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Skin and soft tissue polymicrobial infections from intravenous abuse of drugs
Abstract:
Skin and soft tissue infections were studied in 21 seriously ill narcotic addicts who had been admitted to hospital. Subcutaneous abscesses were present in 14 patients; cellulitis was noted in 3, pyomyositis in 2 and necrotizing fasciitis in 2. In four patients there was septicemia. Infections in 14 patients (66.6 percent) were associated with anaerobic bacteria, which were the exclusive isolates in 6 patients. In seven patients (33.3 percent) isolates were exclusively aerobic bacteria and in eight both aerobes and anaerobes were present. The anaerobic isolates were clostridia (six), peptostreptococci (five), bacteroides (five), peptococci (three), and one of each of Veillonella, Propionibacterium, Eubacterium, Fusobacterium and Actinomyces. Staphylococcus aureus, generally thought to be the most common cause of subcutaneous infections in addicts, was found only in four (19 percent) patients. The other aerobic isolates were Klebsiella (five) and Enterobacter (four) species. When clinical features or the Gram stain of pus suggest that anaerobic bacteria may be present, antibiotic therapy should be directed against both aerobic and anaerobic bacteria until culture results are available.
Insights
Anaerobic bacteria are frequently involved in skin and soft tissue infections among narcotic addicts. Prompt antibiotic therapy targeting both aerobic and anaerobic bacteria is crucial for effective treatment.
Area of Science:
- Infectious Diseases
- Microbiology
- Dermatology
Background:
- Narcotic addiction is associated with a high risk of skin and soft tissue infections (SSTIs).
- Previous understanding often implicated Staphylococcus aureus as the primary pathogen in these infections.
Observation:
- This study investigated 21 seriously ill narcotic addicts admitted to the hospital with SSTIs.
- Common presentations included subcutaneous abscesses, cellulitis, pyomyositis, and necrotizing fasciitis.
- Four patients also presented with septicemia.
Findings:
- Anaerobic bacteria were isolated in 66.6% of patients, being the sole pathogen in 6 cases.
- Common anaerobic isolates included clostridia, peptostreptococci, and bacteroides.
- Staphylococcus aureus was found in only 19% of patients, challenging previous assumptions.
- Aerobic bacteria like Klebsiella and Enterobacter species were also identified.
Implications:
- The findings highlight the significant role of anaerobic bacteria in SSTIs among narcotic addicts.
- Empirical antibiotic therapy should include coverage for both aerobic and anaerobic pathogens.
- This approach is vital when clinical signs suggest anaerobic involvement, pending culture results.