IDU in the preceding year) who had positive cultures for Staphylococcus aureus (any clinical specimen, April-July 2017), group A Streptococcus (invasive specimens, all of 2017) or Candida spp. (blood specimens, all of 2017). We reviewed hospital admission and ED records for one year preceding the positive culture to identify visits during which opportunities to prevent infection and treat SUD by addressing SUD and IDU were missed.
Results : We identified 99 PWID with positive cultures. Median age was 33 years (range 19-68) and 61 were female. Sixty-nine had a skin and soft tissue infection, 44 had a bloodstream infection, and 20 had both. Thirty-one PWID left against medical advice during a hospital admission or an ED visit. Seventy-nine PWID were hospitalized, of whom 4 died. Ninety-five used opioids and 71 used cocaine in the preceding year. Seventy-five PWID had a HCE in the 12 months prior to the index visit, with a median of two HCE per person (interquartile range 1-4); 53 of PWID had a previous HCE for infection and 28 for opioid overdose. SUD was documented during a prior HCE at the same hospital for 61 PWID, but only 10 (16%) were offered MAT during any prior HCE and for 24 (39%) there was no documentation that any form of treatment for SUD was offered.
Conclusion : In this cohort, PWID frequently had one or more healthcare encounters documented at the same hospital in the year prior to a serious bacterial or fungal infection. These prior HCEs were often for infections or overdose that signaled need for MAT, demonstrating that there are critical missed opportunities to identify risks, prevent infection, and treat SUD.