1922. The Challenges of Caring for People Who Inject Drugs: An Opportunity for an Infectious Diseases Service

Abstract

Background. The Royal London Hospital is a tertiary public hospital in the eastern region of London, UK-an ethnically diverse area with high levels of poverty and homelessness. Since its inception in 2015 the Infectious Diseases (ID) service has cared for 229 inpatients-10% were people who inject drugs (PWID). Such patients have complex problems including homelessness, domestic violence and psychiatric illness which impact their inpatient stay and discharge from the hospital. Methods. To retrospectively evaluate the management and treatment of PWID managed by the ID team from April 2015 to June 2017 and identify strategies to improve care. Patients were identifed via electronic records. PWID not under the direct care of the ID team were excluded. Reason for admission, microbiological diagnosis, antibiotic choice, blood borne virus status, central venous access and other specialist input were noted. Results. Twenty-two PWID were identifed; 13 (59%) were male, median age was 39.5 years (IQR 32.5-46). Eighteen patients (82%) received antibiotics via a central line. Tere was one case of line-associated infection (Candida glabrata). Tree patients (14%) lef hospital against advice, eight attended follow-up afer discharge. Tere were no deaths. The mean length of stay was 39 days. Tirteen patients were identifed as homeless and eight of these (62%) were discharged to a home. Conclusion. The majority of PWID managed by the ID team had complicated bacteremia requiring long courses of intravenous antibiotics. Despite concern regarding central access, line associated infection was rare. Signifcant proportions also had blood borne virus infection (86%) and over 50% had psychiatric illness and/or are homeless. Together these factors represent major obstacles to providing the considered "gold standard" care. Tese fndings highlight the currently unmet need for an integrated multidisciplinary approach to the care of PWID.