Active drug users admitted to an Internal Medicine ward: report of an experience

• Autor(a) principal: Gonçalves Pereira, João
• Data de Publicação: 2004
• Outros Autores: Bentes de Jesus, Margarida
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1744
• topic: Toxicodependência; Medicina Interna; enfermaria medicina; infecção; VIH; Drug abuse; Internal Medicine; infection; HIV; medical ward

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.