Injection drug users (IDUs) with poor hygiene practices are at risk for infection with their commensal flora. One example of a poor hygiene practice is licking the needle prior to injecting the drug. There are few published reports addressing the proportion of IDUs who lick their needles prior to injection and no prior studies evaluating the reasons for this practice.We conducted face-to-face interviews with 40 IDUs admitted to the internal medicine service at our institution. We collected data regarding whether the subject licked the needle before injecting drugs, whether the subject licked the injection site before or after injecting drugs, and the reasons they report for doing so.Thirteen (32.5%, 95% CI, 18.6–49.1) of 40 subjects reported licking their needles prior to injecting. Reasons included ritualistic practices, cleaning the needle, enjoying the taste of the drug, checking the “quality” of the drug, and checking that the needle was in usable condition.In our study, approximately one-third of IDUs licked their needles prior to injecting. More data are needed to demonstrate whether the practice of needle licking significantly increases a person's risk for infection with oropharyngeal flora. Medical providers should ask patients about specific practices surrounding injection drug use, and educate drug users about avoiding unhygienic injection practices.

The aim of this study was to describe the characteristics of HAIE and to establish a comparison between health care and community-acquired episodes. HAIE was defined as either IE manifesting >48 hours after admission to the hospital or IE acquired in association with a significant invasive procedure performed during a stay and/or manipulation in a hospital setting within 6 months before diagnosis. Results: HAIE accounted for 16% of 793 cases. Compared with community-acquired infection, patients with HAIE tended to be older (60.1 vs. 53.6; P= 0.0001) and had more co-morbidities (Charlson index, 3.3 vs. 1.8; P= 0.0001) and staphylococcal infections (58.3% vs. 24.8%). Intra-hospital mortality (44.9 vs. 24.2%) was higher in the HAIE group. Vascular manipulation constituted the main cause of bacteremia responsible for HAIE (63%). Septic shock (OR, 10.13; 95% CI, 3.18 32.12; P= 0.0001) and severe heart failure (OR, 2.79; 95% CI, 1.09 7.13; P= 0.03) were independent predictors of intrahospital mortality in the HAIE cohort. Conclusions: The present study demonstrates that HAIE attacks a fragile population and it is principally caused by microorganisms strongly related to vascular manipulations. Extremely careful management of vascular accesses is needed in order to minimize the risk of secondary bacteraemias.

Describir las características epidemiológicas, clínicas y pronósticas de la endocarditis sobre válvula nativa izquierda (EVNI) por estafilococos coagulasa negativos (ECN). Estudio prospectivo multicéntrico de las endocarditis recogidas en la Cohorte Andaluza para el Estudio de las Infecciones Cardiovasculares en los años 1984-2005. De las 470 EVNI recogidas, 39 (8,3%) fueron causadas por ECN con un aumento del 30% de incidencia en la última década. La edad media fue 58,32 15 años, 27 pacientes (69,2%) eran varones y 21 (53,8%) tenían valvulopatía previa. En la mitad de los casos el origen seconsideró nosocomial (el 90% tras manipulaciones vasculares). La mediana del intervalo entre la aparición de síntomas y el diagnóstico fue de 14 días (rango: 1-120). Las complicaciones más frecuentes fueron: insuficiencia renal (53,8%), complicaciones cardíacas (28,2%), afectación del sistema nervioso central (25,6%) y shock séptico (7%). La cirugía fue necesaria en 18 pacientes (46,2%) y 9 (23,1%) fallecieron. Los factores que se asociaron con una mortalidad mayor fueron la insuficiencia renal aguda (p = 0,023), el fallo ventricular izquierdo (p ó 0,047) y un tiempo de evolución previo al diagnóstico inferior a 21 días (p = 0,018). La EVNI por ECN ocurre en pacientes más ancianos (p = 0,018), es con mayor frecuencia de origen nosocomial (p < 0,001) y desarrolla más fracaso renal agudo (p = 0,001). La mortalidad es menor que la EVNI producida por Staphylococcus aureus (47,7%), pero mayorque la EVNI por Streptococcus viridans (10,6%). La EVNI por ECN es una entidad cuya incidencia está aumentando a expensas de una población de edad avanzada, que requiere frecuentemente maniobras diagnósticas o terapéuticas cruentas como consecuencia de sus enfermedades concomitantes. A pesar de ello, la mortalidad no parece ser mayor que en las EVNI causadas por otros patógenos. To describe the epidemiological, clinical, and prognostic characteristics of patients with left-sided native valve endocarditis (LNVE) caused by coagulase-negative staphylococci (CoNS). Prospective multicenter study of endocarditis cases reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2005. Among 470 cases of LNVE, 39 (8.3%) were caused by CoNS, a number indicating a 30% increase in the incidence of this infection over the last decade. The mean age of affected patients was 58.32 ± 15 years and 27 (69.2%) were men. Twenty-one patients (53.8%) had previous known valve disease and half the episodes were considered nosocomial (90% of them from vascular procedures). Median time interval from the onset of symptoms to diagnosis was 14 days (range: 1-120). Renal failure (21 cases, 53.8%), intracardiac damage (11 cases, 28.2%), and central nervous system involvement (10 cases, 25.6%) were the most frequent complications. There were only 3 cases (7.7%) of septic shock. Surgery was performed in 18 patients (46.2%). Nine patients (23.1%) died, overall. Factors associated with higher mortality in the univariate analysis were acute renal failure (P = 0.023), left-sided ventricular failure (P = 0.047), and time prior to diagnosis less than 21 days (P = 0.018). As compared to LNVE due to other microorganisms, the patients were older (P = 0.018), had experienced previous nosocomial manipulation as the source of bacteremia (P < 0.001), and developed acute renal failure more frequently (P = 0.001). Mortality of LNVE due to CoNS was lower than mortality in Staphylococcus aureus infection, but higher than in Streptococcus viridans infection. Left-sided native valve endocarditis due to CoNS is now increasing because of the ageing of the population. This implies more frequent invasive procedures (mainly vascular) as a consequence of the concomitant disease. Nonetheless, the mortality associated with LNVE due to CoNS does not seem to be greater than infection caused by other pathogens.