Sepsis in a person who injects drugs

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Patients with dependent (daily) or erratic and hazardous drug use who are not already engaged with community treatment services can be referred to the drug liaison service by:

If on an opiate substitution programme ensure dosing is confirmed and prescribed appropriately.

Required investigations

Suggested Investigations:

  • Blood cultures x2, PRIOR to antibiotic administration
  • Imaging of injection sites, looking for abscesses, DVT etc.
  • Consider disseminated infection such as septic pulmonary emboli based on symptoms and signs. Consider further chest imaging (CXR or CT) if suspicious.
  • Consider endocarditis in patients with confirmed blood stream infection or where there are clinic signs.
  • Review Staph. aureus blood stream infection if SAB is confirmed.
  • Recommend:  HIV  test, Hepatitis C antibody test, and Hepatitis B surface antigen test. If patient has previously tested positive for Hepatitis C antibodies and is not known to have chronic infection then send Hepatitis C PCR or antigen - discuss with virology.

Antimicrobial recommendations

Antibiotic recommendation

Flucloxacillin 2g every 6 hours IV

PLUS

Gentamicin IV (use NHS Lothian Calculator located AMT intranet page)

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

Where patient has sepsis with refractory hypotension

ADD

Clindamycin 1200mg every 6 hours IV
Penicillin-allergy/Previous MRSA

Vancomycin (use NHS Lothian Calculator located AMT intranet page) - target trough level 10-15mg/L

PLUS

Gentamicin IV (use NHS Lothian Calculator located AMT intranet page)

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

Where patient has sepsis with refractory hypotension

ADD

Clindamycin 1200mg every 6 hours IV

 

REVIEW RESPONSE AT @24-48h: if not improving ask for advice.

 

Notes

Likely organisms: S.aureus. Other organisms can include Clostridium spp, and other anaerobes.

  • There have been outbreaks of anthrax, tetanus and botulism in people who inject drugs both intravenously and subcutaneously (skin popping): discuss potential cases early with microbiology.