A controlled-release oral opioid supports S. aureus survival in injection drug preparation equipment and may increase bacteremia and endocarditis risk
A controlled-release oral opioid supports S. aureus survival in injection drug preparation equipment and may increase bacteremia and endocarditis risk
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DOI：
10.1371/journal.pone.0219777
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发表时间：
2019-08-09
期刊：
影响因子：
3.7
通讯作者：
Silverman, Michael S.
中科院分区：
文献类型：
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作者：
Kasper, Katherine J.;Manoharan, Iswarya;Silverman, Michael S.
安大略注射药物使用相关性心内膜炎（IDUaIE）的发病率最近与氢吗啡酮处方率有关。金黄色葡萄球菌引起安大略和整个北美的大多数IDUaIE病例。氢吗啡酮控释（Hydromorphone-CR）需要复杂的注射技术，因此提供了多种污染机会。Hydromorphone-CR包含几种赋形剂，这可能会提高葡萄球菌的生存和增加的风险，污染injectate.MethodsUsed注射药物制备设备（炊具/过滤器），收集从人谁注射药物（PWID），用水冲洗，并在甘露醇盐琼脂平板。从菌血症PWID中分离的细菌用于评估S.金黄色葡萄球菌和化脓性链球菌在炊具/过滤器上与氢吗啡酮-CR、氢吗啡酮速释（氢吗啡酮-IR）或羟考酮控释（羟考酮-CR）一起使用。加标S.加热金黄色葡萄球菌，计数剩余的活菌数。在用于注射氢吗啡酮-CR的12/87（14%，95%CI 8-23%）炊具/过滤器样品中检测到金黄色葡萄球菌。氢吗啡酮-CR是唯一与甲氧西林敏感的S.金黄色葡萄球菌（MSSA）和耐甲氧西林的S.金黄色葡萄球菌（MRSA）在炊具/过滤器上与无菌水载体对照相比。S的数量减少了2个对数。结论在制备氢吗啡酮控释片的过程中，有14%的炊具/过滤器被金黄色葡萄球菌污染。金黄色。Hydromorphone-CR抑制了炊具/过滤器中MRSA和MSSA的存活。加热炊具/过滤器可能是一种减少危害的策略。
BackgroundInjection drug use-associated endocarditis (IDUaIE) incidence in Ontario has recently been associated with hydromorphone prescribing rates. Staphylococcus aureus causes the majority of cases of IDUaIE in Ontario and across North America. Hydromorphone controlled-release (Hydromorphone-CR) requires a complex technique for injection and therefore provides multiple opportunities for contamination. Hydromorphone-CR contains several excipients, which could enhance staphylococcal survival and increase risk of contaminating the injectate.MethodsUsed injection drug preparation equipment (cookers/filters) was collected from persons who inject drugs (PWID), rinsed with water, and plated on Mannitol salt agar. Bacterial isolates from bacteremic PWID were used to assess the survival of S. aureus and Streptococcus pyogenes on cookers/filters with Hydromorphone-CR, hydromorphone immediate-release (Hydromorphone-IR) or oxycodone controlled-release (Oxycodone-CR). The solutions spiked with S. aureus were heated and the remaining viable bacteria enumerated.ResultsS. aureus was detected in 12/87 (14%, 95% CI 8-23%) cookers/filters samples used for injection of Hydromorphone-CR. Hydromorphone-CR was the only opioid associated with greater survival of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) on cookers/filters when compared to sterile water vehicle control. There was a similar to 2 log reduction in the number of S. aureus that survived when cookers/filters were heated.Conclusion14% of all cookers/filters used in the preparation of Hydromorphone-CR were contaminated with S. aureus. Hydromorphone-CR prolongs the survival of MRSA and MSSA in cookers/filters. Heating cookers/filters may be a harm-reduction strategy.