We recommend HBV screening for core antibodies (level III) and surface antigens (level III) prior to starting treatment in MM patients. For patients who are core antibody positive, we recommend either administering prophylaxis, or monitoring for HBV DNA copies (level III), with pre-emptive anti-viral treatment for those with positive DNA tests/viremia (level III). Patients who are surface antigen positive and/or have positive HBV DNA should receive anti-viral therapy and be treated with entecavir, tenofovir, or lamivudine under the control of specialists, as per standard treatment guidelines [17]. The panel recommends anti-viral prophylaxis (treatments described in the earlier viral prophylaxis section) (level III). It is recommended the VZV reactivation is treated with valacyclovir or IV acyclovir (level III), as per standard treatment guidelines; [17] however, different agents may be used if following local guidelines (level III). We recommend that RRMM patients are vaccinated against VZV (level IIC); there are currently no clear data on stopping anti-viral prophylaxis following vaccination.

SSTIs have a wide variety of manifestations ranging from cellulitis to necrotizing fasciitis and can even resemble a vasculitis. The diagnosis of SSTIs is made by physical examination, and ultrasound can aid when the examination is equivocal for fluid collections. Gram positives and common commensal organisms of the oral cavity are frequently identified. Bone and joint infections are also frequently polymicrobial with a similar microbiologic pattern as SSTIs, and a higher prevalence of gram-negative and fungal pathogens. Novel long-acting and oral antibiotic formulations have shown promising results particularly when barriers to compliance are identified.

Skin infections in people who inject drugs

Complete, often repeated, incision and drainage is a prerequisite for successful outcome in these cases. They include direct extension of subcutaneous abscess into vital areas or structures, necrotizing fasciitis and myositis, bacteremia, and sepsis. An outbreak of a highly lethal SSTI that recently occurred in Scotland, Ireland, and England seems to have resulted from infection with Clostridia spp, including C. A rare but well-documented SSTI in injection drug users is pyomyositis, an abscess-forming infection of skeletal muscle. Although not life-threatening, chronic cutaneous venous ulcers of the lower extremities are common and debilitating, requiring long-term multidisciplinary care for successful healing.

• The practice of injecting subdermally, subcutaneously (‘skin popping’), or intramuscularly (‘muscle popping’) when veins are inaccessible is an important risk factor for developing skin infections.
• However, we recommend use of anti-bacterial prophylaxis for patients with prolonged neutropenia (level IIC).
• While some respondents did receive medical care at a hospital or healthcare facility (35.2%) the use of non-medical care was common.
• It is important to note that serum levels alone are not adequate to inform on an individual’s capacity to mount an antibody response against various pathogens, and it is more important to monitor the frequency of infections (level IIC).
• One important conceptual deficit we identified was defining specifically when an SSTI has progressed to the point when it needs prompt medical intervention.
• Among a sample of persons in western New York who inject drugs and were hospitalized or treated in the emergency department for a bacterial and fungal infection, Staphylococcus aureus was the most common pathogen.

Seven experts convened at the International Myeloma Workshop in Los Angeles, CA on 24th August 2022 to review the literature results. In addition, a survey was constructed prior to the workshop for discussion at the meeting to gain insight and ascertain the level of agreement regarding the panel’s recommendations for the treatment and management of these patients. The survey was sent out in advance of the meeting and completed by three additional experts who were unable to attend in person. Primary articles that were published in English were assessed for relevancy, to ensure inclusion of all papers and abstracts with clinical data with BsAbs. For clinical trials with multiple data cutoffs, the most recent data were used.

Clinical Medicine Journal

All authors contributed to the survey results, and/or interpretation of data and critical review of the manuscript. All authors had full access to, and contributed to the interpretation of, all data reported herein. The corresponding author had final responsibility for the decision to submit for publication. Appropriate use of vaccinations is important in MM patients, to produce immune responses and prevent potentially harmful infections.

Furthermore, in our experience, anaerobic cultures are more likely to be obtained from operative specimens. Since more injection drug users required abscess drainage in the operating room, the more frequent isolation of anaerobes in this group may simply reflect the increased use of anaerobic cultures. It is not known whether the results can be extrapolated to patients seen and discharged from the emergency department. Infectious diseases are a major cause of morbidity and mortality among intravenous drug users (IVDU) [1-8].

How Infections Spread Through IV Drug Use

In addition, task shifting to peer health workers (PHW) is an ongoing debate in low-and-middle-income countries with insufficient medical staffing. In addition to expanding capacity, PHWs can also bridge the cultural gap between the patient and the provider. This occurs because the peer health workers are fluent in the vernacular of their patients, they are the patient’s first point of contact, iv drug use easing them into the difficult to navigate norms of health care setting, and can educate the health care provider on providing culturally appropriate care to the patient [18]. Peer health workers are another resource that should be considered in addressing the disparities in care for PWID. Participants repeatedly reported poor vein health as a result of their history of injection drug use.

Although the recommendations herein are intended as a guide to assist with timely and informed decisions, they should not replace sound clinical judgment or be used as a legal resource. It is essential that physicians and patients consult an infectious disease expert for guidance when appropriate and where possible, regarding diagnosis and management of infections. Routine fungal testing with β-glucan or galactomannan tests is not recommended (level IIC).

Bone and Joint Infections

Cutaneous abscesses and cellulitis are common presentations in people who inject drugs (PWID), while necrotising fasciitis is a medical emergency. For some infections, e.g., for skin and soft tissue infections, sepsis, or pneumonia, 47.1% of the cases were scheduled for additional outpatient therapy after an adequate or best alternative in-hospital course of treatment (Table ​(Table4).4). In 12.2% of the hospitalizations, patients were discharged against medical advice either with or without therapy. During six years, between January 2001 and December 2006, there were 2002 hospitalizations of IVDU (Figure ​(Figure1).1). In 420 of these hospitalizations, a specialist in infectious diseases was consulted.