Wardround 25xi05

I have fixed the paraprotein link.

This week’s theme was related to the NEJM review of bacterial infections in intravenous drug users. Bacterial Infections in Drug Users. Gordon RJ, Lowy FD. NEJM November 3, 2005; 353 (18):1945-1954. (link in last week's blog)

Epidemiology (PS) : Most bacterial infections among drug users are caused by commensal flora, unusual organisms, such as clostridia and Pseudomonas indicate that a particular drug or drug-use behavior is involved. Drug users have a 10-fold increase in community-acquired pneumonia. and an incidence of one abscess per three years of injection.

Pathogenesis (HG): Bacteria are acquired from the commensal flora, the drugs or adulterants, or paraphernalia. The skin barrier is breached and non-aseptic techniques contibute to increased rrisk and use of the groin is a particular risk. Popping, which is relatively unusual locally, increases the risk of anaerobic infection. An example of paraphernalia introducing infection is candidal endophthalmitis, contracted from citric acid used to dissolve heroin.

Clinical features (AS & BA): The clinical presentation of bacterial infections in drug users is generally similar to that encountered in patients who do not use drugs but some features are unique to the drug user.

Treatment (NJ): Recognising the specific risks such as right sided SBE is the first step. Issues of the management of drug withdrawal, adherence to therapy, and difficulties of intravenous access must be a part of the therapeutic strategy. Attention to local outbreaks and bacterial antibiotic-resistance profiles is important.

Prevention (CT): Eliminating drug use is the surest way to control associated infections, but may not be possible. Risk-reducing strategies may help prevent bacterial infections among drug users, particularly among new users, the ones at greatest risk. Advise on using clean needles, not sharing, alcohol skin swabs, avoiding the neck and groin as injection sites. Don’t miss the opportunity for screening (Hep B, C, HIV, TB) and immunisation (Hep B, Hep A, tetanus).

This week’s prize to Dr Tuck...timing, handouts, good precis.

Next week’s theme is anti-arrhythmic drugs, two minutes please on:

Class Ia (AS)
Class Ib (Ash)
Class Ic (CT)
Class II (NM)
Class III (BA)
Class IV (HG)
Cardiac glycosides (MJM)

Interesting topics this week

Paraproteins

Cardiac action potentials and Vaughan-Williams

Technetium bone scans:
Am Fam Physician 1996 Oct;54(5):1639-47. Sutter CW et al. Three-phase bone scan in osteomyelitis and other musculoskeletal disorders. (you can get this through the e-library with your Athens login)

The Reading for next week is Outputs and Utility. Bandolier November 2002
http://www.jr2.ox.ac.uk/bandolier/Extraforbando/Outputs.pdf

MJM