Thomas M Kerkering MD FACP FIDSA Professor of Medicine amp Chief Division of Infectious Disease Virginia Tech Carilion School of Medicine Carilion Monthly Admissions January 2010 August 2018 ID: 918088
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Slide1
Life Threatening & Other Serious Infections as a Consequence of Drug Use. Are We Providing Total Care?"
Thomas M. Kerkering, MD, FACP, FIDSAProfessor of Medicine & Chief, Division of Infectious DiseaseVirginia Tech Carilion School of Medicine
Slide2Carilion Monthly Admissions January 2010 – August 2018
With Substance Abuse as one of the Diagnoses
Significance of trend p < 0.0001
Slide3Infections Associated with IV Drug Usage
Endocarditis (infection of the heart valves)
Osteomyelitis (infection of the bones, usually in the spine)
Necrotizing fasciitis (destruction of soft tissue and muscle, flesh eating bacteria)
3 H’s
Hepatitis B
Hepatitis C
HIV
Most patients have more than one of these at the same time
Slide4Number of admissions per quarter having BOTH endocarditis AND substance abuse.
January 1, 2010 – July 12, 2018
n = 401
Average age = 36 yrs.
Females = 192, avg. age = 32
Males = 209, avg age = 41
Mortality rate = 14.8% (59 deaths)
Slide5Endocarditis Alone
(No Substance Abuse)n = 443Average age = 61 yrs.
Females = 180, avg. age = 59.7Males = 263, avg age = 59.7Mortality rate = 21.4% (95 deaths)
Slide6Bacteremia in Patients with Substance Abuse
But, without Evidence of Endocarditis
Meaning either: vertebral osteomyelitis
and/or necrotizing fasciitis
Significance of trend p < 0.0001
Slide7All Patients with Substance Abuse and Bacteremia
Translate to 15 per month, or
1 patient every other day
14.4% mortality
Hospital costs > $350,000
Slide8Number of New Hepatitis C Cases per Month
Carilion
Slide9Mean age = 41
Baby Boomers
Hepatitis C Age &
Gender Distribution
Slide102000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
KY
0.4
0.9
1.3
2
2.4
2.5
3.3
3.8
4.7
6.4
7.8
10.5
12.3
15
WV
0.5
1
1.7
3.3
3.4
6.9
7.17.510.21114.216.921.733.4NC0.30.40.70.70.91.31.31.61.72.73.54.25.36.4MD6.57.16.76.36.26.66.66.57.18.29.510.611.4
Neonatal Abstinence Syndrome
Carilion
(Rate per 1,000 live births)
Slide11! B.H.A.M. !
BacteremiaHepatitis C
Addiction DisorderMental Health Diagnosis
Slide12For those admitted with B.H.A.M.
- Stabilization in ICU or medical floor - Treatment of the infection
- Monitored detox Psychiatry and Substance Abuse Consults and development of management plans
Once stable, transfer to inpatient Rehab
While in Rehab continue IV antibiotics, while still participating in all sessions and groups (antibiotics can be timed to accommodate this)
In-patient Rehab is usually 28 days (4 weeks). The usual course of IV antibiotics is 4 to 8 weeks (28-56 days). Some patients will complete IV antibiotics while in Rehab, or perhaps Rehab could be extended for those requiring longer duration of antibiotics
- If patient also has HCV, this can be treated while in Rehab (one pill a day for 56 days).
- Treatment can be initiated for HIV, if necessary.
Mental Health Treatment, ongoing in Rehab
Long term mental health follow-up
Continuous and ongoing recovery program
Slide13With this sort of paradigm, the patients’ needs are all and equally addressed. This makes it much more likely the patient will have success, with fewer relapses and rarer admissions for infections.