Display options
Cite
Offerman SR, Schaefer M, Thundiyil JG, et al. Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay. West J Emerg Med. 2009;10(4):251-6
Offerman, S. R., Schaefer, M., Thundiyil, J. G., Cook, M. D., & Holmes, J. F. (2009). Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay. The western journal of emergency medicine, 10(4), 251-6.
Offerman, Steven R, et al. "Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay." The western journal of emergency medicine vol. 10,4 (2009): 251-6.
Offerman SR, Schaefer M, Thundiyil JG, Cook MD, Holmes JF. Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay. West J Emerg Med. 2009 Nov;10(4):251-6. PMID: 20046244; PMCID: PMC2791728.
Copy Download .nbib Format: NLM
Share it on

West J Emerg Med. 2009 Nov;10(4):251-6.

Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay.

The western journal of emergency medicine

Steven R Offerman, Melissa Schaefer, Joseph G Thundiyil, Matthew D Cook, James F Holmes

Affiliations

  1. Kaiser Permanente South Sacramento Medical Center, Department of Emergency Medicine, Sacramento, CA.

PMID: 20046244 PMCID: PMC2791728

Abstract

OBJECTIVES: We sought to identify factors associated with need for mechanical ventilation (MV), length of intensive care unit (ICU) stay, length of hospital stay, and poor outcome in injection drug users (IDUs) with wound botulism (WB).

METHODS: This is a retrospective review of WB patients admitted between 1991-2005. IDUs were included if they had symptoms of WB and diagnostic confirmation. Primary outcome variables were the need for MV, length of ICU stay, length of hospital stay, hospital-related complications, and death.

RESULTS: Twenty-nine patients met inclusion criteria. Twenty-two (76%) admitted to heroin use only and seven (24%) admitted to heroin and methamphetamine use. Chief complaints on initial presentation included visual changes, 13 (45%); weakness, nine (31%); and difficulty swallowing, seven (24%). Skin wounds were documented in 22 (76%). Twenty-one (72%) patients underwent mechanical ventilation (MV). Antitoxin (AT) was administered to 26 (90%) patients but only two received antitoxin in the emergency department (ED). The time from ED presentation to AT administration was associated with increased length of ICU stay (Regression coefficient = 2.5; 95% CI 0.45, 4.5). The time from ED presentation to wound drainage was also associated with increased length of ICU stay (Regression coefficient = 13.7; 95% CI = 2.3, 25.2). There was no relationship between time to antibiotic administration and length of ICU stay.

CONCLUSION: MV and prolonged ICU stays are common in patients identified with WB. Early AT administration and wound drainage are recommended as these measures may decrease ICU length of stay.

References

  1. J Toxicol Clin Toxicol. 2004;42(4):383-7 - PubMed
  2. Semin Neurol. 2004 Jun;24(2):155-63 - PubMed
  3. Ann Intern Med. 1981 Oct;95(4):442-5 - PubMed
  4. Chest. 2001 Aug;120(2):562-6 - PubMed
  5. Muscle Nerve. 1982;5(9S):S28-9 - PubMed
  6. Clin Infect Dis. 2000 Oct;31(4):1018-24 - PubMed
  7. JAMA. 1998 Mar 18;279(11):859-63 - PubMed
  8. BMJ. 2002 Nov 2;325(7371):1020-1 - PubMed
  9. J Food Prot. 2004 Jan;67(1):203-6 - PubMed
  10. Ann Intern Med. 1988 Mar;108(3):363-8 - PubMed
  11. Am J Med. 1984 May;76(5):794-8 - PubMed
  12. Crit Care Clin. 2005 Oct;21(4):825-39, viii - PubMed
  13. JAMA. 1998 Nov 4;280(17):1479-80 - PubMed

Publication Types