Abstract
Infected deep vein thrombophlebitis (i-DVT) in people who inject drugs (PWID) is a clinically challenging but poorly characterised disease. We undertook a retrospective observational study of 70 PWID presenting acutely with i-DVT to improve the clinical and microbiological characterisation of this disease. i-DVT was frequently associated with bacteraemia (59.1% patients with blood cultures obtained), groin abscesses (in 34.3%; of which 54.2% required surgical drainage), and septic pulmonary emboli (38.6%) requiring anticoagulation. Network analysis identified a cluster of patients presenting with respiratory symptoms but lacking typical DVT symptoms, more likely to have septic pulmonary emboli. A microbiologic diagnosis was frequently achieved (70%). Causative pathogens were predominantly gram-positive (S. aureus and streptococci, especially anginosus group), whereas gram-negative pathogens were identified very infrequently (in 6.1% of microbiological diagnoses). This suggests routine empiric therapy against gram-negative bacteria, though commonly administered, is not required. High rates of clinical cure (88.6%) were observed despite the complex nature of infections and independently of the highly variable intravenous and total antimicrobial durations received. There exists a rationale to devise pragmatic approaches to implement novel individualised treatment plans utilising oral antimicrobial therapy for i-DVT. Despite frequent healthcare interactions, opportunities to address HCV treatment and opioid substitution therapy were frequently missed during these acute admissions.
Highlights
People who inject drugs (PWID) are at increased risk of bacterial disease complicating injections, including cellulitis, abscesses and infective endocarditis (IE)
Electronic patient records and Infectious Disease consultation records were searched for the terms “DVT”, “PWID” and “IVDU” for patients admitted to infectious disease, vascular surgery or critical care wards from January 2017–December 2018 inclusive, identifying 2957 acute admissions, 70 of which met the case definition and had available records
Discussion Infected deep vein thrombophlebitis (i-DVT) in PWID was frequently associated with bacteraemia, groin abscesses and septic pulmonary emboli
Summary
People who inject drugs (PWID) are at increased risk of bacterial disease complicating injections, including cellulitis, abscesses and infective endocarditis (IE). Russell contributed to this manuscript deep vein thrombophlebitis (i-DVT) is estimated to account for up to 11% of infectious complications amongst hospitalised PWID, based on a single-centre Swiss retrospective observational study [1]. I-DVT is a clinically challenging entity but poorly characterised. Optimal management is not defined, in comparison to IE in PWID [1,2,3]. PWID are a therapeutically disenfranchised group, often excluded from potentially relevant clinical trials, contributing to a lack of data to guide therapeutic decisions. To improve the clinical characterisation of this entity, we undertook a retrospective observational study of PWID presenting acutely with i-DVT
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