Active drug users admitted to an Internal Medicine ward: report of an experience
Keywords:
Drug abuse, Internal Medicine, infection, HIV, medical wardAbstract
Background: In the last years we have watched
the growth of the burden of disease linked to
the use of illicit drugs, especially infectious
diseases, leading to hospital admission.
These admissions are frequently complicated by problems related to the state of physical
and psychological dependency, notably the
withdrawal syndrome, disruptive behavior andn discharge from the hospital against medical
advice.
The authors intended to characterize the impact of this population in an internal medicine
ward during the year of 1998.
Methods: All patient files from the year of 1998
of an Internal Medicine ward were reviewed
and two different groups were identified: the
first one included the patients who were using
illicit drugs at the time of admission (TD group);
the second one included all the other patients
admitted (control group).
The causes of admission, as well as the duration of hospital stay and mortality rate were
identified for all patients. Biographical data
(sex and age) was also noted, as well as all
infectious episodes (on admission and nosocomial) and positive serologies for immunodeficiency virus (HIV), hepatitis B virus and
hepatitis C virus (HCV).
For drug users the patterns of use were analysed, as well as complications during hospital
stay (especially the withdrawal syndrome).
Results: During the year of 1998, 80 active drug users were admitted (5,8% of all admissions): 50
men (7,1%) and 30 women (4,5%). The average age was 31 years in the TD group and 68,5 years
in the control group.
Among drug users 70% had positive serology
for HIV and 48,7% for HCV (in the control group
the prevalence was 2,4% and 1,2%, respectively).
The mortality rate was respectively 11,3% and
12,7% in TD group and control group, and the
length of stay was of 18,7 and 16 days.
We identified 46 cases of tuberculosis (18,8%
of the TD group and 2,4% of the control group),
293 of pneumonia (28,7% and 21%) and 54 of
soft tissues infection (27,5% and 1,5%, respectively). Only 4 cases of endocarditis (2 in each
group) and 6 of acute hepatitis (all in drug users) were found.
In the TD group 33 episodes of withdrawal
syndrome were found (41,3% of this group). Regarding the discharges, 16 (20%) were against
medical advice and in 4 of them the diagnosis was tuberculosis.
In this population, 10 patients (12,5%) were
homeless (9 men and 1 woman) and 66 (82,5%) were injection drug users.
Conclusions: During the year of 1998 active
drug users represented a significant part of the
population admitted to an Internal Medicine
ward. Although significantly younger, they had
a mortality and lenght of stay similar to the other patients.
Infections were the most frequent cause of
admission in drug users. A high prevalence of
infection by HIV, HCV and tuberculosis in this group was identified.
Also relevant is the large number of discharges
against medical advice in this population, including some patients with potentially contagious
situations.
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