Infected deep vein thrombophlebitis in people who inject drugs: missed opportunities and potential for alternative antimicrobial approaches

• Published in: Infection 2022-04, Vol.50 (2), p.507-511
• Main Authors: McCaughan, Hugh, Russell, Clark D., O’Shea, Dáire T.
• Format: Article
• Language: English
• Subjects: Abscesses; Anti-Bacterial Agents - therapeutic use; Anticoagulants; Antiinfectives and antibacterials; Antimicrobial agents; Bacteremia; Bacteremia - drug therapy; Bacteria; Brief Report; Drug Users; Drugs; Family Medicine; General Practice; Gram-negative bacteria; Health services; Humans; Infectious Diseases; Internal Medicine; Intravenous administration; Medicine; Medicine & Public Health; Narcotics; Network analysis; Observational studies; Pathogens; Patients; Signs and symptoms; Staphylococcus aureus; Substance use disorder; Therapy; Thrombophlebitis; Thrombophlebitis - diagnosis; Thrombophlebitis - drug therapy; Thrombosis; Veins
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-021-01725-3

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.