Clinical Outcomes and Challenges in the Management of Spondylodiscitis in Patients With Intravenous Drug Abuse: A Multicenter Retrospective Study.

The pharmacokinetics of teicoplanin were determined after multiple 30-min intravenous infusions of 10 to 15 mg/kg every 12 to 24 h in 11 intravenous drug abuse (IVDA) patients being treated for bacterial endocarditis. Multiple serum samples were obtained over 7 to 14 days. Twenty-four-hour urine collections were obtained on days 1 and 5. Serum concentration-time data were analyzed by using multiple-dose pharmacokinetic analysis (NONLIN84). Results were compared with pharmacokinetic parameters derived from previous studies in normal healthy volunteers following multiple intravenous infusions of teicoplanin (3 to 6 mg/kg/day). Total and renal clearances of teicoplanin in IVDA patients were found to be significantly greater and more highly variable than those observed previously in normal healthy volunteers. As a result, predicted steady-state trough concentrations in serum may vary up to fivefold. The mechanism responsible for this variation appears to be related to the glomerular filtration rate. In IVDA patients, individualized teicoplanin dosage may be required in the treatment of bacterial endocarditis.

To identify the differences in patient factors, presentation, treatment course, and outcomes of intravenous drug users (IVDA) vs. nonusers (non-IVDA) presenting with pyogenic spinal infections. Study Design/Setting. Retrospective case series. We identified all cases involving spinal infections at our institution between May 2017 and January 2023. Postsurgical infections were excluded, and patients were separated into IVDA and non-IVDA groups. The patient charts were reviewed and analyzed for statistical or clinically significant differences using RStudio (2019 version 3.6.2). Our institutional review board approved this study, IRB# 2020-277, iRISID-2023-1384. Fifty patients (29 males and 21 females) with primary pyogenic spinal infections were included in our study. There were fourteen patients (28.0%) in the IVDA group. The mean age in the IVDA group was 50.6 vs. 61.9 years (p < 0.05) in the non-IVDA group. The average length of stay (LOS) in the IVDA group was 15.8 vs. 14.0 days (p = 0.54) in the non-IVDA group, with no significant difference in readmissions or disposition. Twenty-three non-IVDA patients were diagnosed with diabetes, while eight IVDA patients had a psychiatric diagnosis (other than substance abuse). There were no significant differences in microbial isolate or the duration of antibiotics. In our study population, there is a high incidence of intravenous drug abuse (IVDA), psychiatric disease, diabetes, and chronic kidney disease. Analysis shows a trend of two distinct patient populations. Patients without a history of IVDA were significantly older than those with IVDA and significantly more likely to have medical comorbidities including hyperlipidemia, diabetes, chronic kidney disease, and malignancy than those with IVDA history. Patients with IVDA were younger with significantly higher rates of smoking and psychiatric disorders. IVDA patients struggled to receive continued psychiatric/addiction treatment after discharge, an area for significant improvement. Due to a small sample size and single urban institution setting, this study may be underpowered to demonstrate differences in healthcare resource consumption.

The lack of diagnostic value of the indium scan in acute bacterial endocarditis

Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis

Comorbidity Assessment Using Charlson Comorbidity Index and Simplified Comorbidity Score and Its Association With Clinical Outcomes During First-Line Chemotherapy for Lung Cancer

A comparative analysis of the patient characteristics and cost of managing intravenous drug users (IVDU) with soft tissue abscesses with non-IVDU

Aplastic Anemia in the Elderly: A Nationwide Survey on Behalf of the French Reference Center for Aplastic Anemia

Background: Infective endocarditis (IE) is a serious infection of the heart valves and endocardium with substantial morbidity and mortality. Intravenous drug use (IVDU) is a major risk factor, conferring a nearly 20-fold higher incidence compared to the general population. The impact of valve surgery, including repair and replacement, on mortality risk in IE—particularly among IVDU and non-IVDU populations—requires further investigation. Methods: The National Inpatient Sample (NIS) was queried from 2016 to 2022 to identify adult hospitalizations with a primary diagnosis of infective endocarditis. Patients were categorized based on IVDU status. Comorbidity burden was calculated using Van Walraven weights derived from the Elixhauser Comorbidity Index using ICD-10 codes. Valve surgery (repair or replacement) was identified using procedural codes and In-hospital mortality was the primary outcome measured. Multivariable logistic regression was used to assess the association between IVDU status, valve surgery type, and in-hospital mortality, adjusting for age, sex, and comorbidity burden. Results: Non-IVDU patients exhibited a higher weighted comorbidity burden (mean Van Walraven score: 15.43 [95% CI: 15.35-15.51]) compared to IVDU patients (mean score: 5.90 [95% CI: 5.76-6.05]), nearly a threefold difference. Despite this, the adjusted odds ratio (OR) for in-hospital mortality among IVDU patients compared to non-IVDU patients was 1.10 (95% CI: 0.90-1.30), indicating no significant difference in mortality risk. Valve surgery was associated with a significant protective effect on mortality (adjusted OR: 0.51 [95% CI: 0.33-0.78]), effectively neutralizing the mortality difference between groups. No significant difference in mortality was observed between valve replacement and valve repair (adjusted OR: 0.98 [95% CI: 0.72-1.32]; p=0.89), indicating similar outcomes between surgical approaches. Conclusions: Patients with IVDU-related IE have a lower comorbidity burden than non-IVDU patients yet exhibit similar mortality risks. Valve surgery substantially reduces mortality, regardless of IVDU status, and demonstrates similar protective effects between valve repair and replacement procedures. These findings underscore the importance of timely surgical intervention in IE management, highlighting that both valve replacement and repair provide comparable mortality benefits.

Clinical characteristics and surgical outcomes of spinal infections in intravenous drug users and nonintravenous drug users.

Decreased natural and antibody-dependent cellular cytotoxic activities in intravenous drug abusers

Infective native aneurysms of the femoropopliteal arteries: A systematic review and pooled analysis.

Mitigation and Education

Infective spondylodiscitis is a rare disease. This case review describes the clinical course, risk factors, and outcomes of adult patients on maintenance hemodialysis who presented with infective spondylodiscitis at a single medical center in Taiwan. There were 18 cases (mean age: 64.9 ± 10.8 years) over more than 10 years. Analysis of underlying diseases indicated that 50% of patients had diabetes, 55.6% had hypertension, 55.6% had coronary artery disease, 22.2% had congestive heart failure, 22.2% had a cerebral vascular accident, 16.7% had liver cirrhosis, and 11.1% had malignancies. Sixty-one percent of patients had a degenerative spinal disease and the most common symptom was back pain (83.3%). A total of 38.9% of patients had leukocytosis, 99.4% had elevated levels of C-reactive protein, 78.6% had elevated erythrocyte sedimentation rates, and 55.6% had elevated levels of alkaline phosphatase. The average hemodialysis duration was 72.8 ± 87.5 months, and 8 patients (44.4%) started hemodialysis within 1 year prior to infective spondylodiscitis. Four patients (22.2%) had vascular access infection-associated spondylodiscitis. The lumbar region was the most common location of infection (77.8%), 44.4% of patients developed abscesses, and Staphylococci were the most common pathogen (38.9%). The mortality rate was 16.7%, all due to sepsis. Thirty-three percent of the survivors had recurrent infective spondylodiscitis within 1 year. Infective spondylodiscitis should be considered in hemodialysis patients who present with prolonged back pain with or without fever. Non-contrast MRI is an appropriate diagnostic tool for this condition. Vascular access infection increases the risk for infective spondylodiscitis in hemodialysis patients.

Infections generally occur in intravenous drug abuse (IVDA) patients, most commonly affecting the spine and proximal joints. Numerous serious musculoskeletal complications of IVDA may involve the upper extremity, however. Soft-tissue complications in the upper extremity of IVDA patients include cellulitis, ulceration, abscess, pyomyositis, septic bursitis, tenosynovitis, and necrotizing fasciitis. Foreign bodies in soft tissue due to needle fragments are common findings. Primary bone and joint IVDA complications include osteomyelitis (acute and chronic) and septic arthritis. Other IVDA complications in the upper extremity affecting blood vessels and lymphatics include hematoma, arterial aneurysm and pseudoaneurysm, thrombosis, thrombophlebitis, "puffy hand" syndrome, and lymphadenopathy. These complications usually present as urgent issues requiring prompt and accurate evaluation in the acute setting. Diagnostic imaging not only aids in making the correct diagnosis but also permits precise definition of the location and extent of these abnormalities. We review the imaging findings and illustrate a wide range of disabling and even life-threatening complications affecting the upper extremity of IVDA patients that require early diagnosis for optimal outcome.

Efficacy of Single-Agent Decitabine in Relapsed and Primary Refractory (rel/ref) Acute Myeloid Leukemia (AML)